Noncommunicable Diseases An Overview Dr Ala Alwan Assistant

Noncommunicable Diseases: An Overview Dr Ala Alwan Assistant Director General World Health Organization NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

• What do we mean by "noncommunicable diseases"? • Magnitude and socioeconomic impact of NCDs • The global vision and the plan • Where are we now in implementing the vision • Translating the Global Action into national action NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Noncommunicable diseases (NCDs): cope • • Cardiovascular diseases (e. g. heart diseases, stroke) Cancers Diabetes Chronic respiratory diseases (e. g. asthma) Risk factors for noncommunicable diseases: • Tobacco use • Unhealthy diet • Physical inactivity • Harmful use of alcohol NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Main data sources • 2008 -2013 Action Plan of the Global Strategy for the Prevention and Control of NCDs • WHO Global Burden of Disease (2004 update published in October 2008) • WHO Global Health Risks (published in October 2009) • Further analysis on the burden of noncommunicable diseases based on the WHO Global Burden of Disease NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Distribution of age at death and numbers of global deaths (2004) NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Per cent distribution of age at death by WHO region (2004) NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

The global burden of non-communicable diseases (based on the 2004 update of the Global Burden of Disease) NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Please download at: http: //www. who. int/healthinfo/global_burden_disease/2004_report_update/en/index. html NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Source: 10% Total number of deaths in the world 60 million 5. 8 M 26. 0 M (above the age of 60) 40 million 35 million (60% of all deaths) 30 million 20 million 10 million 9. 0 M (below the age of 60) 18. 0 M 0 Group III - Injuries Low-income countries Group II – Other deaths from noncommunicable diseases Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Source: Total number of deaths in the world 25 million 2. 3 M 6. 8 M 20 million 2. 3 M 15 million 10. 2 M 3. 7 M 13. 6 M 10 million 0. 5 M 5. 9 M 0. 6 M 3. 3 M 3. 0 M 0. 9 M 1. 1 M High-income countries Upper middle-income 3. 3 M 3. 0 M Lower middle-income Low-income countries Group III - Injuries Low-income countries Group II – Other deaths from noncommunicable diseases Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Low- and middle-income countries which are most affected 70% of the global burden of premature deaths from NCDs (22 countries) • Afghanistan • Bangladesh • Brazil • China • DR Congo • Egypt • Ethiopia • Indonesia • Iran • Mexico • Myanmar • Nigeria • Pakistan • Philippines • Russian Federation • South Africa • Thailand • Turkey • Sudan • Ukraine • Vietnam NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

The magnitude in 144 low- and middle-income countries 60 million 10% 50 million 40 million 30 million 5. 3 M 14. 2 M 14. 0 M 34% 28% 20 million 10 million Omitted from the MDGs: 14. 0 million premature deaths from non-communicable diseases Total number of deaths in low- and middle-income countries (2004) Group III - Injuries Low-income countries Group II – Other deaths from non-communicable diseases Group II – Premature deaths from non-communicable diseases (below the age of 70), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010) Source: 17. 4 M

Percentage of deaths in selected countries 80% 60% 40% 20% D en Ba ma ng rk la de sh Be ni Bh n ut an Bu Bo liv rk ia in a Fa s Eg o yp G t ha na Ke M ny oz am a bi qu N epa ic ar l ag U ua ga Ta nda nz Vi ania et N a Za m m bi a 0% Group III - Injuries Low-income countries Group II – Other deaths from noncommunicable diseases Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010) Source: 100%

14, 000 Deaths in Africa* (2004) 7% 12, 000 10, 000 0. 9 2. 2 M 1. 4 M 8, 000 2. 2 M (<70) 17% 11% 65% (<60) 8. 1 M Lower margin 6, 000 7% 11% 4, 000 Source: 17% (<70) 2, 000 65% 0 Lower margin Upper margin Group III - Injuries Low-income countries Group II – Other deaths from non-communicable diseases Group II – Premature deaths from non-communicable diseases (below the age of 60 (left) or 70 (right)) Group I – Communicable diseases, maternal, perinatal and nutritional conditions NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

More women aged 15 -59 years die from NCDs in Africa than in high-income countries NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Breakdown of deaths from non-communicable diseases 6% 4% 3% 3% 6% 3% 12% 13% 49% 27% 50% 25% All countries Low- and middle-income countries Cardiovascular diseases Cancers Respiratory diseases Diabetes Mental health conditions Other NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Age-standardized DALYs for noncommunicable diseases (2004) NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Please download at: http: //www. who. int/healthinfo/global_burden_disease/global_health_risks/en/index. html NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

The 10 leading risk factor causes of death (2004) NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Key findings • High blood pressure is the leading risk factor for mortality, responsible for 13% of deaths globally • Low fruit and vegetable intake, lack of exercise, alcohol and tobacco use, high BMI, high cholesterol, high glucose, and high BP are responsible for more than half of the deaths due to heart disease • Tobacco is responsible for 5. 1 million deaths. Almost 1 in 8 deaths of adults over the age of 30 is due to smoking • Being overweight or obese is the fifth leading risk for death, responsible for 7 per cent of deaths globally • Unsafe sex, which leads to transmission of human papillomavirus, is responsible for deaths due to cervical cancer. Cervical cancer is the leading cause of cancer death in Africa. NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Leading causes of attributable global mortality and burden of disease (2004) Attributable Mortality Attributable DALYs % 1. High blood pressure 12. 8 2. Tobacco use 8. 7 3. High blood glucose 5. 8 4. Physical inactivity 5. 5 5. Overweight and obesity 4. 8 6. High cholesterol 4. 5 7. Unsafe sex 4. 0 8. Alcohol use 3. 8 9. Childhood underweight 3. 8 10. Indoor smoke from solid fuels 3. 3 % 1. Childhood underweight 5. 9 2. Unsafe sex 4. 6 3. Alcohol use 4. 5 4. Unsafe water, sanitation 4. 2 5. High blood pressure 3. 7 6. Tobacco use 3. 7 7. Suboptimal breastfeeding 2. 9 8. High blood glucose 2. 7 9. Indoor smoke from solid fuels 2. 7 10. Overweight and obesity 2. 3 59 million total global deaths in 2004 1. 5 billion total global DALYs in 2004 NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Deaths attributed to 19 leading factors (2004) NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Percentage of DALYs attributed to 19 leading risk factors (2004) NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Tobacco Rising production and consumption in developing countries NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Tobacco: The poor and uneducated are the ones who smoke the most Smoking prevalence in Bangladesh (1995) Source: Sen, B & Hulme D, 2004 NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Overweight and obesity in people over 15 selected countries NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Prevalence of obesity, ages 30+ (2004) male female South-East Asia Western Pacific Africa Eastern-Mediterranean Europe Americas 30% 20% 10% 20% Source: NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010) 30%

Prevalence of obesity, ages 30+ (2015) male female 3% SEA 9% 6% West Pac 5% Africa 12% 21% 32% Eastern-Med Europe 9% 13% 30% 29% Americas NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010) 46%

The top-10 countries reported to have the highest diabetes prevalence are countries in developing regions of the world. ( ( ) ) Source: International Diabetes Federation's Diabetes Atlas NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Global projections (2004 to 2030) 12 Cancers Deaths (millions) 10 Ischaemic HD Stroke 8 6 Acute respiratory infections 4 2 0 2005 2010 2015 2020 2025 2030 Road traffic accidents Perinatal HIV/AIDS TB Malaria NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Projections for the future Death from noncommunicable diseases Increases (in percentage and millions) in 2015 vs 2004 30% 2. 5 M 25% 2. 0 M 20% 1. 5 M 15% Source: 1. 0 M 10% 0. 5 M 5% 0 0% Africa Americas Eastern Europe Med South- Western East Pacific Asia Africa Americas Eastern Europe Med NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010) South- Western East Pacific Asia

Mortality: Global projections (2004 to 2030) 30 Intentional injuries Other unintentional Road traffic accidents Deaths (millions) 25 Other NCD 20 Cancers 15 CVD 10 Mat//peri/nutritional 5 Other infectious HIV, TB, malaria 0 2004 2015 2030 High-income countries 2004 2015 2030 Middle-income countries 2004 2015 2030 Low-income countries NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

What will happen if nothing is done now? Projections of estimated deaths from noncommunicable diseases (millions) Africa The Eastern Americas Med. Europe South Western East Asia Pacific World 2004 2. 8 4. 7 2. 2 8. 1 7. 7 9. 4 35. 0 2015 3. 5 5. 5 2. 7 8. 6 9. 5 11. 4 41. 2 2030 4. 9 7. 1 3. 8 8. 5 12. 6 14. 6 51. 6 Source: NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Why low- and middle-income countries are disproportionally affected NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

NCDs and Development Poverty contributes to NCDs and NCDs cause poverty Poverty at household level Populations in low- and middle-income countries Population ageing and Increased exposure to common risk factors Loss of household income Noncommunicable diseases Limited access to effective and equitable health-care services More than 8 million people die before the age of 60 in developing countries from noncommunicable diseases NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

The poorest people in developing countries are often affected the most The poorest people smoke the most, often spending more than 10 per cent of their household income on tobacco 45 Smoking prevalence Lowest household income quintiles 40 35 30 Highest household income quintiles % 25 20 15 10 5 0 Low-income countries Lower-middle Income Upper-middleincome High-income NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

The poorest people in developing countries affected the most The cost of caring for a family member with diabetes can be more than 20 per cent of low-income household incomes in developing countries The cost per year of diabetes care at household level Insulin Syringes Testing Mali (2004) 38% 34% 8% 7% 12% $339. 4 61% Mozambique (2003) 5% 24% 1% 9% 61% $273. 6 75% Nicaragua (2007) 0% 73% 0% 0% 27% $74. 4 7% Zambia (2003) 12% 63% 6% 6% 12% $199. 1 21% Vietnam (2008) 39% 8% 5% 3% 46% $427. 0 51% Travel Total cost % of per capita Income Consultatio n NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Percent and number of men with and without CVD experiencing catastrophic spending and impoverishment - 2005 Number affected 1. 4 – 2. 0 million 0. 6 -0. 8 million Source: Mahal et al 2010 Catastrophic spending >30% HH income in one year; Impoverishment from above poverty line to below during year NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Source: Mahal et al 2010 Catastrophic spending >30% HH income in one year; Impoverishment from above poverty line to below during year NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

NCDs and Development Conclusions • The premature death, the morbidity and disabilities caused by NCDs lead to lost productivity • Families with members who have NCDs are at increased financial risk and are more likely to be exposed to catastrophic spending and impoverishment • NCDs impede poverty reduction efforts NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)

Oil and gas price spike Retrenchment from globalization Asset price collapse World Economic Forum: Global Risk Assessment 2009 NCDs Fiscal crisis Flu pandemic Food crisis Infectious disease NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010) http: //www. weforum. org/pdf/globalrisks 09/global_risks_2009. pdf The macro-economic impact of NCDs

Key messages • NCDs are already leading health problems in almost all countries and their magnitude is still increasing • Shared risk factors • Premature deaths • The poor are disproportionately affected • Negative impact on socioeconomic development • As countries continue to develop, market forces will further promote unhealthy patterns. • Action is urgently needed NCDs: An Overview – Dr Ala Alwan - Second International Seminar on the Public Health Aspects of noncommunicable Diseases, (Lausanne & Geneva, August 2010)