Ncd ppt

prevention and control of Non Communicable Disease

1. Prevention and control of Non C ommunicable D isease Vipin K Ravi

2. C ONTEN T S Introduction Gaps in natural history GLOBAL initiative GLOBAL ACTION PLAN BEST BUY initiatives National frame work

3. Introduction

4. Prevention Activities to people from getting the disease. Or stop a disease from getting worse. E.g health promotion activities early detection programes

5. Prevention and control Control Activities to slow the course of an existing disease or reduce its severity Activities to control a disease occur after the disease has been contracted. Control activities slow down the pathological effect from the disease.

6. GAPS in Natural History Absence Of A Known Agent Multifactorial Causation Long Latent Period Indefinite Onset

7. GLOBAL AND NATIONAL INITIATIVES STEPS survey 2003 WHO Report on NCD – 2008 Who global non communicable network-2009 NCD ALLIANCE-2009 UN Assembly session 2010 First High level committee meet-2011 UNIATF -2013

8. GLOBAL AND NATIONAL INITIATIVES Global action plan 2013-2025 Second High level committee meet -2014 Global status report on NCD 2014 WHO High level commission on NCD-2017 SDG 2030 – FCTC -2003 NPCDCS- 2010

9. GLOBAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2013-2020

10. Global Action plan Global action plan for the prevention and control of NCDS(2013 to 2020) Vision A world free of the avoidable burden of non communicable diseases. 6 objectives ,9 NCD global targets, 25 indicators

11. (GAPS -2013-2020) G oal To reduce the preventable and avoidable burden and disability due to non communicable disease by means of multisectoral collaborarion and corporation at national ,regional and global level so that population reach the highest attainable standards of health and productivity at every age and those diseases no longer a barrier to wellbeing or socioeconomic development.

12. GAP 2020-OBJECTIVES 1 .To Raise The Priority Accorded To The Prevention And Control Of Non communicable Diseases In Global, Regional And National Agendas And Internationally Agreed Development Goals, Through Strengthened International Cooperation And Advocacy.

13. GAP 2020-OBJECTIVES 2 . To strengthen national capacity, leadership ,governance multisectoral action and partnership to accelerate country response for prevention and control of NCD

14. GAP 2020-OBJECTIVES 3 .T o reduce modifiable risk factors for NCD and underlying social environment through creation of health promoting environment

15. GAP 2020-OBJECTIVES 4 . To strengthen and orient health system to adddress the prevention and control of NCD and underlying social determinants through people centered primary health care and universal health coverage.

16. GAP 2020-OBJECTIVES 5 .To promote and support national capacity for high quality research and development for prevention and control of NCD .

17. GAP 2020-OBJECTIVES 6 . To Monitor The Trends And Determinants Of Noncommunicable Diseases And Evaluate Progress In Their Prevention And Control.

18. Targets of GAP-2020

19. Targets of GAP 2020 1 . A 25% relative reduction in the overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory disease

20. Targets of GAP 2020 2. A 10 per cent relative reduction in harmful use of alcohol as appropriate within national context

21. Targets of GAP 2020 3 .10 per cent relative reduction in prevalence of insufficient physical activity. 4 .10 per cent relative reduction in mean salt intake/ sodium 5 .A 30 per cent reduction in prevalence of current tobacco use in person aged 15+ years

22. Targets of GAP 2020 6 .A 25 per cet relative reduction in pravalence of raised blood pressure. 7 .Halt the rise of diabetes and obesity

23. Targets of GAP 2020 8 . At least 50 per cent of eligible people receive drug therapy and counseling (including glycemic control) to prevent heart attack and stroke.

24. Targets of GAP 2020 9 . 80 per cent availability of affordable technology and essential medicines including generics required to treat major NCD in public and private facilities

25. UNIATF The United Nations Interagency Task Force (UNIATF) on the Prevention and Control of NCDs coordinates the activities of relevant UN organizations and other inter-governmental organizations to support governments to meet high-level commitments to respond to NCD epidemics worldwide.

26. FCTC The WHO FCTC was developed in response to the globalization of the tobacco epidemic The Convention represents a milestone for the promotion of public health and provides new legal dimensions for international health cooperation. INDIA Launced National tobacco control program 2007

27. “Best Buys” From Burden to “Best Buys”: Reducing the Economic Impact of Non-Communicable Diseases in Low- and Middle-Income Countries Individual-based NCD “best buy” interventions – which range from counselling and drug therapy for cardiovascular disease to measures to prevent cervical cancer Population based and indivdual based

28. Pigovian tax Pigovian tax is a tax on any market activity that generates negative externalities (costs not included in the market price). The tax is intended to correct an inefficient market outcome, equal to the social cost of the negative externalities. examples of externalities are environmental pollution, and increased public healthcare costs associated with tobacco and sugary drink consumption.

29. Best Buys Intervention

30. SDG on NCD SDG includedspecific target for NCDS Target 3.4 one third reduction in premature mortality from NCDs by the year 2030 through prevention and treatment and promote mental health and wellbeing 3.5 strengthen and treatment of substance abuse,including narcotic drugs and harmful use of alcohol

31. SDG on NCD Target 3.6 half the deaths due to injuries and accidents Target 3.a strengthen the implementation of WHO – Framework convention on tobacco control by all countries

32. NPCDCS Durinf 11 th plan ,100 districts in 21 states. National Programm on prevention and control of candiabetes,cardiovascular disease and stroke was started, NPCDC+NCCP = NPCDCS 12 th 5 yr plan covered all the districts

33. Objectives – npcdcs 1. Prevent and control common NCDs through behavior and lifestyle changes. 2.Provide early diagnosis and treatment of common NCD. 3.build capacity building at various levels of health care for prevention ,diagnosis and treatment of common NCD

34. Objectives –NPCDCS 4.Train HR within public health set up, doctors, nurses Para medical staff to cope with the increasing burden of NCD 5.Establish and develop capacity for palliative and rehabilitative care

35. NPCDCS- Subcenter Level Health promotion for behavioral and life skill changes Oppertunistic screening of population above 30 years by using BP measurement and blucose by strip method; Test strip and lacent are being procured at central level Suspected cases will be refered to CHC

36. Activities at CHC NCD CLINICS- diagnosis by required investigations Like blood sugar, lipid profile, ultra sound,X ray and ECG, management of Common NCDs Duties of the nurses under the program undertake home visits for bedridden patients Supervise the work of health workers Monthly clinic in the village in random basis Complicated cases shall be referred to district hospital

37. Activities at DISTRICT Level NCD CLINICS at District level-screen persons above 30 for DM,HT and CVD To Identify Individuals are at high risk of developing NCDs and warranting further investigation / action Detailed investigation ON individuals at high risk of developing NCD and those who are referred from CHCs

38. Activities at DISTRICT Level Regular management and annual assessment Home based care- palliative care Promotion of healthy life style

39. Urban health schemes for diabetes and hypertension To screen urban slum population for DM and BP. To create data base for the prevalence of DM and HT in urban slums Sensitize urban slum population about healthy life style

40. New initiatives 1.intervention for prevention and control of RHD under NPCDCS and RBSK Integration of AYUSH doctors with NPCDCS Integration of RNTCP with NPCDCS

41. OPERATIONAL GUIDELINES 1, Systolic BP >140mm of hg, diastolic BP >90mmof hg,RBS >140 (REFER To MO) SUSPECTED CANCER/ Precancer CASES will be refered to screeing sites to the appropriate PHC/CHC/DH Once diagnosed the patients must receive one month of treatment from the phc Once stable provide medicines for 3months

42. OPERATIONAL GUIDELINES ANM/ASHA visiting the patient each month. 3MONTH drug supply could be stocked with the ANM at the subcenter,to be given each month The patient will need to go to the PHCs for first follow up at the end of 3 months. Annual specialized consultation at the nearest nodal Chc /DH

43. OPERATIONAL GUIDELINES 5.Those who are already under treatment of a private practitoner could be offered medicines from public health 6.community follow up by ASHA

44. Tobacco Control Legislation The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 or COTPA, 2003 This Act was enacted by the Parliament to give effect to the Resolution passed by the 39th World Health Assembly.

45. REFERENCES K Park 23 rd edition p 501-550,432 Who (2013) global action plan for the prevention and control of NCD.

46. THANK YOU

47. Prevention and control 1.CVD 2.DM 3.CANCER 4.COPD 5.ACCIDENTS AND INJURIES 6.HYPERTENSION 7.STRESS 8.RHD

48. 1. Unconditional probability of dying between ages of 30 and 70 from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases. 2 Cancer incidence, by type of cancer, per 100 000 population

49. INTRODUCTION Noncommunicable diseases (NCDs)—mainly cardiovascular diseases, cancers, chronic respiratory diseases and diabetes—are the world’s biggest killers. More than 36 million people die annually from NCDs (63% of global deaths), including more than 14 million people who die too young between the ages of 30 and 70. Low- and middle-income countries already bear 86% of the burden of these premature deaths, resulting in cumulative economic losses of US$7 trillion over the next 15 years and millions of people trapped in poverty.

50. Most of these premature deaths from NCDs are largely preventable by enabling health systems to respond more effectively and equitably to the health-care needs of people with NCDs, and influencing public poli - cies in sectors outside health that tackle shared risk factors—namely tobacco use, unhealthy diet, physical inactivity, and the harmful use of alcohol.

51. NCDs are now well-studied and understood, and this gives all Member States an immediate advantage to take action. The Moscow Declaration on NCDs, endorsed by Ministers of Health in May 2011, and the UN Political Declaration on NCDs, endorsed by Heads of State and Government in September 2011, recognized the vast body of knowledge and experience regarding the preventability of NCDs and immense opportuni - ties for global action to control them

52. . Therefore, Heads of State and Government committed themselves in the UN Political Declaration on NCDs to establish and strengthen, by 2013, multisectoral national policies and plans for the prevention and control of NCDs, and consider the development of national targets and indicators based on national situations.

53. To realize these commitments, the World Health Assembly endorsed the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020 in May 2013. The Global Action Plan provides Member States, international partners and WHO

54. with a road map and menu of policy options which, when implemented collectively between 2013 and 2020, will contribute to progress on 9 global NCD targets to be attained in 2025, including a 25% relative reduction in premature mortality from NCDs by 2025. Appendix 3 of the Global Action Plan is a gold mine of current scientific knowledge and available evidence based on a review of international experience.

55. WHO’s global monitoring framework on NCDs will start tracking implementation of the Global Action Plan through monitoring and reporting on the attainment of the 9 global targets for NCDs, by 2015, against a baseline in 2010.

56. Accordingly, governments are urged to ( i ) set national NCD targets for 2025 based on national circumstances; (ii) develop multisectoral national NCD plans to reduce exposure to risk factors and enable health systems to respond in order to reach these national targets in 2025; and (iii) measure results, taking into account the Global Action Plan.

57. Taking note with appreciation of all the region- al initiatives undertaken on the prevention and control of noncommunicable diseases, in- cluding the Declaration of the Heads of State and Government of the Caribbean Commu - nity entitled “Uniting to stop the epidemic of chronic noncommunicable diseases”, adopted in September 2007, the Libreville Declaration on Health and Environment in Africa, adopted in August 2008, the statement of the Com- monwealth Heads of Government on action to combat noncommunicable diseases, adopted in November 2009, the declaration of com- mitment of the Fifth Summit of the Americas, adopted in June 2009, the Parma Declaration on Environment and Health, adopted by the Member States of the WHO European Region in March 2010, the Dubai Declaration on Diabetes and Chronic Noncommunicable Diseases in the Middle East and Northern Africa Region, adopt- ed in December 2010, the European Charter on Counteracting Obesity, adopted in November 2006, the Aruba Call for Action on Obesity of June 2011, and the Honiara Communiqué on ad- dressing noncommunicable disease challenges in the Pacific region, adopted in July 2011;

58. endorsed by the Sixty-fourth World Health As- sembly (resolution WHA64.11), which requests the Director-General to develop, together with relevant United Nations agencies and entities, an implementation and follow up plan for the outcomes of the Conference and the High-level Meeting of the United Nations General Assem - bly on the Prevention and Control of Non-com- municable Diseases (New York, 19–20 Sep- tember 2011) for submission to the Sixty-sixth World Health Assembly;

59. Acknowledging also the Rio Political Declaration on Social Determinants of Health adopted by the World Conference on Social Determinants of Health (Rio de Janeiro, 19–21 October 2011), en- dorsed by the Sixty-fifth World Health Assembly in resolution WHA65.8, which recognizes that health equity is a shared responsibility and re- quires the engagement of all sectors of govern- ment , all segments of society, and all members of the international community, in an “all for equity” and “health-for-all” global action

60. Target Indicator MORTALITY & MORBIDITY A 25% relativeUnconditional probability of dying between ages of 30 and 70 from cardiovascular diseases, cancer, diabetes or chronic respiratory diseasesreduction in the overallPremature mortality from noncommunicable diseasemortality fromcardiovascular diseases, cancer, diabetes, orchronic respiratory diseases Additional indicator Cancer incidence, by type of cancer, per 100 000 population

61. A global analysis of the economic impact of NCDs by the World Economic Forum and the Harvard School of Public Health • An analysis of the costs of scaling up a core intervention package in low- and middle-income countries by the World Health Organization

62. INDICATORS 1. Unconditional probability of dying between ages of 30 and 70 from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases. 2 Cancer incidence, by type of cancer, per 100 000 population

63. Total (recorded and unrecorded) alcohol per capita (aged 15+ years old) consumption within a calendar year in litres of pure alcohol, as appropriate, within the national context Age-standardized prevalence of heavy episodic drinking among adolescents and adults, as appropriate, within the national context Alcohol-related morbidity and mortality among adolescents and adults, as appropriate, within the national context

64. Prevalence of insufficiently physically active adolescents, defined as less than 60 minutes of moderate to vigorous intensity activity daily Age-standardized prevalence of insufficiently physically active persons aged 18+ years (defined as less than 150 minutes of moderate-intensity activity per week, or equivalent)

65. 8.Age-standardized mean population intake of salt (sodium chloride) per day in grams in persons aged 18+ years Prevalence of current tobacco use among adolescents Age-standardized prevalence of current tobacco use among persons aged 18+ years