Call to action on NCDs:
Challenges and Way Forward
for Maternal and Child Health
Dr. Niloufer Sultan Ali
Professor, Family Medicine
Aga Khan University, Karachi
1

‘Each year, millions of
women & children die
from preventable causes.
These are not mere statistics.
They are people with names & faces.
Their suffering is unacceptable in the
21st century’,
Ban Ki-moon,
United Nations Secretary-General
2

A neglected dimension of
women’s health
NCDs are the world’s number one killer
• 35 million people die every year
18 million are women
NCDs represent the biggest threat to women’s
health worldwide
3

WHO report 2008
4

Total deaths
around the world:
58 million
Deaths from NCDs:
35 million
Deaths from NCDs
in developing
countries:
28 million
Countdown to 2015, Maternal Child and Newborn survival, the 2012 report
5

NCDs are no longer diseases of the rich and
elderly
Increasingly impacting on women in developing
countries during the prime of their life
Urgent priority for women’s
health
6

Source: WHO Chronic Disease Report, 2005
7

0
1
2
3
4
5
6
7
8
9
10
1990
2000
2010
2020
1990
2000
2010
2020
1990
2000
2010
2020
1990
2000
2010
2020
Ratio
India
China Other Asia-Pacific
Latin America
& Carribean
Ratio of Non-Communicable/ Communicable Deaths,
India, China, Other Asia-Pacific, 1990-2020
Source: WHO Chronic Disease Report, 2005
Deaths due to NCDs are 3 times more as compared to
communicable diseases in Asia Pacific
8

NCD Diseases
4 Diseases, 4 Modifiable Shared Risk Factors
Tobacco
Use
Unhealthy
diets
Physical
Inactivity
Harmful
Use of
Alcohol
Cardio-
vascular
Diabetes
Cancer
Chronic
Respiratory
Source: WHO Chronic Disease Report, 2005
9

NCD in Pakistan
WHO report 2008
10

NCD in Pakistan…Cont
WHO report 2008
11

2006-2015 (cumulative)
2005
Lost national income from
premature deaths due to
heart disease, stroke and
diabetes
Lost national income
(billions)
Lost national income
(billions)
Countries
49
3
Brazil
558
18
China
237
9
India
8
0.4
Nigeria
31
1
Pakistan
303
11
Russian Federation
3
0.1
Tanzania
Source: WHO Chronic Disease Report, 2005
IMPACT OF NCD
NCDs macro-economic impact
Lost National Income
12

Women & Diabetes
• Currently,143 million women are suffering from
diabetes
• By 2030, this number is expected to rise to 222
million
• Diabetes is the ninth leading cause of death in women
globally
• Gestational diabetes develops in one in 25
pregnancies worldwide.
Source: WHO Chronic Disease Report, 2005
13
Source: Countdown to 2015, Maternal Child and Newborn survival, the 2012 report

Women & Cancer
• Over 3 million women die of cancer each year
• Breast & lung cancers are the most common cancer
killers of women
• An estimated 1.7 million women will be diagnosed
with breast cancer in 2020—a 26% increase from
current levels—mostly in the developing world
Source: WHO Chronic Disease Report, 2005
14

Women & CVD
Source: WHO Chronic Disease Report, 2005
• CVD is the number one killer of women worldwide
• Causes 9.1 million deaths among women annually
• In 2008, CVD killed 1.2 million women aged
between (20-59 years) the most productive years of
life
• Developing countries are more affected
15

Offspring CVD Risk by Parental CVD
Status: Framingham Study
0
0.5
1
1.5
2
2.5
MEN WOMEN
NONE
MATERNAL
PATERNAL
Risk Ratio
2.5
2
1.5
1
0.5
0
Male offspring Female offspring
1.0
1.7
2.2
1.0
1.7 1.7
Parental CVD
<55 men, <65 Women
Source: International Society of Hypertension
16

NCDs in women compromises
child health
NCDs not only affect the health of women but also the
health of their children
• Being born to a malnourished mother increases the
chances of the infant suffering from under-nutrition,
late physical and cognitive development and NCDs in
adulthood
17

Childhood Obesity
• 43 million children under five years are overweight
• Girls are more likely to be overweight
> Restrained from regular physical activity
and sport
>Lack of safe and supportive environments
18

Source: The Growth Assessment and Surveillance Unit, Department of Nutrition
for Health and Development, World Health Organization, Geneva, Switzerland.
19

Current Challenges & Barriers
to Women’s Health
20

Socio-cultural Barriers
Women Education & Empowerment
– Young women & girls are unable to make
decisions about care for themselves or for their
children without the permission of their husbands
– Higher rates of illiteracy among women results in
less access to information about NCD risk factors,
prevention & treatment
21

Health System Barriers
• Women are less likely to seek medical care from male
health providers due to cultural taboos
• Shortage of female health care providers
• Lack of NCD component in existing health systems
22

Health System In Pakistan
Source: WHO, country profile 2008
23

A Way Forward
24

Fight for NCDs
Reduce modifiable risk factors among
individuals & populations
•Tobacco use
• Unhealthy diet
• Physical inactivity
• Harmful use of alcohol
25

A CALL FOR ACTION
We need to move away from the fragmented
approach to health and move towards taking a
holistic view of the health of girls and women
26

A call for Action…Cont
• Enhance women education and empowerment
• NCD component to be integrated into existing health
systems
• Link information of NCDs to reproductive health
programs
• Involvement of women in identifying problems,
solutions & implementing policies in the fight against
NCDs
27

We can act
TOGETHER, LET’S MAKE NCDs
A
PRIORITY FOR WOMEN’S
HEALTH
AND DEVELOPMENT
28

Act now on NCDs
for girls,
women
and
future
generations
29

We all have a role to play
Everyone has a critical role to play in improving
the health of women and children
30

Role of Family Physicians
• Promote healthy lifestyle
• Provide opportunistic care
• Share information regarding NCDs
• Address modifiable risk factors
• Conduct public awareness sessions
• Emphasize on regular check-ups
31

Thank You