1. Stronger health systems. Greater health impact.
The Decade of Chronic
Non-Communicable Diseases (C-NCDs)
D r. G loria S angiwa
D ire ctor of Te ch nical Q u ality and Innovation
M anage m e nt S cie nce s for H e alth
C O Management SciencesS pHealth M e e ting, M ay 1 , 201 2
R E G rou p for ring 1

2. Outline
• What are Chronic Non-Communicable Diseases (Chronic NCDs)?
• Why is there an increased global focus on the need to tackle Chronic
NCDs in low and middle-income countries (LMICs)?
• What have been the global responses?
• What is needed to address Chronic NCDs in LMICs?
Management Sciences for Health 2

3. Chronic Non-Communicable Diseases Defined
hronic Non-Communicable Diseases abbreviated as Chronic
NCDs:
• Defined as diseases or conditions that occur in, or are known to
affect, individuals over an extensive period of time and for
which there are no known causative agents that are
transmitted from one affected individual to another.
owever:
» Chronic conditions are not limited to non-communicable
diseases. Public health specialists increasingly view HIV/AIDS
as a chronic condition.
» Some cancers are attributed to infectious agents (e.g. HPV
and Cervical Cancer or Hepatitis and Liver Cancer).
Management Sciences for Health 3

4. What are the main Chronic NCDs
and
why are they grouped together?
Management Sciences for Health 4

5. Big Four (+) and Causal Links
Big Four + : Cardiovascular Disease; Diabetes; Cancers; Chronic
Respiratory Diseases
Causal links
ris iolog olic NCDs
ac ical
ys tab
s
tor
Raised blood pressure
ph /Me
Overweight/obesity
kf
Raised blood glucose
Raised lipids
ac al
k f ur
s
tor
ris avio
Tobacco use
Unhealthy diet
h
Be
Physical inactivity
Harmful use of alcohol
ers
riv
Social
gd
Globalization
yin
Determinants Urbanization
erl
of Health Population ageing
d
Un
[Source: WHO, Dr. Ala Alwan]
Management Sciences for Health 5

6. Why we are seeing an increased
global focus on addressing
Chronic NCDs in LMICs?
Management Sciences for Health 6

7. Chronic Non-Communicable Diseases
(NCDs): A Global Challenge
There is a high and increasing global burden of chronic NCDs
 Chronic NCDs account for 60% (35 million) of global deaths
annually
 80% (28 million) of these deaths occur in low- and middle-
income countries
 8 million preventable chronic NCD deaths occur among
those < 60 years
­ Comparison: AIDS, TB, and Malaria account for 6 million
Source: WHO
Management Sciences for Health 7

8. Age-standardized death rates for Chronic
NCDs are higher in low & middle income
countries
Total chronic NCD death rates, age standardized, Males, 2008
Source: WHO Global Health Observatory, 2011 www.who.int/gho/
Management Sciences for Health 8

9. Chronic NCDs are killing people at a
younger age in low & middle income countries
Percentage of all chronic NCD deaths occurring under age of 70, Males, 2008
Source: WHO Global Health Observatory, 2011 www.who.int/gho/
Management Sciences for Health 9

10. Chronic NCD major risk factors – vary among
countries, often increasing with economic growth
Darker colors = increased risk (see source for specific risk levels)
Cigarette consumption Overweight
Inadequate
Alcohol consumption physical activity
Source: WHO Global Health Observatory, 2011 www.who.int/gho/
Management Sciences for Health 10

11. Those in Developing Countries…
 Tend to develop Chronic NCDs a decade
earlier in life
 Have more preventable complications
 Are diagnosed at later stages (if at all)
 Die sooner than those in high-income
countries
 Mortality from chronic NCDs before the
age of 60 is 3x higher in poorer countries
than in rich countries
Management Sciences for Health 11

12. Given current trends the problem will get
worse before it gets better
Projected global deaths (millions of deaths)
 33%
 58%
 89%
High Income Middle Income Low Income
Source: WHO, Global Burden of Disease, 2004, Figure 15
Management Sciences for Health 12

13. Projected increase of the Chronic NCD
burden - low income countries
Number of Deaths for low income countries
(each silhouette = 1 million annual deaths)
2004 2030 (projected)
Chronic NCDs
HIV, TB, malaria, others
Maternal, perinatal,
related
Accidents/ injuries
Chart based on WHO Global Burden of Disease, 2004, figure 15
Management Sciences for Health 13

14. Global Responses: UN High-level Meeting
 “… the global burden and threat of non-communicable diseases
constitutes one of the major health challenges…”
 “… which undermines social and economic development throughout
the world…”
 No major new funding for chronic NCDs
 Focused on the problems without agreed solutions
 Mobilized civil society movement, but public not yet fully engaged
 Few champion countries
Management Sciences for Health 14

15. Setting Global Targets for Chronic NCDs
WHO recommends global targets for the following areas:
Mortality from chronic NCDs Obesity
Diabetes Prevention of heart attack
and stroke
Tobacco Smoke
Cervical cancer screening
Alcohol
Elimination of industrially
Dietary salt intake produced trans-fats from food
Blood pressure/hypertension supply
Management Sciences for Health 15

16. WHO’s Recommended Targets
Target Area Target Goal
Mortality from NCDs 25% relative reduction in overall mortality from cardiovascular disease,
cancer, diabetes, or chronic respiratory disease
Diabates 10% relative reduction in prevalence of diabetes
Tobacco smoking 40% relative reduction in prevalence of current tobacco smoking
Alcohol 10% relative reduction in persons aged 15+ alcohol per capita consumption
(APC)
Dietary Salt intake Mean population intake of salt less than 5 grams per day
Blood pressure, 25% relative reduction in prevalence of raised blood pressure
Hypertension
Obesity No increase in obesity prevalence
Prevention of heart 80% coverage of multidrug therapy (including glycaemic control) for people
attack and stroke aged 30+ years with a 10 year risk of heart attack or stroke ≥ 30%, or
existing cardiovascular disease
Cervical Cancer 80% of women between ages 30‐49 screened for cervical cancer at least
Screening once
Trans-Fat Elimination of industrially produced trans‐fats (PHVO) from the food supply
Management Sciences for Health Source: WHO, 2012 16

17. Responding to the Chronic NCD Epidemic –
what is needed
 Whole of society response – public, private, civil society
 Universal health coverage (UHC) for financing base
 Integration and localization from the beginning
 High leverage prevention
 Efficiency and cost-consciousness at every step
Management Sciences for Health 17

18. Now is the time for UHC – the example of the
“African tigers” with two decades of growth
Average Growth Rates
per Capita, 1996–2008
Emerging countries
Threshold countries
Other countries
Oil exporters
Source: Emerging Africa,
Steven Radelet, 2010
Management Sciences for Health 18

19. The Universal Health Coverage movement –
Growing “buzz” around the globe
Implementing UHC
reforms
Stated interest in
achieving UHC
Management Sciences for Health 19

20. The Universal Health Coverage (UHC) Vision
World UHC Coverage: World Coverage:
4 out of 10 people are covered 8 out of 10 people are covered
Out-of-Pocket Expenditure: 60% Out-of-Pocket Expenditure: 30%
Source: The Rockefeller Foundation; WHA Resolution 58.33 Geneva: WHO 2005
Management Sciences for Health 20

21. Integration and localization –
an example of leveraging existing platforms
Cervical and Breast Cancer Screening in Eastern Uganda (STAR-E)
• Integration of HIV/AIDS and cervical/breast cancer prevention and treatment
services
• 484 women and girls living with HIV/AIDS screened for cervical and breast
cancer in 18 health centers as part of HIV-related care
• 884 personal health assistants (PHAs)
sensitized on family planning and
elimination of maternal-to-child transmission
• Patient referrals for cryotherapy for cervical
cancer at regional hospitals
Management Sciences for Health 21

22. Efficiency and cost-consciousness - targeting “best
buy” interventions for prevention and treatment
Interventions Cost per person
per year (US $)
China India Russia
1. Tobacco use – Accelerated implementation of the WHO 0.14 0.16 0.49
Framework Convention on Tobacco Control
2. Dietary salt – Mass‐media campaigns and voluntary action by 0.05 0.06 0.16
food industry to reduce consumption
3. Obesity, unhealthy diet, and physical inactivity – media 0.43 0.35 1.18
campaigns, food taxes, subsidies, labeling, marketing restrictions
4. Harmful alcohol intake – Tax increases, advertising bans, and 0.07 0.05 0.52
restricted access
5. Cardiovascular risk reduction – Combination of drugs for 1.02 0.90 1.73
individuals at high risk of NCDs
Total cost per person 1.72 1.52 4.08
Source: Beaglehole et al, Lancet 2011.
Management Sciences for Health 22

23. Take Away Messages
• The world faces a growing burden of chronic NCDs.
• Chronic NCDs pose a significant burden to the
health system and economic development.
• Strategies exist to prevent and treat cancer, heart
disease, diabetes and lung disease and cost just
$1.20 per person per year in LMICs.
• The “business as usual” approach is not appropriate.
• Health systems strengthening and pharmaceutical management have been identified as one of the
critical elements required to meet the long-term needs of people living with chronic NCDs.
• Chronic NCDs can be effectively addressed by leveraging existing platforms and investments.
Management Sciences for Health 23

24. Inspiring Quotes……..
“Non-communicable diseases(NCDs) represent an epidemic of gigantic proportions and
the call to address them nationally, regionally, globally and to dispel the myths that
enshroud them has an urgency that is impatient of further debate.”
 Sir George Alleyne, UN Special Envoy for HIV in the Caribbean and Former Chair of the
Caribbean Commission on Health and Development
“The global health community is at a critical crossroads. For the past decade, it was
essential to fund interventions for specific diseases because the number of infections
was so vast. As demographics change and people are living longer, however, a health
systems approach to NCDs has the greatest health impact and ensures that
interventions are sustainable, efficient, and effective.”
 Jonathan D. Quick, MD, MPH, President and CEO, Management Sciences for Health
“As the world grapples with the combined challenges of economic slowdown; the
increasing globalization of the economic system and of diseases; and growing demands
for chronic care, the need for universal health coverage (and a strategy for financing it)
has never been greater.”
 Dr. Margaret Chan, Director General, World Health Organization
Management Sciences for Health 24

25. Stronger health systems. Greater health impact.
Saving lives and improving the health
of the world’s poorest and most vulnerable people
by closing the gap between knowledge and action in public health.
Management Sciences for Health 25