1. 1 Chapter 6: Non-Communicable Diseases

2. 2 Impact of Non- Communicable Diseases These chronic diseases drive healthcare costs at an alarming annual rate: Heart Disease and Stroke: $432 billion/year Heart Disease and Stroke: $432 billion/year Diabetes: $174 billion/year Diabetes: $174 billion/year Lung Disease: $154 billion/year Lung Disease: $154 billion/year Alzheimer’s Disease: $148 billion/year Alzheimer’s Disease: $148 billion/year

3. 3 Population Health Strategies to Address Non-communicable Diseases Screening Screening Multiple Risk Factor Reduction Multiple Risk Factor Reduction Cost Effective Treatment Cost Effective Treatment Genetic Counseling Genetic Counseling Tissue and organ replacement Tissue and organ replacement Improve transplantation process http://edition.cnn.com/2009/HEALTH/12/08/v ideo.wall.gender.baby/ Improve transplantation process http://edition.cnn.com/2009/HEALTH/12/08/v ideo.wall.gender.baby/ http://edition.cnn.com/2009/HEALTH/12/08/v ideo.wall.gender.baby/ http://edition.cnn.com/2009/HEALTH/12/08/v ideo.wall.gender.baby/

4. 4 What is asymptomatic?

5. 5 Four Criteria for an Ideal Screening 1) The disease produces substantial death and/or disability 2) Early detection is possible and improves outcomes 3) There is a feasible testing strategy for screening 4) Screening is acceptable in terms of harms, costs, and patient acceptance

6. 6 Does this screening fit the criteria? Phenylketonuria (PKU) is an inherited metabolic disorder caused by the absence of a specific enzyme (phenylalanine hydroxylase). PKU is caused by a hereditary defect in the metabolism of a biochemical in food called phenylalanine, organic compound, one of the 22 α-amino acids commonly found in animal proteins. Without dietary treatment, many children with PKU develop profound mental retardation below average level of intellectual functioning, usually defined by an IQ of below 70 to 75, combined with limitations in the skills necessary for daily living. Severe cognitive damage often occurs before the condition is clinically evident. Phenylketonuria (PKU) is an inherited metabolic disorder caused by the absence of a specific enzyme (phenylalanine hydroxylase). PKU is caused by a hereditary defect in the metabolism of a biochemical in food called phenylalanine, organic compound, one of the 22 α-amino acids commonly found in animal proteins. Without dietary treatment, many children with PKU develop profound mental retardation below average level of intellectual functioning, usually defined by an IQ of below 70 to 75, combined with limitations in the skills necessary for daily living. Severe cognitive damage often occurs before the condition is clinically evident. Screening options Heelstick tests for all newborns Heelstick tests for all newborns Detect PKU in a developing fetus using chorionic villus sampling during pregnancy. This involves the removal of a small piece of tissue from the uterus Detect PKU in a developing fetus using chorionic villus sampling during pregnancy. This involves the removal of a small piece of tissue from the uterus Determine whether the parents carry the defective phenylalanine hydroxylase (PAH) gene by getting an enzyme assay. This is a blood test done on adults. If both parents carry the recessive gene, then there is a 25 percent chance of the baby having PKU. Determine whether the parents carry the defective phenylalanine hydroxylase (PAH) gene by getting an enzyme assay. This is a blood test done on adults. If both parents carry the recessive gene, then there is a 25 percent chance of the baby having PKU.

7. 7 The four quadrants of cost and net effectiveness Increased Costs Decreased Effectiveness (Q1) Increased Costs Increased Effectiveness (Q2) Decreased Costs Decreased Effeteness (Q3) Decreased Costs Increased Effectiveness (Q4)

8. 8 Is there a role for genetic counseling and intervention in public health? Is there a role for genetic counseling and intervention in public health? What are some of the potential issues or benefits on a population level? What are some of the potential issues or benefits on a population level?

9. 9 Hints for exam Sequential Testing Sequential Testing Who is impacted most by noncommunicable diseases? Who is impacted most by noncommunicable diseases? Cost effectiveness Cost effectiveness Multiple Risk Factor Reduction Multiple Risk Factor Reduction Asymptomatic Asymptomatic Epidemiologic Transition Epidemiologic Transition