4 Projected deaths by cause and income (2004 to 2030) WHOIntentional injuriesOther unintentionalRoad traffic accidentsOther NCDCancersCVDMat//peri/nutritionalOther infectiousHIV, TB, malaria
5 Noncommunicable Diseases Burden of disease in disability adjusted life years (2004) Launched October 2008
6 Noncommunicable Diseases Global burden of disease attributable top 20 risk factors (2002) UnderweightUnsafe sexHigh blood pressureTobaccoAlcoholWorld Health Report, 2002)Unsafe water, S&HHigh cholesterolIndoor smoke from solid fuelsIIron deficiencyHigh BMIZinc deficiencyLow and middle incomeLow fruit and vegetablesHigh incomeVitamin A deficiencyPhysical inactivityOccupational injury risksLead exposureIllicit drugsUnsafe health care injectionsLack of contraceptionChildhood sexual abuse0%1%2%3%4%5%6%7%8%9%10%Attributable DALYs (% total 1.44 billion)
7 Noncommunicable Diseases Tobacco is a risk factor for 6 of the 8 leading causes of death (World Health Statistics, 2008)
8 Tobacco Rising production and consumption in developing countries 8
9 Tobacco: The poor and uneducated are the ones who smoke the most Smoking prevalence in Bangladesh (1995)Source: Sen, B & Hulme D, 2004
10 Overweight and obesity in people over 15 selected countries
11 The epidemiological transition in this region is already well advanced; all countries are at risk irrespective of income and socioeconomic development
13 Prevalence of tobacco use among males in the Eastern-Mediterranean Region Launched February 2008
14 Noncommunicable Diseases Adult Overweight and Obesity in Arab Countries
15 Noncommunicable Diseases Overweight among school children (13-15 yrs old)* % overweight or atrisk of overweight**Djibouti12.3Egypt20.6Jordan16.8Lebanon18.4Libya21.7United Arab Emirates33.2*Results from the Global School-based Student Health Survey (**overweight or at risk of becoming overweight=above the 85th percentileT this is becoming an issue of major concern when we look at trends in school children where you see worrying figures
16 Noncommunicable Diseases Age-adjusted estimates of diabetes prevalence in the Eastern-Mediterranean Region(Source: Comparative DM prevalence, table 1.12 and 1.13 of Diabetes Atlas)I mentioned diabetes. Top is GCC. This does not show the prevalence of the so called prediabetes- sometimes on third of the adult populationAdults (20-79)
18 Impact of increasing medical costs and the need for prevention Total Health Expenditure per capita ranges between US$ 325 to 2750Out of pocket spending ranges between 18-23% THEAdvanced epidemiological and demographic transitions are expected to result in a several fold increase in health care spending in Gulf Cooperation Countries in the coming 2 decadesPrevention has to be taken seriouslySources: WHO WHR 2008,- WHO NHA database, WHO-EMRO, Mapping health care financing, EMR countriesForecasts are made on the increase in health spending as a result of advanced epidemiological and demographic transitions. Calculations based on current data including a recent study done forecasting a five fold increase in health care spending in Gulf Cooperation Countries in the coming 2 decades.This means an enormous increase in spending which may overwhelm even high income countries. Cost containment strategies and programs have to be considered seriously but the main realistic approach should be based on taking prevention seriously.
19 Catastrophic Expenditures Studies in some Arab countries show that % of the population face catastrophic expenditures – meaning spending 40 % or more from their disposable income (excluding food), when a member of the family becomes sickmillions individuals may face such situation every year1-1.4 % of the households are pushed into poverty when a member of the family becomes ill, resulting into 2.5 to 4 millions of poor individuals for the whole region(Source: B. Sabri – WHO/EMRO)There is a higher prevalence of catastrophic expenditure in people with CVD. Studies in some Arab countries including Morocco and Tunisia have shown that % of the population face catastrophic expenditures – meaning spending 40 % or more from their disposable income (excluding food), when a member of the family becomes sick. Extrapolating these figures to the whole Arab World – excluding GCC countries, one finds that from 5.5 to 13 million individuals face such situation every year.This can be impoverishing.Another WHO study showed that % of the households are pushed into poverty when a member of the family becomes ill, resulting into 2.5 to 4 millions of poor individuals for the whole region.
20 Proportion of family income devoted to diabetes care Tis is just an example from a country outside the region showing how a considerable part of the family income in LICs is spent on chronic diseases like CVD and diabetes . The impact is much more among low income group. Up to 25% of income is spent on management of diabetes in tis caseSource: Ramachandran A Diabetes Care 2007
21 In Conclusion: Barrier to Development CVDs and other NCDs Will Further Widen the Health Gap between Rich and Poor CountriesThey Are Killing and Disabling People at Their Peak ProductivityThey Will Slow Economic Growth Rates in Poor Countries21