GARD Launch Press Conference N Zhong (China): Chronic respiratory diseases (CRD) are a major burden in China S Hurd (USA): The burden of CRD N Khaltaev (WHO): From the fragmented CRD programs to GARD J Bousquet (France): The GARD action plan M Boland (Ireland): Health promotion and CRD prevention J Walsh (USA): The patients expectations
The World Health Organization estimates that over 1 billion people suffer from chronic respiratory diseases worldwide Prevalence and severity are increasing globally Cause substantial socioeconomic burden to individuals and societies In all countries, chronic respiratory diseases are: –Under recognized –Under diagnosed –Under treated Chronic Respiratory Diseases: An Increasing Global Public Health Problem
Injuries Other Chronic Diseases Diabetes Chronic Respiratory Diseases (CRD) Cancer Cardiovascular Communicable diseases; Maternal/perinatal, Nutritional deficiencies Source: Preventing Chronic Diseases, a vital investment, WHO, 2005 7% > 4,000,000 Global Distribution – Chronic Disease Mortality: All ages, 2005
19992020 Increasing Burden of Diseases and Injuries: Change in Rank Order of DALYs* *DALY = Disability-adjusted life year 1.Acute lower respiratory infections 2. HIV/AIDS 3. Perinatal conditions 4. Diarrhoeal diseases 5. Unipolar major depression 6. Ischemic heart disease 7. Cerebrovascular disease 8. Malaria 9. Road traffic injuries 10. COPD 11. Congenital abnormalities 12. Tuberculosis 1. Ischemic heart disease 2. Unipolar major depression 3. Road traffic injuries 4. Cerebrovascular disease 5. COPD 6. Acute lower respiratory infections 7. Tuberculosis 8. War 9. Diarrhoeal diseases 10. HIV ……. 15. Trachea, bronchus, lung cancers Source: WHO Evidence, Information and Policy, 2000
Chronic Respiratory Diseases (CRD) Global Prevalence Asthma > 300 million Allergic rhinitis > 400 million Chronic obstructive > 80 million moderate pulmonary disease to severe COPD; many millions with mild COPD
Burden of Asthma Asthma is one of the most common chronic diseases in the world Prevalence ranges from 1% to 18% An estimated 250,000 deaths annually, many of them preventable Direct costs (hospital, medications) account for 1-3% of total medical expenses in most countries
Affordability of Asthma Drugs Moderate persistent asthma, 1998 N. Ait-Khaled and al Int J Tuberc Lung Dis 2000; 4, 3: 268-271 Cost in US$
Burden of COPD COPD is a major cause of morbidity, mortality and disability High prevalence, morbidity and mortality of COPD present challenges for healthcare systems Despite its ease of diagnosis, COPD remains an under-diagnosed disease, chiefly in its milder and more treatable form
COPD Mortality by Gender, USA, 1980-2000 Year Number Deaths x 1000 Source: Mannino D, US CDC, August 2002
Cigarette Smoke Environmental tobacco smoke Fumes/gases Indoor/outdoor pollution Occupational dusts Risk Factors for COPD Nutrition Socio-economic status Infections
Chronic Respiratory Diseases are a Global Public Health Problem
N Khaltaev - WHO From the fragmented CRD programs to GARD
WHA resolution 53.17 The 53 rd World Health Assembly recognized the enormous human suffering caused by chronic respiratory diseases (CRDs) requestedand requested the WHO Director General to continue giving priority to the prevention and control of CRDs with special emphasis on developing countries and other deprived populations WHA resolution 53.17, May 2000 endorsed by all 191 WHO Member States
WHO calls for a global and coordinated effort to fight chronic respiratory diseases GARD
GARD The Global Alliance against Chronic Respiratory Diseases (GARD) is a voluntary alliance of organizations, institutions, and agencies working towards a common vision to improve global lung health according to the local needs. Vision: A world where all people can breathe freely: Breath for all.
Experience from Brazil In Brazil since 2002 the ministry of health provides free pharmaceutical assistance for severe asthmatics. In the province of Salvador this lead to the reduction of 55% of hospital submissions. The mean annual income of families of severe asthmatics increased by 10 %. The public health system has saved 566 US$ per patient per year.
A Success Story: France Increase awareness on asthma (patients and public) Improve – management of acute severe asthma – follow-up of asthmatics – diagnosis and management of childhood asthma in schools Increase patient education Better manage and prevent occupational asthma Surveillance of asthma and risk factors
Healthcare benefits from asthma intervention Asthma Indices (base 100 in 1981) Reimbursement asthma Hospitalization days Death rate Year 350 300 250 200 150 100 50 0 19811983198519871989199119931995 Haahtela et al, Thorax 1998
Specific Objectives of GARD Build a stepwise and integrated program of prevention and control of CRD. Improve collaboration between the fragmented WHO and non-WHO programs. Increase awareness of CRD. Reduce the burden of CRD, and foster country- specific initiatives appropriate to local needs. Focus on developing countries and deprived populations.
Specific Objectives of GARD Availability and affordability of medications Provide appropriate training for health care personnel. Provide education to patients, care givers and families.
Comprehensive and integrated action is the means to prevent and control chronic diseases
Estimate population needs and advocate WG.1- Burden, risk factors and surveillance (G Viegi, S Buist, Y Fukuchi) WG.2- Awareness and advocacy (C Lenfant, A Turnbull, P van Cauwenberge)
Formulate and adopt policy WG.3- Prevention and health promotion (M Boland, A Custovic) WG.4- Diagnosis of CRD and allergy (K Rabe, S Wenzel) WG.5- Control of CRD and allergies, availability and affordability of drugs (J Bousquet, E Bateman, L Fabbri, C van Weel) WG.6- Pediatric asthma (C Baena-Cagnani, E Mantzouranis, FER Simons, E Valovirta)
Identify Policy Implementation Steps The GARD action plan should be applied at the country level. A national coordination group will: – Provide existing national statistics on CRD – Assess the specific needs for the given country – Review the GARD action plan – Determine the relevant issues for the country action plan – Develop a country-specific action plan
M Boland - Ireland Health promotion and CRD prevention
Health promotion and disease prevention Key messages: Everyone has the right to live in a clean air environment Environmental exposure to unhealthy environment causes incurable COPD, asthma, cardiovascular disease and cancer Complete elimination is the only way to remove the risk This applies to tobacco smoke and all other at risk environments
WG.3- Health promotion and disease prevention Goals: Help all countries to build and implement policies to reduce the burden of –tobacco smoke, –indoor and outdoor pollution, –occupational hazards –and other risk factors of relevance for CRD
WG.3- Health promotion and disease prevention Some WHO programs are already available: –FCTC (Framework Convention on Tobacco Control) –Healthy Environment for Children Alliance –WHO program on prevention of allergy and asthma –Environment –Occupational diseases
Tobacco Cessation No. of Smokers fallen by 25% Slan Surveys OTC/MRBI Tracker Smoking Ban
WG.3- Health promotion and disease prevention Biomass fuels –Over 2 billion people in the developing world burn traditional biomass fuels indoor for cooking and heating. –Resulting in an estimated 1.6 million deaths each year, largely among women and children. –Acute respiratory infections and COPD (700,000 deaths/yr)
Personal History of J. Walsh When did the disease start Symptoms Effects on daily life Treatment Expectations Future
Patients Expectations from GARD Health care professionals should be able to recognize CRD at an early phase and introduce early management The patient must be taken more seriously about his/her symptoms Health care systems should be structured to manage patients with chronic disease, including regular and long term follow up …. continued
Patients Expectations from GARD (continued) Health care systems should develop a structured patient education, information and training programs General public should become more informed of CRDs problems and take a more positive attitude toward the needs of CRD patients Societies should be more receptive to the value of environmental changes
Doctors and Patients must be Partners in Care of CRDs. Doctors and Patients must be Partners in Care of CRDs.
Conclusions Hundreds of millions of people suffer from chronic respiratory diseases Over 4 million people die prematurely each year Huge economic burden In all countries, and particularly in developing countries In all age groups Prevalence and mortality are increasing