GARD Global Alliance against Chronic Respiratory Diseases WHO J Bousquet, R Dahl, N Khaltaev, HJ Bekedam.
J Walsh - USA The patients expectations. Personal History of J. Walsh When did the disease start Symptoms Effects on daily life Treatment Expectations.
GARD Global Alliance against Chronic Respiratory Diseases WHO J Bousquet, R Dahl, N Khaltaev, HJ Bekedam.
Presentation on theme: "GARD Global Alliance against Chronic Respiratory Diseases WHO"— Presentation transcript:
1GARD Global Alliance against Chronic Respiratory Diseases WHO J Bousquet, R Dahl, N Khaltaev, HJ Bekedam
2www.who.int/chp Good afternoon. It's my pleasure to share with you the overall messages and key findings of this new WHO global report: Preventing chronic diseases: a vital investment. Several misunderstandings about chronic diseases have contributed to their global neglect. This report dispels these misunderstandings with the strongest evidence and proposes a way forward for stopping the rising global epidemic.
3GARD Launch Press Conference N Zhong (China): Chronic respiratory diseases (CRD) are a major burden in ChinaS Hurd (USA): The burden of CRDN Khaltaev (WHO): From the fragmented CRD programs to GARDJ Bousquet (France): The GARD action planM Boland (Ireland): Health promotion and CRD preventionJ Walsh (USA): The patient’s expectations
5Chronic Respiratory Diseases: An Increasing Global Public Health Problem The World Health Organization estimates that over 1 billion people suffer from chronic respiratory diseases worldwidePrevalence and severity are increasing globallyCause substantial socioeconomic burden to individuals and societiesIn all countries, chronic respiratory diseases are:Under recognizedUnder diagnosedUnder treated
7Global Distribution – Chronic Disease Mortality: All ages, 2005 > 4,000,000Communicable diseases;Maternal/perinatal,Nutritional deficiencies7%CardiovascularCancerChronic RespiratoryDiseases (CRD)DiabetesOther Chronic DiseasesInjuriesSource: Preventing Chronic Diseases, a vital investment, WHO, 2005
8Increasing Burden of Diseases and Injuries: Change in Rank Order of DALYs*19992020Acute lower respiratoryinfections2. HIV/AIDS3. Perinatal conditions4. Diarrhoeal diseases5. Unipolar major depression6. Ischemic heart disease7. Cerebrovascular disease8. Malaria9. Road traffic injuries10. COPD11. Congenital abnormalities12. Tuberculosis1. Ischemic heart disease2. Unipolar major depression3. Road traffic injuries4. Cerebrovascular disease5. COPD6. Acute lower respiratory infections7. Tuberculosis8. War9. Diarrhoeal diseases10. HIV…….15. Trachea, bronchus, lung cancers*DALY = Disability-adjusted life yearSource: WHO Evidence, Information and Policy, 2000
9Chronic Respiratory Diseases (CRD)Global PrevalenceAsthma > 300 millionAllergic rhinitis > 400 millionChronic obstructive > 80 million moderate pulmonary disease to severe COPD; many millions with mild COPD
10Burden of AsthmaAsthma is one of the most common chronic diseases in the worldPrevalence ranges from 1% to 18%An estimated 250,000 deaths annually, many of them preventableDirect costs (hospital, medications) account for 1-3% of total medical expenses in most countries
11Affordability of Asthma Drugs Moderate persistent asthma, 1998 SETTING: The cost and availability of the medications required for the treatment of asthma may represent potential barriers to effective management. METHOD: A survey of prices and policies for components of asthma treatment in 1998, in Algeria, Burkina Faso, Ivory Coast, Guinea, Mali, Syria, Turkey and Vietnam. RESULTS: Medications were consistently available in only four of the eight countries studied. The cost of essential medications for standard case management varied by over five times for beclomethasone and by over three times for inhaled salbutamol. In all but two countries, the cost of one year of drugs for treatment of a moderate, persistent case exceeded the monthly salary of a nurse in that country. The essential drugs list included inhaled salbutamol in five of eight countries and beclomethasone in three of eight. The costs of medications were lower where generic preparations were available and, to a lesser extent, where the medications are on the essential drugs list. CONCLUSIONS: The cost and availability of medications vary widely, and may represent an important barrier to effective management in some low and middle income countries.Cost in US$N. Ait-Khaled and al Int J Tuberc Lung Dis 2000; 4, 3:
12Burden of COPDCOPD is a major cause of morbidity, mortality and disabilityHigh prevalence, morbidity and mortality of COPD present challenges for healthcare systemsDespite its ease of diagnosis, COPD remains an under-diagnosed disease, chiefly in its milder and more treatable form
13COPD Mortality by Gender, USA, 1980-2000 Number Deaths x 1000Recent data from the US Centers for Disease Control and Prevention shows that while the mortality rates for COPD in men continue to rise in the US, a startling finding was the steep rise in mortality in women.YearSource: Mannino D, US CDC, August 2002
14Risk Factors for COPD Occupational dusts Cigarette Smoke Environmental tobacco smokeFumes/gasesIndoor/outdoorpollutionOccupationaldustsRisk Factors for COPDNutritionSocio-economic statusInfections
15Chronic Respiratory Diseases Global Public Health Problem are aGlobal Public Health Problem
16From the fragmented CRD programs N Khaltaev - WHOFrom the fragmented CRD programsto GARD
17WHA resolution 53.17 The 53rd World Health Assembly recognized the enormous human suffering caused by chronic respiratory diseases (CRDs)and requested the WHO Director General to continuegiving priority to the prevention and control of CRDswith special emphasis on developing countries and other deprived populationsWHA resolution 53.17, May 2000endorsed by all 191 WHO Member States
18GARD WHO calls for a global and coordinated effort to fight chronic respiratory diseasesGARD
19A world where all people can breathe freely: GARDThe 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.
20Fragmented success stories Asthma and COPD plans:BrasilChinaFinlandFrancePortugalUSA
21Experience 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.
22A Success Story: France Increase awareness on asthma (patients and public)Improvemanagement of acute severe asthmafollow-up of asthmaticsdiagnosis and management of childhood asthma in schoolsIncrease patient educationBetter manage and prevent occupational asthmaSurveillance of asthma and risk factors
23Healthcare benefits from asthma intervention 350Reimbursement asthmaHospitalization daysDeath rate300250(base 100 in 1981)Asthma Indices2001501005019811983198519871989199119931995YearHaahtela et al, Thorax 1998
25Specific 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.
26Specific Objectives of GARD Availability and affordability of medicationsProvide appropriate training for health care personnel.Provide education to patients, care givers and families.
27Comprehensive and integrated action is the means to prevent and control chronic diseases Good afternoon.It's my pleasure to share with you the overall messages and key findings of this new WHO global report: Preventing chronic diseases: a vital investment. Several misunderstandings about chronic diseases have contributed to their global neglect. This report dispels these misunderstandings with the strongest evidence and proposes a way forward for stopping the rising global epidemic.
28Estimate 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)
29Formulate 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)
30Identify Policy Implementation Steps The GARD action plan should be applied at the country level.A national coordination group will:Provide existing national statistics on CRDAssess the specific needs for the given countryReview the GARD action planDetermine the relevant issues for the countryaction planDevelop a country-specific action plan
31Health promotion and CRD prevention M Boland - IrelandHealth promotion and CRD prevention
32Health promotion and disease prevention Key messages:Everyone has the right to live in a clean air environmentEnvironmental exposure to unhealthy environment causes incurable COPD, asthma, cardiovascular disease and cancerComplete elimination is the only way to remove the riskThis applies to tobacco smoke and all other at risk environments
33WG.3- Health promotion and disease prevention Goals:Help all countries to build and implement policies to reduce the burden oftobacco smoke,indoor and outdoor pollution,occupational hazardsand other risk factors of relevance for CRD
34WG.3- Health promotion and disease prevention Some WHO programs are already available:FCTC (Framework Convention on Tobacco Control)Healthy Environment for Children AllianceWHO program on prevention of allergy and asthmaEnvironmentOccupational diseases
35Tobacco Cessation No. of Smokers fallen by 25% Smoking Ban ‘Slan’ SurveysOTC/MRBI TrackerSmoking Ban
37WG.3- Health promotion and disease prevention Biomass fuelsOver 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)
39Personal History of J. Walsh When did the disease startSymptomsEffects on daily lifeTreatmentExpectationsFuture
40Patient’s Expectations from GARD Health care professionals should be able to recognize CRD at an early phase and introduce early managementThe patient must be taken more seriously about his/her symptomsHealth care systems should be structured to manage patients with chronic disease, including regular and long term follow up….continued
41Patient’s Expectations from GARD (continued) Health care systems should develop a structured patient education, information and training programsGeneral public should become more informed of CRDs problems and take a more positive attitude toward the needs of CRD patientsSocieties should be more receptive to the value of environmental changes
42Partners in Care of CRDs. Doctors and Patientsmust bePartners in Care of CRDs.
43ConclusionsHundreds of millions of people suffer from chronic respiratory diseasesOver 4 million people die prematurely each yearHuge economic burdenIn all countries, and particularly in developingcountriesIn all age groupsPrevalence and mortality are increasing
44www.who.int/chp Good afternoon. It's my pleasure to share with you the overall messages and key findings of this new WHO global report: Preventing chronic diseases: a vital investment. Several misunderstandings about chronic diseases have contributed to their global neglect. This report dispels these misunderstandings with the strongest evidence and proposes a way forward for stopping the rising global epidemic.