Non-Communicable Diseases Global overview and implications for Pakistan DR GHULAM NABI KAZI WHO Country Office Pakistan The Aga Khan University 27th February 2014

The Non Communicable Diseases Non Communicable Diseases (NCDs)—mainly cardiovascular diseases, cancers, chronic respiratory diseases and diabetes—are the world’s biggest killers Other NCDs include renal, endocrine, neurological, haematological, gastro-enterological, hepatic, musculo-skeletal, skin and oral diseases and genetic disorders); Mental disorders; Disabilities, including blindness and deafness; Nutritional disorders Violence and injuries

More than 36 million people die annually from NCDs (63% of global deaths) These include > 14 million people who die young between the ages of 30 and 70 Low- and middle-income countries bear 86% of the burden of these premature deaths, resulting in cumulative economic losses of US$7 trillion over the next 15 years with millions of people trapped in poverty Most of the premature deaths are preventable

Tobacco accounts for almost 6 million deaths every year and is projected to increase to 8 million by 2030 About 3.2 million deaths annually can be attributed to insufficient physical activity Approximately 1.7 million deaths are attributable to low fruit and vegetable consumption These behaviors lead to four key metabolic/ physiological changes that increase the risk of NCDs: raised blood pressure, overweight, obesity, hyperglycemia and hyperlipidemia

Cardiovascular diseases account for most NCD deaths - 17 Cardiovascular diseases account for most NCD deaths - 17.3 million people annually, followed by cancers - 7.6 million, respiratory diseases - 4.2 million and diabetes - 1.3 million These four groups of diseases account for around 80% of all NCD deaths The NCDs share four risk factors: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets. These diseases are driven by forces that include ageing, rapid unplanned urbanization, and the globalization of unhealthy lifestyles

Major Global Targets in the Action Plan 2008-2013 25% relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context.10% relative reduction in prevalence of insufficient physical activity 30% relative reduction in mean population intake of salt/sodium

30% relative reduction in prevalence of current tobacco use in persons aged 15+ years 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure as per the national position Halt the rise in diabetes and obesity. At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes. An 80% availability of the affordable basic technologies and essential medicines, required to treat major NCDs in public and private facilities

Framework for National NCD Surveillance Exposures Behavioral risk factors: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diet. Physiological and metabolic risk factors: raised blood pressure, overweight/obesity, raised blood glucose, and raised cholesterol. Social determinants: educational level, household income, and access to health care.

Outcomes Mortality: NCD-specific mortality. Morbidity: Cancer incidence and type (as core). Health system capacity and response Interventions and health system capacity: infrastructure, policies and plans, access to key health-care interventions and treatments, and partnerships.

NCD BURDEN ESTIMATES - Pakistan Proportional mortality 54% (380,000 M 301,000 F) CVD 25% Cancers 7% Respiratory diseases 5% Diabetes 1% Other NCDs 8% Injuries 8% Prevalence of diabetes 10% Tobacco Use Males 36% Tobacco Use Females 7% People with Disabilities 2.49% (4.58 m) Mental Health problems 67% F and 25% M

32.7%, 30.3% and 40.0 % are suffering from Iron, Vitamin A and Zinc deficiency, respectively while 62.5% are anemic