1. Call to action on NCDs: Challenges and Way Forward for Maternal and Child Health Dr. Niloufer Sultan Ali Professor, Family Medicine Aga Khan University, Karachi 1

2. ‘Each year, millions of women & children die from preventable causes. These are not mere statistics. They are people with names & faces. Their suffering is unacceptable in the 21st century’, Ban Ki-moon, United Nations Secretary-General 2

3. A neglected dimension of women’s health A neglected dimension of women’s health NCDs are the world’s number one killer 35 million people die every year 18 million are women NCDs represent the biggest threat to women’s health worldwide 3

4. WHO report 2008 4

5. Total deaths around the world: 58 million Deaths from NCDs: 35 million Deaths from NCDs in developing countries: 28 million Countdown to 2015, Maternal Child and Newborn survival, the 2012 report 5

6. NCDs are no longer diseases of the rich and elderly Increasingly impacting on women in developing countries during the prime of their life Urgent priority for women’s health 6

7. Source: WHO Chronic Disease Report, 2005 7

8. Ratio of Non-Communicable/ Communicable Deaths, India, China, Other Asia-Pacific, 1990-2020 Source: WHO Chronic Disease Report, 2005 Deaths due to NCDs are 3 times more as compared to communicable diseases in Asia Pacific 8

9. NCD Diseases 4 Diseases, 4 Modifiable Shared Risk Factors Tobacco Use Unhealthy diets Physical Inactivity Harmful Use of Alcohol Cardio- vascular Diabetes Cancer Chronic Respiratory Source: WHO Chronic Disease Report, 2005 9

10. NCD in Pakistan WHO report 2008 10

11. NCD in Pakistan…Cont WHO report 2008 11

12. 2006-2015 (cumulative)2005 Lost national income from premature deaths due to heart disease, stroke and diabetes Lost national income (billions) Countries 493 Brazil 55818 China 2379 India 80.4 Nigeria 311 Pakistan 30311 Russian Federation 30.1 Tanzania Source: WHO Chronic Disease Report, 2005 IMPACT OF NCD NCDs macro-economic impact Lost National Income 12

13. Women & Diabetes Currently,143 million women are suffering from diabetes By 2030, this number is expected to rise to 222 million Diabetes is the ninth leading cause of death in women globally Gestational diabetes develops in one in 25 pregnancies worldwide. Source: WHO Chronic Disease Report, 2005 13 Source: Countdown to 2015, Maternal Child and Newborn survival, the 2012 report

14. Women & Cancer Over 3 million women die of cancer each year Breast & lung cancers are the most common cancer killers of women An estimated 1.7 million women will be diagnosed with breast cancer in 2020—a 26% increase from current levels—mostly in the developing world Source: WHO Chronic Disease Report, 2005 14

15. Women & CVD Source: WHO Chronic Disease Report, 2005 CVD is the number one killer of women worldwide Causes 9.1 million deaths among women annually In 2008, CVD killed 1.2 million women aged between (20-59 years) the most productive years of life Developing countries are more affected 15

16. Offspring CVD Risk by Parental CVD Status: Framingham Study Risk Ratio 2.5 2 1.5 1 0.5 0 Male offspring Female offspring 1.0 1.7 2.2 1.0 1.7 Parental CVD <55 men, <65 Women Source: International Society of Hypertension 16

17. NCDs in women compromises child health NCDs not only affect the health of women but also the health of their children Being born to a malnourished mother increases the chances of the infant suffering from under-nutrition, late physical and cognitive development and NCDs in adulthood 17

18. Childhood Obesity 43 million children under five years are overweight Girls are more likely to be overweight > Restrained from regular physical activity and sport >Lack of safe and supportive environments 18

19. Source: The Growth Assessment and Surveillance Unit, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland. 19

20. Current Challenges & Barriers to Women’s Health 20

21. Socio-cultural Barriers Women Education & Empowerment – Young women & girls are unable to make decisions about care for themselves or for their children without the permission of their husbands – Higher rates of illiteracy among women results in less access to information about NCD risk factors, prevention & treatment 21

22. Health System Barriers Women are less likely to seek medical care from male health providers due to cultural taboos Shortage of female health care providers Lack of NCD component in existing health systems 22

23. Health System In Pakistan Source: WHO, country profile 2008 23

24. A Way Forward 24

25. Fight for NCDs Reduce modifiable risk factors among individuals & populations Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol 25

26. A CALL FOR ACTION We need to move away from the fragmented approach to health and move towards taking a holistic view of the health of girls and women 26

27. A call for Action…Cont Enhance women education and empowerment NCD component to be integrated into existing health systems Link information of NCDs to reproductive health programs Involvement of women in identifying problems, solutions & implementing policies in the fight against NCDs 27

28. We can act TOGETHER, LET’S MAKE NCDs A PRIORITY FOR WOMEN’S HEALTH AND DEVELOPMENT 28

29. Act now on NCDs for girls, womenandfuturegenerations 29

30. We all have a role to play Everyone has a critical role to play in improving the health of women and children 30

31. Role of Family Physicians Promote healthy lifestyle Provide opportunistic care Share information regarding NCDs Address modifiable risk factors Conduct public awareness sessions Emphasize on regular check-ups 31

32. Thank You