1. Introduction to Non Communicable diseases
Dr Farhat R Malik
Assistant Professor
Community Health Science Department (PMC)

2. Session Plan By the end of the lecture students will be able to:
Define Non-Communicable diseases.
Classify Non Communicable diseases.
Know the risk factors for the NCDs.
Understand the epidemiology of NCDs.
Elaborate the impacts of NCDs.
Explain global response towards NCDs.
Know the statistics of NCD for Pakistan

3. Total deaths around the world:
58 million

4. Total deaths around the world:
58 million
Deaths from noncommunicable diseases around the world:
35 million

5. Total deaths around the world:
58 million
Deaths from noncommunicable diseases around the world:
35 million
Deaths from noncommunicable diseases in developing countries:
28 million

6. Total deaths around the world:
58 million
Deaths from non-communicable diseases around the world:
35 million
Deaths from non-communicable diseases in developing countries:
28 million
Deaths from non-communicable diseases in developing countries which could have been prevented: an estimated
14 million

7. NON- COMMUNICABLE DISEASES
These are by definition non-infectious & non- transmissible between persons , chronic diseases of longer duration but slow progression or may result in rapid death.
An impairment of bodily structure & functions that necessitates a modification of patients normal life and has persisted over an extended period of time.

8. WHO- Fact Sheet NCDs Kill more than 36 million people each year.
Nearly 80% of NCDs occur in low- and middle-income countries.
More than nine million of all deaths attributed to NCDs occur before the age of 60; 90% of these "premature" deaths occurred in low- and middle- income countries.
Cardiovascular diseases account for most NCD deaths, or 17.3 million people annually, followed by cancers (7.6 million), respiratory diseases (4.2 million), and diabetes (1.3 million1).
These four groups of diseases account for around 80% of all NCD deaths.
They share four risk factors: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets.
NCDs are preventable.

9. Trends in Developing Countries (source; IDF)
NCDs
Comm. Dis.
Injuries 40 30
Deaths (millions) 20 10
1990
2000
2010
2020

10. Burden of NCDs in Pakistan
Causes of Burden of Disease (DALYs)
Percentage (%)
Communicable Disease
38.4
Non-Communicable Disease
37.7
Causes of Deaths
Year (1992)
Year (2003)
Communicable Disease
49.8
26.2
Non-Communicable Disease
34.1
54.9
The world bank. Pakistan towards a health sector strategy. Washington, USA: health Nutrition and population unit, South Asia region, the world bank: 1998
Government of Pakistan. Respective surveys for the years federal bureau of statistics; Pakistan demographic surveys. Islamabad, Pakistan: statistics division.

11. Rising Life Expectancy
Health Transition
Non-communicable diseases/diabetes in developing countries
Rising Life Expectancy
Life expectancy has risen from below to almost 70 years during the industrial era. Three major factors have contributed to this
increase
Improved living standards
public health &
medical care
All are important, though to varying degrees in different eras.
WHO report, 1997

12. Noncommunicable Diseases Death trends (2006-2015)
2005
(cumulative)
Geographical regions (WHO classification)
Total deaths (millions)
NCD deaths (millions)
Trend: Death from infectious disease
Trend: Death from NCD
Africa
10.8
2.5 28
+6%
+27%
Americas
6.2
4.8 53
-8%
+17%
Eastern Mediterranean
4.3
2.2 25
-10%
+25%
Europe
9.8
8.5 88
+7%
+4%
South-East Asia
14.7
8.0 89
-16%
+21%
Western Pacific
12.4
9.7
105 +1
+20%
Total
58.2
35.7
388
-3%
(WHO Chronic Disease Report, 2005)
Wendy Baldwin and Lindsey Amato
(July 2012) Noncommunicable diseases (NCDs), also referred to as chronic diseases, are the leading causes of death worldwide. In 2008, 80 percent of NCD deaths were in developing countries, up from 40 percent in NCDs will steadily increase the number of healthy years (or disability-adjusted life years—DALYs) lost in middle-income countries, but the loss will increase very quickly in low-income countries. By 2030, low-income countries will have eight times more deaths attributed to NCDs than high-income countries.
WHO projects that over the next 10 years, the largest increase in deaths from cardiovascular disease, cancer, respiratory disease and diabetes will occur in developing countries. 12

13. Types of Non- Communicable Diseases
CVDs
COPDs
Hypertension.
Obesity.
Diabetes Mellitus
Renal Disorders.
Nervous & mental diseases.
Osteoporosis.
Blindness.
Cataracts.
Cancers
Disasters.
Animal Bites
Burns
Alcohol consumption
Congenital Anomalies
Deafness & hearing loss
Dementia
Depression
Road Traffic Injuries
Violence
Epilepsy
Elderly Maltreatment
Accidents

15. Risk Factors Modifiable Non- Modifiable
Can b classified into modifiable & non-modifiable risk factors,aging,unplanned uirbanization and unhealthy life style globalization are the driving forces behind them. All age groups are vulnerable . Raised blood pressure.
Raised cholesterol.
Tobacco use.
Alcohol abuse.
Overweight.
Stress factors.
Life style changes.
Environmental risk factors.
In ability to obtain preventive services

18. Links to NCDs
Pakistan NCDs Statistics
Info graphics- WHO

19. Socio-economic impacts of NCD.
Threatens progress to UN MDGs.
Poverty closely linked.
Vulnerable & socially disadvantaged persons get sick quicker.
In poor health care cost for CVS, cancers and other diseases can quickly drain resources of the poor.

20. Noncommunicable Diseases 4 Diseases, 4 Modifiable Shared Risk Factors
Tobacco
Use
Unhealthy diets
Physical
Inactivity
Harmful
Use of
Alcohol
Cardio-vascular
Diabetes
Cancer
Chronic
Respiratory

21. Noncommunicable Diseases Mortality among men and women aged 15-59 years (2004)

22. Treatment Options Effective & inexpensive medicines availability.
Integrated approach.
Hi risk persons be identified.
Survivors cared for.
New technology be available .

23. The major challenge to development in the 21st century

Noncommunicable diseases in developing countries are a major public health and socio-economic problem
The major challenge to development in the 21st century

24.  prevent 40 to 50% of premature deaths
Affordable solutions exist to
prevent 40 to 50% of premature deaths
from noncommunicable diseases
These solutions can prevent an estimated
14 million premature deaths each year
in developing countries

25. 
Noncommunicable diseases should no longer be excluded from global discussions on development

26. Global Noncommunicable Disease Network

Global Noncommunicable Disease Network
(NCDnet)
Promoting collaborative action to help developing countries in addressing noncommunicable diseases

27. Noncommunicable Diseases Why working in partnership?
Consolidate fragmented efforts
Promote results-oriented collaborative efforts
Engage partners outside the health sector
Scale up by pooling limited resources

28. Noncommunicable Diseases Global Action Plan 2008-2013: Six Objectives
1. Integrating NCD prevention into the development agenda, and into policies across all government departments
2. Establishing and strengthening national policies and programmes
3. Reducing and preventing risk factors
4. Prioritizing research on prevention and health care
5. Strengthening partnerships
6. Monitoring NCD trends and assessing progress made at country level
Here are the objectives of the plan. Under each of the six objectives there are three sets of actions to be iplemented during the six year period, one set for member sates, another for WHO and a third for international partners
Under each of the 6 objectives, there are sets of actions for member states, WHO Secretariat and international partners

29. Noncommunicable Diseases Proven National Policies and Plans
Early detection of hypertension and other risk factors reduce heart disease mortality 35-60%
Multi-drug regimens for patients reduce risk of heart disease and stroke
Early detection and treatment of cancers account for 30-80% reduction in mortality
Universal access to preventive and curative care essential
Strengthening health care for people with noncommunicable diseases:
Reducing the level of exposure of individuals and populations to risk factors:
Tobacco use
Unhealthy diet
Physical inactivity
Harmful use of alcohol
Here are the objectives of the plan. Under each of the six objectives there are three sets of actions to be iplemented during the six year period, one set for member sates, another for WHO and a third for international partners

30. Noncommunicable Diseases Selected Multi-sectoral Approaches to Reduce Unhealthy Diet
Reduce trans fatty acids and salt
Restrict availability of energy dense foods and high calorie non- alcoholic beverages
Increase availability of healthier foods including fruits and vegetables
Practice of responsible marketing to reduce impact of unhealthy foods to children
Make healthy options available and affordable
Provide simple, clear and consistent food labels that are consumer friendly
Reshape industry to introduce new products with better nutritional value
Here are the objectives of the plan. Under each of the six objectives there are three sets of actions to be iplemented during the six year period, one set for member sates, another for WHO and a third for international partners

31. Pakistan’s Policy about NCDs
NCD Policy Document

32. NCDs in developing & developed countries. Are they same?
Impact of NCDs on Developing Countries
NCDs in developing & developed countries. Are they same?
The compressed time frame of transition in developing countries imposes a large, double burden of communicable and non- communicable diseases.
Major shift in Pakistan
While the determinants of health transition in the developing countries are similar to those that charted the course of the epidemics in the developed countries, their dynamics are different.
The epidemiologic transition in Asia is very different from the classic transition that occurred in the West. First, the transition in the West was essentially reciprocal--communicable diseases went down and were replaced by a rising burden of noncommunicable diseases. In the developing countries of Asia, however, there is an overlap, with countries having to face fairly significant burdens of communicable and noncommunicable disease simultaneously.
Second, the transition is occurring much faster in Asia's developing countries than it did for countries in the industrialized West. One reason may be the rapid economic growth and improvements in health care infrastructure that have paralleled the shift in the causes of ill-health.
The compressed time frame of transition in the developing countries imposes a large, double burden of communicable and non-communicable diseases. Unlike in the developed countries where urbanization occurred in prospering economies, urbanization in developing countries occurs in settings of high poverty levels and international debt, restricting resources for public health responses. Organized efforts at prevention began in developed countries when the epidemic had peaked, and often accelerated a secular downswing, while the efforts in the developing countries are commencing when the epidemic is on the upswing. Strategies to control CVD in the developing countries must be based on recognition of these similarities and differences. Principles of prevention must be based on the evidence gathered in developed countries, but interventions must be context-specific and resource-sensitive

33. Economic Impact of NCDs
In 2005 alone, Pakistan lost 1 billion dollars in national income from premature deaths due to heart disease, stroke & diabetes and will lose 31 billion dollars over next ten years if the solutions are not implemented
Press Release: Karachi, Pakistan-26 February 2006

34. NCD’s are to a great extent preventable
Prevention
in developed countries
epidemic had peaked and accelerated towards a downswing
in the developing countries
efforts starting when the epidemic is on the upswing.
While the determinants of health transition in the developing countries are similar to those that charted the course of the epidemics in the developed countries, their dynamics are different.
The epidemiologic transition in Asia is very different from the classic transition that occurred in the West. First, the transition in the West was essentially reciprocal--communicable diseases went down and were replaced by a rising burden of noncommunicable diseases. In the developing countries of Asia, however, there is an overlap, with countries having to face fairly significant burdens of communicable and noncommunicable disease simultaneously.
Second, the transition is occurring much faster in Asia's developing countries than it did for countries in the industrialized West. One reason may be the rapid economic growth and improvements in health care infrastructure that have paralleled the shift in the causes of ill-health.
The compressed time frame of transition in the developing countries imposes a large, double burden of communicable and non-communicable diseases. Unlike in the developed countries where urbanization occurred in prospering economies, urbanization in developing countries occurs in settings of high poverty levels and international debt, restricting resources for public health responses. Organized efforts at prevention began in developed countries when the epidemic had peaked, and often accelerated a secular downswing, while the efforts in the developing countries are commencing when the epidemic is on the upswing. Strategies to control CVD in the developing countries must be based on recognition of these similarities and differences. Principles of prevention must be based on the evidence gathered in developed countries, but interventions must be context-specific and resource-sensitive
Simple changes in these lifestyles can prevent chronic diseases and promote health.

35. Strategies to prevent the emergence of NCDs
Primary prevention
(limit the number of new cases)
Population strategy
Public health approach
Targets population
High risk strategy
Clinical management
Targets individuals

37. Sample MCQ
1- Deaths from non-communicable diseases in developing countries which could have been prevented; a) 35 million b) 14 million c) 28 million d) 5 million e) 18 million Answer: 14 million
Answer (b) 14 million

38. Any Questions ??????

39. References
Global status report on noncommunicable diseases Geneva, World Health Organization, 2012. 
World Health Organization. Global Health Estimates: Deaths by Cause, Age, Sex and Country, Geneva, WHO, 2014.
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006, 3(11):e442.
Global status report on noncommunicable diseases Geneva, World Health Organization, 2011. 
Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Geneva, World Health Organization, 1999 (WHO/NCD/NCS/99.2).