UNIT 9: Control of Non-Communicable Diseases

Non-communicable diseases

- chronic diseases or lifestyle related diseases

- 4 major diseases:

* Cardiovascular diseases

* Cancer

* Chronic obstructive pulmonary diseases (COPD)

* Diabetes Mellitus (DM)

Non-communicable diseases

- The rapid rise in the prevalence of these diseases represents one of the major health challenges to global development in the coming century

- the leading cause of mortality

Non-communicable diseases

- By 2020 these diseases are expected for 73% of deaths and 60% of disease burden

- expected to increase worldwide by 2030

- in 2005, contributed 60-63% of deaths worldwide

Non-communicable diseases

- threatens economic and social development as well as the lives and health of millions of people

- cause disability as well as high death toll, often for decades of a person's life

Disability Adjusted Life per Year

- widely used summary measure of the burden of the disease

- combines the number of years of healthy life lost to premature death with time spent in less than full health

- 1 DALY = 1 lost healthy year of life

Non-communicable diseases

- Projected burden of disease of these disease is approximately 48% of the burden of disease

- In the Philippines, increasing life expectancy, urbanization and lifestyle changes have brought about a considerable change on the health status of the country

Non-communicable diseases

- In the Philippines, 75% of the total deaths are attributed to NCDs similar to other developing countries and 30-50% occurs at the age of 60 years of age

- Globalization and social changes has influenced the spread of these diseases by increasing exposure to risk

69.6 years

Life expectancy of Filipinos in 2002

Non-communicable diseases

- The process of aging brings out myriad health problems that are degenerative by nature

- The consequences of these diseases are staggering in terms of productivity losses, not withstanding the emotional and psychological havoc it brings to those who are afflicted and their families

Non-communicable diseases

3 major risk factors:

- Tobacco smoking

- Physical inactivity

- Unhealthy diet

Non-communicable diseases

- Major strategy is health promotion across the life course and prevention of the emergence of the risk factors in the 1st place

- Promotion of a healthy lifestyle then becomes imperative

Top 10 Causes of Death in Philippines

1. Diseases of the heart

2. Cerebrovascular diseases

3. Malignant neoplasm

4. Pneumonia

5. Tuberculosis

6. COPD

7. Diabetes

8. Nephritis, nephrotic syndrome

9. Assault

10. Certain conditions arising from perinatal period

Integrated Community-Based NCD Prevention and Control Program

should be put in place by:

- LGU

- Workplaces

- Various stakeholders

Goal: Reduce the morbidity, disability and premature deaths due to chronic, non-communicable lifestyle related disease.

Integrated Community-Based NCD Prevention and Control Program

Objectives:

Analyze the social, economic, political and behavioral determinants of NCD that will serve as basis for:

a. Developing policy guidelines;

b. Setting legislative and political directions; and

c. Providing financial measures to support NCD prevention and control.

Integrated Community-Based NCD Prevention and Control Program

Objective:

- Reduce exposure of individuals and population to major determinants of NCD while preventing emergence of preventable common risk factors

- must focus on modification of unhealthy lifestyles and behaviors that predispose populations to NCD

Integrated Community-Based NCD Prevention and Control Program

Objective:

The health sector should lobby for a health protective environment by:

a. Proposing health public policies that encourage health-promoting settings in school, workplaces and communities;

b. Encouraging governments to provide protection against activities by industry and commerce that promote unhealthy products and lifestyle; and

c. Communicating the consequences of major risk factors of NCD, paying particular attention to the most vulnerable group.

Integrated Community-Based NCD Prevention and Control Program

Objective:

- Strengthen health care for people with NCD through health sector reforms and cost effective interventions.

- In order to contribute to the improved health status of individuals and respond to the community's basic health care needs, there must be enhanced capability to take action to address these major NCD risk factors.

- Enhanced capability reiterates the value of strong community participation combined with institution-building and appropriate, cost-effective health interventions.

Integrated Community-Based NCD Prevention and Control Program

- Comprehensive Approach

- Community-based Approach

- Integrated Approach

Comprehensive Approach

- Focused on Primary Prevention Comprehensive long-term strategy for control of NCDs

- Include:

* Prevention of emergence of risk factors referred to as primordial prevention; and

* Specific protection from NCD by removal of the risk factors or reduction in their levels.

Community-based Approach

- recognizes people as the center of any health and development effort

- The community is given the right, responsibility and capability to identify and address its own health problems and needs

Community-based Approach

Given their limitations and constraints, the program is expected to provide a mechanism for people to participate in activities that have the potential to positively impact health.

Community-based Approach

key ingredients to successful and sustainable community-based health initiative are:

* Active community participation;

* Involvement of community leaders, community committees and other community groups;

* Strong support and guidance from LGU and technical experts; and

* Multi-sectoral collaboration

Integrated Approach

- healthy community contributes to the socio-economic development of the community

- in the same manner, improved economic and social status will enable the population to attain healthy condition

Integrated Approach

it is viewed in the following context:

* NCD and its major risk factors are not regarded solely as health issues.

* Since the risk factors are rooted on the people's way and quality of life, it becomes inherent that the NCD program be part of the overall development program of the locality

* Policy decisions and appropriate legislation towards a health protective environment will be a major influencing factor in the reduction or removal of these risk factors.

Integrated Approach

it is viewed in the following context:

* Interventions for NCD and its major risk factors encompass the 3 levels of disease prevention

* Interventions aimed at the primary prevention can be integrated with the health services and activities at the community level utilizing the primary health care approach while the secondary and tertiary prevention activities can be readily made available and accessible through a referral pathway

* Health initiatives of the private sector to develop community health services and facilities must be supported and integrated into the overall scheme of NCD prevention and control program

Key Intervention Strategies

- Establishing program direction and infrastructure;

- Changing environments;

- Changing lifestyle; and

- Reorienting health services (from curative to health promotion and wellness);

Role of PHN in NCD Prevention and Control

- Health Advocate;

- Health Educator;

- Health Care Provider;

- Community Organizer;

- Health Trainer; and

- Researcher.

Non-Communicable Disease

- a medical condition that is non-infectious and non-transmissible

- are referred to as "chronic disease" due to their long duration

Non-Communicable Disease

termed chronic because the condition interferes with the individual's way of living a normal life brought about by different signs and symptoms lasting for more than 6 months

Non-Communicable Disease

referred to as lifestyle-related disease due to the common risk factors such as lifestyle of the individual that increases the likelihood of NCDs

Non-Communicable Disease

- diseases that are usually brought about by having an unhealthy lifestyle; and

- Effects of NCDs may alter the normal functioning of the individual for a long duration

- public health problem of great proportions

Non-Communicable Disease

- 75% estimate of the total deaths are of NCDs

- In 2005, 49.9% of mortality causes in the country were caused by chronic Lifestyle-related non communicable disease (LRNCDs)

- expected that the onset of chronic LRNCDs will continue over the next few years

Lifestyle-related non communicable disease (LRNCDs)

- Cardiovascular

- Cerebrovascular

- Cancer

- COPD

Cardiovascular Disease/Heart Disease

the general term used to refer to disease that involve the heart or blood vessels (arteries, capillaries, and veins)

Cerebrovascular Disease/Stroke

a group of brain dysfunction related to the disease of the blood vessels supplying to the brain

Cardiovascular and Cerebrovascular Disease

Most common causes:

- atherosclerosis

- hypertension

33.8% of the leading causes of death (NSO, 2009)

hypertension/high blood pressure

- Systolic BP equal to or above 140 mmHg

- Diastolic BP equal to or above 90 mmHg

Atherosclerosis

Disease of the blood vessels characterized by the deposition of fats and cholesterol within the walls of the artery

Uncontrolled Hypertension and Atherosclerosis

lead to:

- heart attack

- stroke

- kidney damage

- host of complications

Cardiovascular and Cerebrovascular Disease

common risk factors:

- unhealthy diet

- smoking

- sedentary lifestyle

- alcohol consumption

Cardiovascular and Cerebrovascular Disease

- 5% of the population are now considered obese, 10% are diagnosed with hypercholesterolemia, and 24% are considered hypertensive

- Studies reveal that there has been an observable increase in the consumption of NCD-implicated food items

screening

One of the strategies in the prevention of cardiovascular and cerebrovascular disease

screening

The identification of an unrecognized disease by the application of test, examination or other procedures that can be applied rapidly to help identify an individuals's chances of becoming ill

Hypertension screening

involves monitoring of BP through:

- Reliable aneroid sphygmomanometers that are calibrated every 6 months (recorded twice daily in AM and PM) for several days before diagnosis of hypertension can be made

- Measurements on the 1st day is discarded

- 2 consecutive measurements are taken, at least a minute apart and with the person seated.

Cholesterol screening

involves taking a blood sample to determine the total serum cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL)

Cholesterol screening

- Prior to testing, NPO for at least 8 hours to ensure accuracy of results;

- In all adults aged 20 or older, a fasting lipoprotein profile should be obtained once every 5 years

- If a test is done to a non-fasting individual, the values for total cholesterol and HDL will be used.

elevated LDL cholesterol

- a major cause of cardiovascular disease

- a bad cholesterol as it increases the likelihood of plaque formation that can block blood flow in the arteries

- increases the risk of the individual to develop cardiovascular disease

HDL

- a good cholesterol because it clears the excess LDL in the arteries

- the higher, the better the health of the individual

total cholesterol

the sum total of all cholesterol (LDL, HDL, and other cholesterol) at a given time

Normal BP

Prehypertension

120-139/80-89

Stage 1 Hypertension

140-159/90-99

Stage 2 Hypertension

160-179/100-109

Stage 3 Hypertension

≥ 180/110

Cancer

- One of the most common causes of death worldwide

- WHO (2010) over 12M people are diagnosed every year

- In the Philippines, 50,000 cases have been recorded and estimated to increase to 5% every year;

Breast Cancer

- 16% of the recorded deaths are due to this

- leading cancer killer in both men and women (15%) in 2010 and ranked 1st among women (28%)

- leading site in males (22%) and 3rd leading site among women (6%)

Cancer

- malignant neoplasm

- a group of various disease involving unregulated cell growth

- cells divide, grow uncontrollably forming malignant tumors, and invade parts of the body

Carcinogens

Substances that can cause some cells to undergo genetic mutations

Cancer

lifestyle-related factors:

- cigarette smoking

- alcohol drinking

- unhealthy diet

- physical inactivity

- overweight/obesity

Cancer

Screening:

- Involves early detection of the warning signals

- CAUTION US Developed by American Cancer Society

CAUTION US

Change in bowel or bladder habits.

A sore that does not heal.

Unusual bleeding or discharge.

Thickening or lump in the breast or elsewhere.

Indigestion and difficulty in swallowing

Obvious change in wart or mole.

Nagging cough or hoarseness in voice.

Unexplained anemia

Sudden weight loss.

Chronic Obstructive Pulmonary Disorder (COPD)

- a disease of the lungs in which the airways narrow over time

- includes bronchitis, chronic asthma, and emphysema

- estimated that 7% of deaths worldwide are due to this

Smoking

- a strong risk factor for COPD

- 15% develop COPD

- secondhand and pollution aggravate the problem

Chronic Obstructive Pulmonary Disorder (COPD)

Characteristic symptoms:

- cough

- sputum production

- dyspnea/SOB upon exertion

*Chronic cough and sputum production often precede the development of airflow limitation by many years

Spirometry

done to determine degree of obstruction (through spirometry the client can be categorized as having restrictive, obstructive or mixed pattern of ventilatory effect

Spirometry

- values vary with age, height, sex and race

- Filipino spirometric values are lower than Caucasian

Diabetes Mellitus

a group of metabolic disease in which an individual has high blood sugar because the pancreas does not produce enough insulin or the cells do not respond to the insulin produced

Insulin

a hormone that regulates blood sugar

hyperglycemia/high blood sugar

the common effect of diabetes

Diabetes Mellitus

- Prevalence of high FBS among adults in 2008 was 4.8%

- Mortality rate has increased significantly to 18.1 deaths per 100,000 population

- Experts predict the number of cases to increase by 2025

Diabetes Mellitus

Signs and Symptoms:

- Polyuria

- Polydipsia

- Polyphagia

- Weight loss

- Vision changes

- Fatigue

Diabetes Mellitus

complications:

- neuropathies

- amputations

- dental disease

- heart disease

Diabetes Mellitus

lifestyle-related factors:

- overweight

- obesity

Diabetes Mellitus Screening

Current WHO guidelines for the diagnosis of diabetes are:

- FASTING BLOOD SUGAR (FBS) > 7.0 mmol/I (126 mg/dl)

- 2-hour BLOOD SUGAR TEST of > 11.1 mmol/I (200 mg/dl)

- These test predict the risk for premature mortality

Risk Factors for NCDs

- Physical Inactivity

- Cigarette Smoking

- Unhealthy Eating

- Excessive Alcohol Drinking

- Viruses

- Radiation

Physical Inactivity

defined as less than 5 times of 30 minutes of moderate activity per week or less than 3 times of 20 minutes of vigorous activity per week or equivalent

Physical Inactivity

considered to be one of the most important public health problems in the 21st century

Physical Activity

the key determinant of energy expenditure and is thus fundamental to energy balance and weight control

Physical Activity

improves endothelial function that enhances vasodilation and vasomotor function in the blood vessels

Physical Activity

contributed to:

- weight loss

- glycemic control

- improved blood pressure

- lipid profile

- insulin sensitivity

Physical Inactivity

- attributed to an estimated 2M deaths

- a global health crisis

- 60% of world's population

- risk of getting a cardiovascular disease increases by 1.5 times

Cigarette Smoking

- a primary risk factor for the development of NCDs

- attributed to 6-8% or an average of 87,600 of mortality in the Philippines

- damages the lining of blood vessels and reduces HDL cholesterol and oxygen in the blood

Cigarette Smoking

- its chemicals are known to cause cancer

- causes cancer of the lung, mouth, pharynx, larynx and esophagus

Unhealthy Eating

- obesogenic

- one of the major risk factors responsible for the global increase of cardiovascular disease, cancer, diabetes, and obesity worldwide

Unhealthy Eating

high dietary intakes of saturated fat, trans-fat, cholesterol, and salt and low intakes of fruits and vegetables and fish are linked to overweight and obesity

Unhealthy Eating

- adverse metabolic effects on blood pressure, cholesterol, triglycerides and insulin resistance

- food and nutrition environments are believed to be major contributors to obesity

Excessive Alcohol Drinking

may lead to metabolic and physiological effects on all organs such as gastrointestinal and cardiovascular disturbances

Excessive Alcohol Drinking

- may cause malabsorption, inflammation of the gastrointestinal tract, liver problems and cancer

- associated with colon and rectal cancer

Excessive Alcohol Drinking

has also been linked to the development of cancers of the breast, liver, esophagus, mouth and larynx and cardiovascular disturbances include cardiac dysrhythmias, cardiomyopathy, hypertension, and atherosclerosis

Excessive Alcohol Drinking

- has also been shown in several large cohort studies to predict diabetes incidence by increasing the glucose levels in the blood

- an average of 4.8 liters of alcohol is consumed by every Filipino

Excessive Alcohol Drinking

the 2010 midline survey for the National Objectives of Health showed that the highest prevalence of alcohol intake was among adults and adolescents with 42.8% and 31.3 %

Excessive Alcohol Drinking

- data revealed that 1/3 of all household members are alcoholic beverage

- As of 2007, WHO reports that 17% of Filipino adolescents have been drunk at least once

- the risk factors of acquiring NCD is a growing concern to all age groups

Viruses

- plays a role in the development of certain cancers

- causes mutation by breaking the normal cell's DNA chain during infection

-

Human Papillomavirus

virus that is linked with cervical and vulvar cancer

Epstein-Barr virus

virus that is associated with nasopharyngeal and anal cancer

HTLV-1 (Human t-lymphocytic virus)

virus that is linked with non-Hodgkin lymphoma

HBV and HCV (Hep B and Hep C virus)

the most common liver cancer in the Philippines

oncoviruses

viruses that are capable of causing cancer

ionizing radiation

- causes tissue and cell damage by breaking the DNA molecule

- includes X-ray, gamma rays, and particulate radiation from nuclear accidents, occupational exposure and treatments

Radiation

- the energy emitted and transferred through matter and space

- risk for developing cancer depends on the type, amount and length of exposure, but evidence suggests that the risks tend to be cumulative