AN OVERVIEW
Chona G. Dazon, BSN, RN
SITUATIONER
Globally NCDs/Chronic Diseases accounts for:
2005
60% of deaths = 35,000,000 80% of deaths in low and middle income countries 48% of disease burden (DALY)
2020
73% of deaths 60% of disease burden
Global goal: 2% decrease in mortality rate each year
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NCD Situationer: Global
The Philippines is one of the 23 selected countries contributing to around 80% of the total mortality burden attributable to chronic diseases in developing countries, and 50% of the total disease burden caused by non-communicable diseases worldwide.
MORTALITY Ten Leading Causes of Mortality by Sex Number, Rate/100,000 Population & Percentage Philippines,
Cause Male Female Number 1. Heart Diseases 2. Vascular System Diseases 3. Malignant Neoplasm 4. Accidents 5.Pneumonia 6. Tuberculosis, all forms 7. Symptoms, signs and abnormal clinical, laboratory findings, NEC 8. Chronic lower respiratory diseases 38,677 29,054 20,634 27,720 15,831 18,367 10,740 12,998 29,019 22,814 18,664 6,246 16,224 8,404 10,623 5,907 67,696 51,868 39,298 33,966 32,055 26,771 21,363 18,905 Both Sexes Rate 83.5 64.0 48.5 41.9 39.5 33.0 26.3 23.3 Percent* 17.1 13.1 9.9 8.6 8.1 6.8 5.4 4.8
9. Diabetes Mellitus
10. Certain conditions originating in the perinatal period Source: The 2003 Philippine Health Statistics * percent share from total deaths, all causes, Philippines Last Update: January 11, 2007
6,823
8,397
7,373
5,725
14,196
14,122
17.5
17.4
3.6
3.6
RISK FACTORS
90% of Filipinos has one or more of these 6 prevalent risk factors (NNHeS, FNRI 2003)
Physical inactivity60.5% Smoking.34..8% Hypertension.22.5% (SBP>140 or DBP>90) Hypercholesterolemia ..8.5% (TC>240) Obesity4.9% (BMI>30) Diabetes..4.6%
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2.5
Trends in overweight among children 0-10 years old
0-5 2 6-10
2
1.6
Percent
1.5
1
1.4
1.3
1
0.6 0.4 0
0.8 0.4
0.5
0.4 0
0 1993 1996
1998
Year
2001
2003
2005
Trends in overweight among adolescents
7
5.8
11-12 13-19
6 5
4.2 3.4 3.1 2.2 2.5 2.5 4.4
Percent
4 3 2 1 0 1993
1998 Year
2003
2005
Integrated NCD Prevention and Control Program
Vision: Improved quality of life for all Filipinos Mission: To ensure that quality prevention and control
NCD services are accessible to all, especially to the vulnerable and at-risk population.
Goal: To reduce mortality and morbidity due to NCDs
Integrated NCD Prevention and Control Program
Objectives:
To reduce the exposure of population to risks related to NCDs primarily smoking, unhealthy diet, physical inactivity. To increase the proportion of NCD cases given appropriate treatment and care
Policy Thrusts
1.
2.
3.
Adoption of an integrated, comprehensive and community-based response to NCD prevention and control; Strengthening health promotion to effect changes that lead to significant reduction in mortality and morbidity due to NCDs; Fostering complementary accountabilities in the implementation of the program.
Adoption of an integrated, comprehensive and community based response to NCD prevention and control:
Focuses on common risk factors cutting across specific diseases guided by a life course perspective; Encompasses the three levels of disease prevention: primary, secondary and tertiary level Emphasizes strategies which would benefit entire population or large packets of population Integrates across settings; such as health centers, schools, workplaces and communities Makes explicit links to other government programmes, community based organizations Emphasizes intersectoral action
Health Status Targets
Reduction of mortality from lifestyle-related diseases: Heart diseases (from 79.1/100,000) Vascular diseases (from 63.2/100,000) COPD (20.8/100,000) Diabetes mellitus (from 14.1/100,000) Malignant neoplasm all form (from 47.7/100,000)
STRATEGIES
I. Governance Review of policies and issuance relevant policies (includes AO for an integrated NCD strategy Integration of NCD indicators in the Sentrong Sigla Phase II Strengthening research Best practices and initiatives Development of insurance benefit packages for NCDs Building partnerships and coalitions Strengthening the NCD Coalition Strengthening collaboration with DepEd and other partners Enhancing collaboration with the private sector
STRATEGIES
I. Governance
Enhancing capacity of health sector and partners
Provision of training and fellowship opportunities Integration of HL in nursing., midwifery, and other health-related courses Manual of operations for establishing and sustaining community-based NCD initiatives Management guidelines (CPGs) for hypertension, diabetes, and other NCDs
Development of tools for implementation
STRATEGIES
I.
Governance (Surveillance)
Support to regular population-based surveys on NCDs and risk factors (includes NNHeS, GYTS, GHHS) Support to registries for NCDs; Expansion to LVM and other diseases Strengthening analysis, utilization, and dissemination of surveillance data
STRATEGIES
II. Service Delivery (Health Promotion) Mag HL Tayo Campaign
Enhancing awareness on healthy lifestyle and prevention and control of NCDs
Continuing advocacy work for support to HL initiatives Publication and dissemination of accomplishments and best practices
STRATEGIES
II. Service Delivery (Clinical Prevention) Provision of minimum package of services: Primary level of care: Risk factor assessment; HL modification measures; Basic treatment; Referral and follow-up Secondary level of care: Primary level services plus diagnostic procedures; non-specialized treatment and care Tertiary level of care: advanced diagnosis; specialized treatment; rehabilitation; and palliative care
STRATEGIES
II. Service Delivery (Clinical Prevention) Development of consensus management guidelines for hypertension, diabetes, and other NCDs Strengthening networking and referral system at various levels of the health system
STRATEGIES
IV. Regulation
Enhancing access to quality affordable medicines
Continuous availability of affordable medicines at the Botica sa Barangay/ Botica ng Bayan
Enhancing implementation of RA 9211 (Tobacco Regulatory Law)
Food labeling/Food bill
STRATEGIES
IV. Financing
Ensuring sustainability mechanisms
Advocacy for increased LGU budget Establish health promotion foundation
Enhancing coverage of social health insurance for NCDs
SITUATIONER
4 major NCDs: CVDs, CA, COPDs, DM Linked by common preventable risk factors
Tobacco
use Unhealthy diet Physical inactivity
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Factors influencing NCD increasing trend:
Increased life expectancy- older persons, chronic diseases Increased urbanizationover population, poverty Environmental pollution Proliferation of conveniences resulting to poor nutrition & sedentary life Globalization increased trade in products like foodstuffs and tobacco products
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IMPACT OF LIFESTYLES
Diet changed Reduced level of activity Access to alcohol & tobacco Health care costs of treatment and rehab are also increased NEED* Direct public health EFFORTS to PREVENTION rather than CURE
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DID YOU KNOW THAT:
Obesity and being overweight increase the chance of developing high blood cholesterol and high blood pressure. Physical inactivity increases the risk of heart attack. Diabetes is an independent risk factor for CAD; this means that having diabetes even without other risk factors may lead to heart disease. That is because diabetes accelerates development of atherosclerosis.
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Key Areas for Prevention
PROMOTE REGULAR PHYSICAL ACTIVITY AND EXERCISE; exercise increases HDL, prevents obesity and improves optimum functioning of the heart. ENCOURAGE PROPER NUTRITION particularly by limiting intake of saturated fats that increase LDL, limiting salt intake and increasing intake of dietary fiber by eating more vegetables, fruits, unrefined cereals and wheat bread.
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Key Areas .. cont.
MAINTAIN BODY WEIGHT AND PREVENT OBESITY through proper nutrition and physical activity/exercise. ADVISE SMOKING CESSATION for active smokers and prevent exposure to second-hand smoke by family members, friends and coworkers of active smokers. In general, promote a smoke-free environment through advocacy and community mobilization.
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HEALTH PROMOTERS
Healthy Diet Physical Fitness Less Stress
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Approaches
Community based
People centered
Peoples right to participate in addressing their own health problems
Active community participation Involvement of community leaders Strong LGU / technical expert support Multi sectoral collaboration
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Strategies
Direction and Infrastructure
Enhancing LGU capability to develop and implement policies and programs
Community diagnosis/plans/financial resources/technical assistance from experts
Strengthen research capability
Risk factor surveillance
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Strategies
Changing Lifestyle
Raising awareness
Changing Environment
Development of policies Full community participation Integrating to other initiatives
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Lifestyle Change: Info, Education, Communication
Smoking and Alcohol
Marketing of non-smoking lifestyle (raise prices, ban ads) Marketing of responsible alcohol intake (stop recruiting young drinkers)
Promotion of Healthy Diet
varied in fruits and vegetables (major problem in Philippines) lower fat lower salt intake
Promotion of Physical Activity
Promote incidental movement Promote physical activity (Hataw and MagHL Tayo)
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Create Supportive Environments
Micro: Health-Promoting Settings
Health-Promoting Schools, Workplaces, Communities Promote healthy lifestyle through policies, pricing, services, participation
Macro Level: National Activity
Food and Nutrition Policy: secure and accessible supply of low fat, varied diet with fruits and vegetables
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Create Supportive Environments
Tobacco Control: effective control of price, smoke free public places, and marketing, support for Framework Convention on Tobacco Control Alcohol control: effective control of price, marketing and sales, drinking and driving Physical Activity:
provision of public transport, sidewalks, bicycle lanes, and safe places for physical activity (e.g. parks) in urban areas; provision of opportunities for sports and recreational exercise Sports For All not just elite sports
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Strategies
Reorienting health services
From cure to health promotion and wellness mode Developing human resource for prevention and control Strengthening prevention and control in primary health settings
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Engage in Healthy Lifestyle.
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