Download Definition Hypertension is high blood pressure. Blood pressure is

Non-communicable diseases
(NCDs)
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Non-communicable diseases (NCDs)
 Is a disease which is not infectious. Such diseases may result from
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genetic or lifestyle factors.
A non-communicable disease is an illness that is caused by something
other than a pathogen.
It might result from hereditary factors, improper diet, smoking, or
other factors. Those resulting from lifestyle factors are sometimes
called diseases of affluence.
Examples include hypertension, diabetes, cardiovascular disease,
cancer, and mental health problems, asthma, atherosclerosis, allergy
etc.
The non-communicable diseases are spread by: heredity, surroundings
and behavior.
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 The risks of high blood pressure and high blood cholesterol,
tobacco and alcohol consumption, obesity and physical inactivity
were more commonly associated with affluent societies.
 Warning: becoming dominant in all middle and low income
countries and not limited to the effluent countries.
 NCDs, is responsible for almost 60% of world deaths (31.7 million
deaths) and 43% of the global burden of diseases.
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 This increase is clearly related to changes in global dietary
patterns and increased consumption of industrially processed
fatty, salty and sugary foods.
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NCDs Situation in Palestine:
NCDs are the leading cause of death among adult
population in the Palestinian society, contribute
to more than 50% of causes of death among adults
common Risk factors to NCDs in Palestinian
population.
 Tobacco consumption is among the highest in the
world.
 Diet rich in saturated fat, and in simple sugars,
with the decreased consumption of fibers and
whole grain foods has lead to the increased
prevalence of these illnesses.
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Health services today will not be able to meet the
challenges of (NCDs) In Palestine
 Weak national data is available on the overall incidence and
prevalence of NCDs.
 In general we depend on mortality data to estimate the impacts of
these diseases.
 No classification by age or gender. No any information on disabilities
resulting from any of the chronic diseases
 The current system counts mainly the visits of the patients to PHC
centers, which does not reflect the real prevalence and incidence.
 Fragmentation in reporting and managing system regarding NCDs in
general.
This lack of information leads to:
- Inability to estimate the cost; resources required e.g. drugs, policy; and
decision making regarding prevention and treatment
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Some Continuing Challenges
 Lack of national policies for NCD prevention and
control
 Low resources for NCD prevention & control.
 Lack of NCD surveillance systems
 Fragmented and uncoordinated care
 PHC capacity to deal with NCDs is poor
…
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NCD CHALLENGES
Cost Pressures
Disease burden,
interventions, drugs
CHANGES NEEDED
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Quality of Care
Care teams, medical records,
& financial incentives
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Information flows
Continuity
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Organized Care
Communication
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With policy/legislation
support
Coordination
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Prevention
Fragmentation, lack of
protocols, lack of financial
incentives/support
Poverty
Comprehensiveness
Orient. on self management
Community linkages
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How to strengthen health
systems for NCDs?
 Financing (increased, better and sustained
 Regulation (assured quality and affordability)
 Service Delivery (ensured access and
availability)
 Governance (improved performance)
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Obesity
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 Obesity is a condition in which people have an excess of
body fat.
 According to the National Institutes of Health, almost
one-third of Americans are obese.
 Obesity is growing problem across the globe.
 Worldwide, more than 300 million adults are obese,
according to (WHO).
 Obesity is the second-leading cause of preventable death
in the U.S, surpassed only by smoking. At least 300,000
Americans die each year as a result of factors attributed to
obesity, American Obesity Association
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Obesity is a major risk factor for a number
of serious health conditions, including:
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Coronary heart disease.
Cancer.
Diabetes.
Fatty liver disease.
Gallbladder disease.
High blood pressure..
Osteoarthritis.
Stroke.
Sleep apnea and other breathing problems.
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Classification
Obesity, in absolute terms, is an increase of
body adipose tissue (fat tissue) mass.
BMI
Body mass index or BMI is a simple and
widely used method for estimating body
fat mass.
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 BMI is an accurate reflection of body fat
percentage in the majority of the adult
population. It is less accurate in people such as
body builders and pregnant women in whom body
composition is affected.
 BMI is calculated by dividing the subject's weight
by the square of his or her height:
BMI = kg / m2
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BMI
Classification
Less than 18.5
underweight
18.5–24.9
normal weight
25.0–29.9 is
overweight
30.0–34.9 is
class I obesity
35.0–39.9
class II obesity
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Questions ??
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The literature breaks down "class III" obesity into further categories:
 Any BMI > 40 is severe obesity
 A BMI of 40.0–49.9 is morbid obesity
 A BMI of >50 is super obese
Finish
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Cancer
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Cancer
 medical term: (malignant neoplasm) is
a class of diseases in which a group of
cells display uncontrolled growth,
invasion and sometimes metastasis
(spread to other locations in the body
via lymph or blood) .
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 Cancer may affect people at all ages, even fetuses, but
the risk for most varieties increases with age.
 Cancer causes about 13% of all deaths.
 According to the American Cancer Society, 7.6
million people died from cancer in the world during
2007.
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2006 Estimated US Cancer Deaths* (last)
Lung & bronchus
31%
Colon & rectum
10%
Men
Women
Lung & bronchus
26%
Breast
15%
Prostate
9%
Colon & rectum
10%
Pancreas
6%
Pancreas
6%
Leukemia
4%
Ovary
6%
Liver & intrahepatic
bile duct
4%
Leukemia
4%
3%
Esophagus
4%
Non-Hodgkin
lymphoma
Uterine corpus
3%
Multiple myeloma
2%
Non-Hodgkin
lymphoma
3%
Urinary bladder
3%
Kidney
3%
All other sites
Brain/ONS
2%
All other sites
23%
23%
ONS=Other nervous system.
Source: American Cancer Society, 2006.
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Cardiovascular Disease
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Introduction
Non communicable disease account for a
large and increasing burden of disease
worldwide. It is currently estimated that
non communicable disease accounts for
approximately 59% of global deaths and
43% of global disease burden. This is
projected to increase to 73% of deaths and
60% of disease burden by 2020.
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Introduction, cont.
The worldwide burden of cardiovascular disease is
substantial. In most industrialized countries,
cardiovascular disease are the leading cause of
disability and death. Developing countries, with
previous low rate are now seeing increased rates as
economic develop, infectious disease are controlled
and life expectancy improves.
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Definition
Cardiovascular disease refers to the class of
diseases that involve the heart or blood
vessels (arteries and veins). While the term
technically refers to any disease that affects
the cardiovascular system, it is usually used
to refer to those related to atherosclerosis
(arterial disease).
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CVD are present in many forms and have
different categories and include: Hypertension (high blood pressure)
 Coronary heart disease (heart attack)
 Cerebrovascular disease (stroke)
 Peripheral vascular disease
 Heart failure
 Rheumatic heart disease
 Congenital heart disease
 Cardiomyopathies
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Risk factors for cardiovascular
disease
 Non-modifiable Risk Factors
 Age
 Gender, men under the age 64 are much more likely to die of
coronary heart disease than women, although anyone can die
from it.
 Genetic factors/Family history of cardiovascular disease.
 Race (or ethnicity), Studies show that blacks are twice as likely
to develop high blood pressure as Caucasians.
 Environment, your chances can increase because of areas with a
lot of smog or other form of air pollution, including passive
smoking
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Risk factors, cont.
 Modifiable Risk Factors
cigarette smoking, high cholesterol and high blood
Pressure, lack of exercise, diabetes, obesity, alcohol,
certain infections and inflammation, estrogens,
androgens, and certain psychosocial factors.
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Risk factors for CVD in Palestine
 There is little published information on the cardiovascular
disease risk factors of Palestinian population.
 A study done to identify the most common coronary heart
disease risk factors among adult population in Gaza Strip to
develop preventive health education and health promotion
programs
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This study showed that the most common
identified CHD risk factors were physical
inactivity 53%, hypertension and obesity 43%
for each, family history 38%, diabetes mellitus
34%, high LDL 34%, elevated cholesterol level
33%, smoking 29%, low HDL 27%,
hyperuricemia 25%, and elevated triglycerides
level 14%
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 The result of previous study seems to be that
most of the identified CHD risk factors could be
preventable.
 These results may highlight the problem as a
public in nature that need community-based
intervention programs integrated to health
education programs.
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Global Burden of Cardiovascular
Disease
Cardiovascular disease is the number one cause of
death globally and is projected to remain the leading
cause of death.
An estimated 17.5 million people died from
cardiovascular disease in 2005, representing 30 % of all
global deaths.
Of these deaths, 7.6 million were due to heart attacks
and 5.7 million were due to stroke.
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Statistics, cont
Around 80% of these deaths occurred in low and
middle income countries .
If appropriate action is not taken, by 2015, an
estimated 20 million people will die from
cardiovascular disease every year, mainly from heart
attacks and strokes. (WHO, 2005)
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Cardiovascular disease in
Palestine
Cardiovascular disease (CVDs), principally heart diseases
is the first leading cause of death among population in
Palestine in the year 2005 exactly as it is in the whole
world.
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There are no available data to suggest the
overall
prevalence
or
incidence
of
cardiovascular disease and hypertension, we
depend on mortality data from the different
health centers to estimate the impact of theses
diseases on society.
finish
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Diabetes Mellitus
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Definition of DM
Diabetes is a chronic disease that occurs when the
pancreas does not produce enough insulin, or
alternatively, when the body cannot effectively use the
insulin it produces. Insulin is a hormone that regulates
blood sugar
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Glucose Tolerance Categories
2-hr PG on OGTT
FPG
mg/dL
126
100 and <126
<100
mg/dL
Diabetes Mellitus
Prediabetes
Glucose
Normal
200
Diabetes Mellitus
140 and <200
Prediabetes
Tolerance
<140
Normal
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care.
2002;25(suppl):S5
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Etiologic Classification of Diabetes
Mellitus
Type 1
b-cell destruction with lack of
insulin
Type 2
Insulin resistance with insulin
deficiency
Other specific types
exocrine Genetic defects in b-cell
pancreas diseases drug- or chemical
induced, and other rare
forms
Gestational
Insulin resistance with b-cell
dysfunction
Adapted from The Expert Committee on the Diagnosis and Classification of
Diabetes Mellitus. Diabetes Care. 1997;20:1183-1197.
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Complications of Diabetes
Macrovascular
Brain
Cerebrovascular disease
• Transient ischemic
attack
• Cerebrovascular
accident
• Cognitive impairment
Heart
Coronary artery disease
• Coronary syndrome
• Myocardial infarction
• Congestive heart
failure
Extremities
Peripheral vascular
disease
• Ulceration
• Gangrene
• Amputation
Microvascular
Eye
Retinopathy
Cataracts
Glaucoma
Kidney
Nephropathy
• Microalbuminuria
• Gross albuminuria
• Kidney failure
Nerves
Neuropathy
• Peripheral
• Autonomic
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 "Diabetes is a major threat to global public health that
is rapidly getting worse, and the biggest impact is on
adults of working age in developing countries. At least
171 million people worldwide have diabetes. This
figure is likely to more than double by 2030 to reach
366 million."
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GLOBAL PROJECTIONS FOR THE
DIABETES EPIDEMIC: 2003-2030 (millions)
World
2003 = 194 million
2030 = 366 million
Increase 75%
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Epidemiology
 Diabetes is in the top 10 and perhaps the top
5 of the most significant diseases in the
developed world.
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Prevalence of DM in Palestine
 The prevalence of DM in Palestine is about 9% in 2005. It is
around the reported prevalence rate in Egypt and Tunisia (9%)
and less than in Saudi Arabia (12%) and Oman (13%).
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 The gap between the expected prevalence rates of DM
and cases under supervision reflects under registration
and underreporting and also requires special efforts to
accelerate early case finding activities in order to avoid
high cost of treating the complications and disability
consequences of the disease .
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Major risk factors
 Family history
 Obesity
 Age (older than 45)
 History of gestational diabetes
 High cholesterol
 Hypertension
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Prevention of effects combination
approach
 Increased exercise
Decreases need for insulin
 Reduce calorie intake
Improves insulin sensitivity
 Weight reduction
Improves insulin action
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Triad of Treatment
 Diet
 Medication
 Oral hypoglycemics
 Insulins
 Exercise
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Diet
 Lower calorie
 Fewer foods of “high glycemic index”
 Spread meals evenly
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Diabetic Meal Plan Using the Food
Guide Pyramid
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Anti-Diabetic medications
 Oral hypoglycemic agents
 Insulin
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Thanks …
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