THE THIRD MEETING OF THE GLOBAL FORUM ON NCD PREVENTION AND CONTROL, Rio de Janeiro, Brazil, 912 Nov

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THE THIRD MEETING OF THE GLOBAL FORUM ON NCD
PREVENTION AND CONTROL, Rio de Janeiro, Brazil,
9-12 November

• Dr OUSSAMA KHATIB
• MRCP, MD, PhD
• RA/NCD

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NONCOMMUNICABLE DISEASESEMRO REGIONAL SITUATION

• CVD IS THE LEADING CAUSE OF EM MORBIDITY AND
  MORTALITY AND IS RESPONSIBLE FOR ONE-IN-THREE
  DEATHS
• THE MAJORITY OF INDIVIDUALS WHO DEVELOP HEART
  ATTACK OR STROKES HAVE ONE OR MORE NCDs RISK
  FACTORS
• HYPERTENSION
• DIABETES
• SMOKING
• HIGH BLOOD LIPIDS OR
• PHYSICAL INACTIVITY

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Deaths, by broad cause group and WHO Region, 2000

Noncommunicable conditions
75
Injuries
Communicable diseases, maternal and perinatal
conditions and nutritional deficiencies
50
25
AFR
EMR
EUR
SEAR
WPR
AMR
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CAN WE PREVENT NON- COMMUNICABLE DISEASE

• A CHALLENGING DEMAND

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POSITIVE REASONS

• DECREASE INCIDENCE OF INFECTOUS DISEASES
• IMPROVEMENT OF SANITATON
• FAMILY PLANNING PROGRAMMES
• NUTRITION STATUS
• MAJORITY EM COUNTRIES HAD A SIGNIFICANT
  IMPROVEMENT

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NEGATIVE REASONS

• ADOPTION OF WESTERN LIFESTYLE
• PHYSICAL INACTIVITY
• INCREASE NCD RISK FACTORS SUCH AS
• HYPERTENSION
• DIABETES
• HYPERCHOLESTEROLAEMIA
• CIGARETTE SMOKING

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• Strong Negative Reason
• Disease burden has changed towards chronic
  conditions world wide.
• Health systems havent

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Within EMR-Health Services Chronic conditions
require an evolution of health care from an acute
model towards a coordinated, comprehensive system
of care
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No longer is each chronic illness diabetes,
cardiovascular, cancer, arthritis, etc., being
considered in isolation. Awareness is increasing
that similar strategies can be equally effective
in treating many different conditions.EMAN IS
AIMING FOR COMPREHENSIVE INTEGRATED APPROACH
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DIABETES LINKING PROCESS

• IN OUR REGION, 85-90 OF TYPE 2 DIABETES ARE
  OVER-WEIGHT OR OBESE
• 50 OF Type 2 DM ARE HYPERTENSIVE HAD OTHER
  FORMS OF CVD
• 50 HYPERLIPIDAEMIA
• 50 SMOKERS
• 90 EAT UNHEALTHY FOOD, WITH 1000 KCAL EXTRA
  CONSUMPTION
• 50 CHRONIC COMPLICATIONS NEPHROPATHY,
  NEUROPATHY RETINOPATHY
• 85 OF DIABETIC PATIENTS ARE PHYSICALLY INACTIVE

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DIABETES HYPERTENSION,CVD, NEPHROPATY,
NEUROPATHY, RETINOPATHY, ALL NCD RISK FACTORS

• DEVELOPMENT OF STANDARDS OF CARE, GUIDELINES FOR
  PRIMARY PREVENTION, SCREENING, EARLY DETECTION
  AND MANAGEMENT
• PRIMARY PREVENTION AT PHC
• COMMUNITY-BASED PROGRAMMES ARE NEEDED TO BE
  DEVELOPED AND SUPPORTED
• ? LINKING ..

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PRIMARY PREVENTION

• IS THE BEST APPROACH FOR NCD
• AFFORDABLE
• EUROPE, AMERICAS, SECONDARY PREVENTION IS NOW
  WITH PHC
• POLICY-MAKERS NEED TO BE ORIENTED FOR ADOPTING
  NATIONAL PRIMARY PREVETION ACTIONS.

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PRIMARY PREVENTION

• IS A KEY STRATEGY APPROACH TO NCDS
• ONE THIRD OF ALL CANCERS CAN BE AVOIDED BY MODEST
  CHANGES IN DIET AND PA
• MAJORITY OF CANCERS CAN BE PREVENTED BY CONTROL
  OF RISK-FACTORS
• MAJORITY OF CHRONIC RESPIRATORY DISEASES AND
  DEATH FROM CANCER AND HEART CONDITIONS IS DRIVEN
  BY TOBACCO USE.
• 5 OF CANCERS ARE THOUGHT TO BE INHERITED, MANY
  ARE CURABLE WHEN DIAGNOSED AND TREATED EARLY

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NEGLECTING NCD NCDs RISK FACTORS

• IS
• UNAFFORDABLE

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WHERE ARE WE
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PROBLEMS

• LACK OF HARMONIZATION OF MONITORING AND
  SURVEILLANCE METHODOLOGIES

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• Lack of
• Mortality Data
• Training for Professionals and Para-medicals on
  NCD Prevention and Control
• Adequate Information on Health Care Services
  Management for Major NCDs
• Work on assessing the cost-effectiveness of the
  various interventions

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STEPWISE SURVEILLANCE SYSTEM

• CONSULTATIVE MEETING FOR GULF, LEBANON, JORDAN,
  IRAN
• 5-7 JULY 2002
• WORKSHOP ON WHO-STEPWISE/SURVEILLANCE SYSTEM
  DAMSCUS, SYRIA, 25-29 AUGEST 2002
• WORK SHOP ON STEPWISE SURVEILLANCE SYSTEM FOR
  MOROCCON COUNTRIES 17-19 AUGUST 2003
• WORKSHOP ON STEPWISE/SURVEILLANCE
• FOR EGYPT, SUDAN YEMEN 7-9 SEPTEMBER 2003

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STEPWISE NCD RISK FACTORS SURVEILLANCE

• SUFFICENT DATA FROM GULF,
• STARTED IN SYRIA, LEBANON, WILL BE STARTED IN
  BAHRAIN, KUWAIT, MOROCCO, SAUDI ARABIA TUNISIA

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The WHO STEPS approach
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RISKFACTORS

• EM COUNTRIES NEED TO BE ENCOURAGED FOR RISKFACTOR
  ANALYSIS FOR
• ASSESSING
• TREATABLE INTERVENTIONS

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THE ROLE OF REGIONAL OFFICE/EMAN

• SUPPORTED AND WILL CONTINUE SUPPORTING THE
  DEVELOPMENT OF CLINICAL GUIDELINES FOR COST
  EFFECTIVE SCREENING, EARLY DETECTION, PRIMARY
  PREVENTION MANAGEMENT. (HYPERTENSION, CANCER
  DIABETES)

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EMAN PRIMARY PREVENTION

• FOR PROPER MANAGEMENT OF CVD INDIVIDUALS NEEDS TO
  DETECT HYPERTENSION THROUGH
• OPPORTUNISTIC SCREENING
• COULD BE ADOPTED FOR USE WITH DIABETES SMOKING
  AS ENTRY POINTS

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2002-2003 RO EMAN HAD FOUR NCD CONSULTATION
MEETINGS WITH FIVE PUBLICATIONS

• EMAN GUIDELINE, AND PROTOCOL,NOVEMBER, 2003
• 2 REGIONAL GUIDELINES ON BREAST CANCER DETECTION
  MANAGEMENT JULY AND DECEMBER 2003
• TWO REGIONAL GUIDELINES ON DIBETES MANAGEMENT AND
  EDUCATION DECEMBER 2003

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National capacity for NCD prevention and care
WHAT EM Countries lack, WHAT EMAN NEEDS TO WORK

• Few clear policies and strategies
• Limited resources
• Fragmented and uncoordinated care
• Low commitment to Primary prevention
• Low commitment to screening early detection
• Lack of surveillance systems
• Inadequate treatment guidelines
• PHC capacity to deal with NCDs is poor
• Severe lack of investment in NCDs research

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• EMAN CHALLENGING ISSUES
• Disease burden has changed towards chronic
  conditions world wide. The health system hasnt.
  More training at PHC for medicals and
  paramedicals
• Prevention and health promotion are still ignored
  in health systems. Primary prevention for NCD
  meeting mid 2004
• Current health systems are designed to provide
  episodic, acute health care. A combined NCD and
  Community-Based Initiatives Consultation March
  2004
• Chronic conditions will manifest at primary
  health care and will need to be dealt with at
  this level.
• EMAN FIELD ACTIVITIES DEMONSTRATION AREAS

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EASTERN MEDITTERANEAN APPROACH TO
NONCOMMUNICABLE DISEASES EMAN

• IMPROVE THE HEALTH OF EM COMMUNITY BY REDUCING
  MORTALITY AND MORBIDITY FROM MAJOR NCD THROUGH
  INTEGRATED COMPREHENSIVE AND COLLABORATIVE
  COMMUNITY-BASED PROGRAMMES

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EMRO WHO

• COLLABORTING CENTERS
• 2003

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NCD/EMRO/WHO COLLABORATING CENTRS

• ISFAHAN CARDIOVASCULAR CENTRE FOR CVD PREVENTION
  CARE, 2003,
• IT WILL BE AN ACTIVE CVD CENTRE FOR TRAINING
  MEDICAL PARA-MEDICALS AT NATIONAL REGIONAL
  LEVEL
• OCTOBER 2003 TRAINING COURSE WAS ONE OF MOST
  SUCCESSFUL REGIONAL TRAINING COURSES

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SHAHEED CENTRE FOR ENDOCRINE METABOLISM
RESEARCH, 2003

• NATIONAL REGIONAL CENTRE FOR
• DIABETES
• LIPIDS
• CENTRE FOR TRAINING SETTING GOALS FOR DIABETES
  PRIMARY PREVENTION CARE

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KING FAISAL AND RESEARCH CENTRE FOR CANCER
PREVENTION CARE

• WHO COLLABORATING CENTRE 2003
• WILL BE A NATIONAL REGIONAL FOR SETTING
  STANDARDS FOR PRIMARY PREVENTION, EARLY SCREENING
  DETECTION OF MOST COMMON CANCERS
• PALLIATIVE CARE PAIN RELIEF
• REGIONAL TRAINING CENTRE FOR MEDICALS
  PARA-MEDICALS
• ABOE CENTRE IS SHARING IN FINALIZING TWO REGIONAL
  GUIDELINES ON BREAST SCREENING AND MANAGEMEN

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EMAN/NCD DEMONSTRATION AREAS

• KUWAIT FOR DIABETES PREVENTION CARE
• BAHRAIN FOR CANCER PREVENTION CARE

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Key messages on chronic conditions

• no nation is immune to the rising burden of
  chronic conditions.
• if not addressed, they will become the most
  expensive problem faced by our health care
  systems.
• their burden can be dramatically reduced but ONLY
  if governments and health care leaders decide to
  do so.

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RO HAD ESTABLISHED NCD EMAN EMRO WEBSITE

• NATIONAL REGIONAL DATA ON NCD NCD RISK
  FACTORS
• EMAN AND ACTIVITIES
• NATIONAL REGIONAL REVIEWS, PAPERS ABSTRACTS
  ABOUT NCD NCD RISK FACTORS
• PUBLICATIONS
• STEPWISE SURVEILLANCE SYSTEM

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www.emro.who.int/ncd/
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THANK YOU
Dr. OUSSAMA KHATIB MD, PhD, RA/NCD