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... Crude Death Rate 6.6 7.0 Natural Growth Rate 14.4 14.5 Selected Health Statistics for Gujarat and India SRS Bulletin 2013. ... 4 20.0 Dyslipidemia 26.7 18 ... – PowerPoint PPT presentation

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Title: gk


1
Prevention and Control of NCDs Need for Reducing
major Risk Factors
K R Thankappan MD,MPH Professor and Head Achutha
Menon Centre for Health Science Studies Sree
Chitra Tirunal Institute for Medical Sciences
and Technology, Trivandrum, India Email
kavumpurathu_at_yahoo.com
2
Outline
  • Global Burden of Disease
  • NCD Risk Factors in Gujarat and India
  • Health Expenditure pattern
  • Challenges for prevention
  • Way forward
  • Conclusions

3
Top 10 Causes of Death in the World Ranked in
1990 and 2010
RANK Causes of Death Causes of Death
RANK 1990 2010
1 Ischemic heart disease Ischemic heart disease
2 Stroke Stroke
3 Lower respiratory infections COPD
4 COPD Lower respiratory infections
5 Diarrhea Lung cancer
6 Tuberculosis HIV/AIDS
7 Preterm birth complications Diarrhea
8 Lung cancer Road injury
9 Malaria Diabetes
10 Road injury Tuberculosis
Lozano et al , Lancet 20123802095-128
4
Years of life lost in the world (YLLs) ranked in
1990 and 2010
RANK DISORDER DISORDER
RANK 1990 2010
1 Lower respiratory infections Ischemic heart disease
2 Diarrhea Lower respiratory infections
3 Preterm birth complications Stroke
4 Ischemic heart disease Diarrhea
5 Stroke Malaria
6 Malaria HIV/AIDS
7 COPD Preterm birth complications
8 Proteinenergy malnutrition Road injury
9 Tuberculosis COPD
10 Neonatal encephalopathy Neonatal encephalopathy
Lozano et al , Lancet 20123802095-128
5
Disability adjusted life years lost due to 10
leading risk factors in 1990 2000
Rank 1990 2010
1 Childhood underweight High Blood Pressure
2 Household air pollution from solid fuels Tobacco smoking including SHS
3 Tobacco smoking including SHS Alcohol use
4 High Blood Pressure Household air pollution from solid fuels
5 Suboptimal breastfeeding Diet low in fruits
6 Alcohol use High Body Mass Index
7 Diet low in fruits High fasting plasma glucose
8 Ambient particulate matter pollution Childhood underweight
9 High fasting plasma glucose Ambient particulate matter pollution
10 Iron deficiency Physical inactivity and low physical activity
Lim SS et al . Lancet 20123802224-60
6
Selected Health Statistics for Gujarat and India
Indicators Gujarat India
Infant Mortality Rate 38 42
Crude Birth Rate 21.1 21.6
Crude Death Rate 6.6 7.0
Natural Growth Rate 14.4 14.5
SRS Bulletin 2013.
7
Current Tobacco Use Gujarat and India ( of
males aged 15 years and above)
Type of Tobacco Gujarat India
Any Tobacco Use 46.2 47.9
Smoking Only 14.8 15.0
Smokeless only 26.4 23.6
Both forms 05.0 09.3
GATS India 2009-10
8
Current Tobacco Use Gujarat and India ( of
females aged 15 years and above)
Type of Tobacco Gujarat India
Any Tobacco Use 11.3 20.3
Smoking Only 00.3 01.9
Smokeless only 09.8 17.3
Both forms 01.2 01.1
GATS India 2009-10
9
Alcohol Use Gujarat and selected States ( of
males and females 15-49 years)
States Males Females
Gujarat 16.0 0.8
Rajasthan 19.1 0.2
Jammu and Kashmir 12.5 0.0
Andhra Pradesh 47.2 6.8
Kerala 45.2 0.7
National Family Health Survey -3, 2005-06
10
Fruit Consumption Gujarat and selected States
( of males and females 15-49 years)
States Males Females
Gujarat 48.4 49.6
Rajasthan 31.0 22.9
Jammu and Kashmir 57.4 49.6
Andhra Pradesh 56.0 47.6
Kerala 79.6 65.7
National Family Health Survey -3, 2005-06
11
Overweight /Obese Gujarat selected States (
of males and females 15-49 years)
States Males Females
Gujarat 11.3 16.7
Rajasthan 06.2 08.9
Jammu and Kashmir 06.2 16.7
Punjab 22.2 29.9
Kerala 17.8 28.1
National Family Health Survey -3, 2005-06
12
Hypertension Prevalence in a District in
Gujarat (15-64 Years)
Hypertension () Urban Rural
Male 37.3 17.9
Female 27.3 19.9
Total 29.1 18.4
Bhagyalaxmi A, Atul T, Shikha J. 2013 3178-85
13
Risk factor prevalence among doctors in
Trivandrum City, Kerala
Risk factors Men (N86) Women (N60)
Overweight 55.8 40.0
Abdominal obesity 52.3 51.7
Diabetes 34.9 21.7
Hypertension 24.4 20.0
Dyslipidemia 26.7 18.3
Current tobacco use 18.6 0.0
Current Alcohol use 40.7 0.0
Patra L, Mini GK, Mathews E, Thankappan KR. Br J
Sports Med 2013 June 14.
14
Health Expenditure of Selected countries
Countries Health expenditure (as of GDP) Health expenditure (as of GDP) Health expenditure (as of GDP)
Countries Total Govt. by Govt.
India 6.1 1.3 21
China 5.8 2.0 34
Sri Lanka 3.7 1.8 49
US 14.6 6.6 45
UK 7.7 6.4 83
Canada 9.6 6.7 70
Source World Health Report 2005
15
Private Health Expenditure in Selected Indian
States 2004-05
States
Kerala 90.3
Gujarat 79.2
Rajasthan 75.6
Karnataka 71.9
India 78.0
Kumar AKS et al. Lancet 2011 377 668-79
16
Issues in Privatization of Health Care
  • High provider induced demand for procedures and
    drugs
  • One example is the increased proportion of
    cesarean sections
  • Difficult to quantify the magnitude of
    unnecessary care

17
Prevention is generally undervalued and
underused-1
  • The right knowledge is often not in the right
    hands
  • Visible Sick Patients rule of rescue
  • Irrational use of invasive procedure
  • Gains of prevention are illusive and often
    invisible

18
Prevention is generally undervalued and
underused-2
  • Powerful commercial interests obstruct policy
    change
  • Health professionals favor treatment
  • Media highlights new cures, obscure treatments

19
Comprehensive Framework for Cardiovascular and
Respiratory Health, Cancer and Diabetes Control
Macro-economic and environmental change
Behaviour change
Risk factor detection and control
Chronic care and rehabilitation
Acute care management
End-of-life care
Source WHO
20
Comprehensive Framework for Cardiovascular and
Respiratory Health, Cancer and Diabetes Control
Macro-economic and environmental change
Behaviour change
Risk factor detection and control
Chronic care and rehabilitation
Acute care management
End-of-life care
Source WHO
21
Way forward -1
  • Strong leadership by heads of state and
    governments needed to meet national commitments
    to the UN Political declaration on
    non-communicable diseases (NCD) and to achieve
    the goal of 25 reduction of premature NCD
    mortality by 2025
  • A simple, phased national response to the
    political declaration needs three steps
    planning, implementation and accountability.

22
Way forward -2
  • National accountability involves monitoring and
    reviewing progress and appropriate response to
    accelerate progress with appropriate
    institutional mechanisms.

23
Conclusions
  • Global burden of disease has shifted to chronic
    non-communicable diseases
  • NCD risk factors are high in Gujarat
  • In most developed countries except the US public
    sector provides most of the health care
  • In India and Gujarat private sector is the
    predominant health care provider
  • Prevention is the key
  • Strong leadership is required to meet national
    commitments to the UN political declaration on
    NCDs.
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