Epidemiologi “ terapan “

NON-COMMUNICABLE DISEASES
– LIFESTYLE RELATED DISEASES
In various countries
Idea from : WILMA N. BERALDE, RM, RN, MAN
Non – Communicable Disease Coordinator
Presented by : suherman for pasca sarjana UIKA Bogor
 Classifying deaths and
diseases (WHO)

• Communicable diseases [Group I]

– Those where death is directly due to the action of
a communicable agent
• Non-communicable diseases
– Diseases [Group II]
• Cancer, diseases of various organ systems (eg
respiratory, cardiovascular etc.), diabetes, mental health
etc.
– External causes (injuries, poisonings and
violence) [Group III]
What are NCDs?

• NCD is a medical condition or disease, which

is not infectious

• NCDs are diseases or medical conditions

with long duration and relatively slow
progression

• NCDs are usually called “Chronic Diseases”

 Why NCDs Are Important in
Public Health?

• 65 million deaths that occurred globally in

2011
• 36 million – 63.2%, almost two thirds – were
due to NCDs
• 9 million death that occurred among people
under age 60
• mainly cardiovascular diseases, cancers,
diabetes and chronic lung diseases
7
8
NCDs are an increasing
global challenge…
Most significant cause of death (63%) worldwide1
NCDs cause premature deaths under age 60:
13% in high income countries
29% in low middle income countries

Even in African nations, NCDs are rising rapidly, projected to exceed

communicable, maternal/perinatal, and nutritional diseases as the most
common causes of deaths by 2020
1Except in sub-Saharan Africa.
Source: World Health Organization (WHO).

Public Health Agency of Canada | Agence de la santé publique du Canada 14

…and their impacts extend beyond health.
• NCDs represent a major fiscal and
productivity risks for the economies of
low, middle, and high income
countries

• NCDs increase income inequities,

deplete household wealth, increase
health spending and lower labour
productivity

• Most countries will not be able to

address NCD challenge with medical
care alone: Prevention is critical
Source: World Bank 2011.

Public Health Agency of Canada | Agence de la santé publique du Canada 15

 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETES ACCIDENTS &
INJURIES

Cardiovascular Disease
• describes a range of diseases that affect the heart and blood vessels and includes:
Coronary Artery Disease

Myocardial Infarction
Congenital Heart Disease

Congestive Heart Failure

Hypertension

Stroke
Arrhythmias

others.
Urbanisation
 100

90
Urbanisation North America
Latin America & Caribbean
80
Urban population as % of total

Europe

70 Oceania

60
WORLD Asia
50
Africa
40

30

2007
20

10

0
1950 1960 1970 1980 1990 2000 2010 2020 2030
19
20
Drivers of the epidemiological
transition in low and middle
income countries
• Population ageing
• Major socio-economic changes (especially
urbanisation)
– changes in risk factors such as diet, physical activity,
smoking etc.
 22

The Cost…

Public Health Agence de la santé

Agency of Canada publique du Canada
…and NCD rates are
increasing at 14 percent each year.

Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using POHEM Model, Statistics Canada.

Public Health Agency of Canada | Agence de la santé publique du Canada 23

…and so is our
economy. NCDs Economic burden of NCDs
cost $190 billion
in 2010.
Individual Household Employer Government

Health care

Out of pocket
drugs
COSTS
Lost
productivity

Disability

Public Health Agency of Canada | Agence de la santé publique du Canada 24

 Description of Major NCDs
Cardiovascular diseases and their risk factors
– Coronary artery diseases
• increased total cholesterol, high LDL,
low HDL, smoking,
obesity/overweight, physical
– Hypertension
inactivity, diabetes
• Family history, age, high salt intake,
obesity, excess alcohol intake
– Cerebrovascular diseases • Age, sex, heredity, hypertension,
(stroke) smoking, diabetes, heart disease, high
RBC, excessive alcohol intake, drug
abuse
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETES ACCIDENTS &
INJURIES
Treating NCDs
is costly.
Canada’s declining deaths from heart disease due in part to an
increase in treatment.
140 6

120
5

100
4
Expenditures
80 on
Deaths per
100,000 pop. 3 cardiovascular
(sdr) disease
60 medication
(Billion $)
2
40

1
20
Deaths

Expenditures
0 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Years

Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from OECD HEALTH DATA 2010; and CMAJ, July 7, 2009 - 1881 (1-2).

Public Health Agency of Canada | Agence de la santé publique du Canada 25

…but the economic impact
goes beyond the health sector.

Direct health care

costs in 2010 =
$68 billion
Indirect costs
due to income
and productivity
losses = $122 billion
estimated about twice
the direct
health care costs
Source: Centre for Chronic Disease Prevention and Control, Public Health
Agency of Canada, using data from the Canadian Institute for Health
Information and from the data of the Economic Burden of Illness in Canada,
1986, 1993, 1998.

Public Health Agency of Canada | Agence de la santé publique du Canada 26

 27

The Cost-effectiveness Options…

Public Health Agence de la santé

Agency of Canada publique du Canada
We understand
the pathway to
NCDs
NCDs...
Raised blood pressure
Overweight/obesity
Raised blood glucose
Raised lipids

Tobacco use
Unhealthy diet
Physical inactivity
Harmful use of alcohol

Social Globalization
Determinants Urbanization
of Health Population ageing

Source: Global Status Report on Noncommunicable Diseases 2010, World Health Organization.

Public Health Agency of Canada | Agence de la santé publique du Canada 28

…and we know
prevention is critical.
Common risk factors
80% of heart disease,
diabetes and respiratory
diseases and 40% of
cancers are preventable
by eliminating f our Tobacco Unhealthy Physical Harmful use
common risk fa ctors use diets inactivity of alcohol
Cardiovascular
diseases

Diabetes
NCDs
Cancer

Respiratory
diseases Source: WHO, Raising the priority of non-communicable disease in development
work at global and national levels.

Public Health Agency of Canada | Agence de la santé publique du Canada

 HYPERTENSION
An increase in blood pressure ≥ 140/90 mmHg in two (2) or
more separate occasions.
One of the leading causes of disability among Filipinos due to
stroke.
BLOOD PRESSURE SYSTOLIC BP DIASTOLIC BP
CLASSIFICATION

LESS THAN 80
NORMAL LESS THAN 120 mmHg
mmHg
PRE HYPERTENSION 120 - 139 mmHg 80 – 89 mmHg
Stage 1
140 – 159 mmHg 90 – 99 mmHg
Hypertension
Stage 2 100 mmHg or
160 mmHg or Higher
Hypertension higher
Classification of blood pressure for adults
 HYPERTENSION
RISK FACTORS
 Smoking
 Excessive alcohol consumption
 Overweight
 Family history of hypertension, heart disease, diabetes and
kidney disease
 Sedentary lifestyle
 Chronic stress
 Advancing age

PREVENTION
 Regular exercise and eating”heart healthy” diet
 Excessive alcohol consumption and cigarette smoking
also increases the likelihood of hypertension
 HYPERTENSION
USUAL SIGN AND SYMPTOMS
NOT ALL HYPERTENSIVE PATIENTS HAVE SYMPTOMS….
 Headache
 Dizziness
 Blurring of visions
 Nape/ neck discomfort
EARLY DETECTION IS AN IMPORTANT FACTOR FOR PREVENTING
FURTHER COMPLICATIONS……
POSSIBLE COMPLICATIONS
Chronic, undiagnosed and untreated hypertension may
result to:
Heart attack stroke kidney failure loss of vision
Lifestyle modification to prevent and manage
hypertension
LIFESTYLE RECOMMENDATION APPROXIMATE SYSTOLIC
MODIFICATION BP REDUCTION
Weight reduction Maintain normal body weight 5-20 mmHg
Adopt DASH eating Consume a diet rich in fruits, 8-14 mmHg
plan (dietary vegetables, and low fat dairy
Approach to stop products
hypertension)
Dietary sodium (salt) Reduce dietary sodium intake 2 – 8 mmHg
restriction
Physical activity Engage in regular aerobic physical 4 -9 mmHg
activity such as brisk walking (at
least 30 min per day, most days of
the week)
Moderation of Limit consumption to no more than 2 -4 mmHg
alcohol consumption 2 drinks per day in most men and
not more than 1 drink per day in
women and lighter weight persons
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETES ACCIDENTS &
INJURIES
Body’s failure to Secondary to
produce insulin decreased
and usually sets activity of the
in among the Type 1 Type 2 insulin produced
young which results in
population increased blood
groups sugar level and
usually sets in
among the older
age groups
Description of Major NCDs

Diabetes and its risk factors

– Diabetes • Family history, overweight, lack of

physical activity, hypertension,
HDL < 35mg/dl, triglyceride
>250mg/dl, history of gestational
diabetes, with impaired glucose
tolerance
 DIABETES
group of metabolic disorders
characterized by high blood sugar level
on 2 separate occasions

results when the body cannot properly

regulate the amount of sugar (e.g.
glucose in the blood)
 DIABETES
4 clinical types of diabetes
Type 1 : INSULIN DEPENDENTDIABETES
Type 2 : NON-INSULIN DEPENDENTDIABETES
who can be managed through oral anti-diabetic
medications but may eventually also require insulin
treatment to attain good blood glucose control
Type 3 : GESTATIONAL DIABETES
who were first diagnosed to have diabetes during pregnancy
Type 4 :SECONDARY DIABETES
acquired diabetes that may be drug or chemical-induced such as those who are being
treated for AIDS or from other endocrine diseases such as hyperthyroidism.
Values for the diagnosis of diabetes and other categories of
hyperglycemia
Criteria for
Type of Testing FBS Values Classification Diagnoses of
Diabetes Mellitus
Fasting blood sugar 109 mg% Normal Any of the following:
(FBS) - no caloric intake 110- 125 mg% Impaired
for at least 8 hours glucose Symptoms of diabetes
which means no food, tolerance plus RBS> 200 mg/dL
juices, milk, but water is 126 mg% Possible (11.1 mmol/L)
allowed diabetes
mellitus FBS> 126 mg/ dL (7.0
2-hour blood sugar test: mmol)
performed after using
75 g glucose dissolved in 2-hr blood sugar >
water or after a good 200 mg/dL (11.1
meal mmol/L) during an
oral glucose tolerance
test (OGTT)*
* FPG estimation is the biochemical test of choice for screening in all age groups. In adults,
FPG measurement has been found to be more reproducible than the 2-hour plasma glucose
level following an OGTT.
**OGTT is the gold standard for diagnosing diabetes and can be used as a screening test.
 DIABETES
RISK FACTORS FOR DIABETES
 High blood pressure
 High triglyceride levels
 Giving birth to an 8 lb baby
 Sedentary lifestyle
 Obesity
 Family history of type 2 diabetes mellitus among 1st
degree relatives
USUAL S/S OF DIABETES
 Fatigue excessive urination
 Unexplained weight loss poor wound healing
 Excessive thirst Excessive hunger
 DIABETES
PREVENTION
Diabetes , a lifestyle –related disease which can
be prevented through regular exercise (at least
30 min every other day) and eating a “heart
healthy” diet (i.e. low -salt ,low-fat diet)

Excessive alcohol consumption and cigarette

smoking also increases the likelihood of
diabetes
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETES ACCIDENTS &
INJURIES
Guidelines for Common Screening
Procedures for Major NCDs

Cancer warning signs

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 or difficulty swallowing
Obvious change in warts or moles
Nagging cough or hoarseness in voice
Unexplained anemia
Sudden weight loss
 Description of Major NCDs
Some cancers and their risk factors
– Oral cancer • Smoking, excessive alcohol
use, chronic irritation, Vitamin
A deficiency
– Breast cancer • Early menarche/late
menopause, high fat diet,
obesity, physical inactivity,
alcohol, family history
• Smoking, radiation exposure
– Lung cancer
• Smoking, HPV infection,
chlamydia infection, low
intake of fruits and vegetables,
– Cervical cancer family history
 Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for breast cancer
(targets 15-60 years old and above)
• Monthly breast self-examination
• Breast examination by health worker (annually) for all child-bearing
woman
• Annual mammography for women over 50 years old and above
• For certain high risk women, baseline mammography at age 35 with
repeat upon recommendation of attending physician
• Genetic screening and counseling for high risk patients or if
appropriate
• Referral to hospital for further management if found positive (+) for
mass or any abnormalities
Guidelines for Common Screening
Procedures for Major NCDs

Breast Self- Examination

Stand in front of a Clasp your hands

mirror. Check each behind your head and
breast for anything press hands forward.
unusual (dimpling, Check contour of
discharge). breast.
Guidelines for Common Screening
Procedures for Major NCDs

Breast Self- Examination

Gently squeeze each nipple While standing, raise one arm. Use
and look for discharge finger pads to check the breast and
surrounding area – firmly, carefully and
thoroughly.
Guidelines for Common Screening
Procedures for Major NCDs
Breast Self- Examination

Lines

Wedges Circles
Guidelines for Common Screening
Procedures for Major NCDs

Breast Self- Examination

Lie flat on your back, with one arm over your head and a
pillow or folded towel under the shoulder. This position
flattens the breast and makes it easier to check.
 Guidelines for Common Screening
Procedures for Major NCDs
Changes in the breast that should be noted and reported to a
physician
• Any lump or hard knot
found in the breast or
armpit
• Any lump or thickening
of the tissue that does
not shrink or lessen aftr
her next period
• Any change in the size,
shape, or symmetry of
her breast
• A thickening or swelling
of the breast
• Any dimpling, puckering,
or indention in the
breast
• Dimpling, skin irritation,
or other change in the
breast skin or nipple
• Redness or scaliness of
the nipple or breast skin
• Discharge from the
nipple (fluid coming from
the nipples other than
breast milk), particularly
if the discharge is clear
and sticky, dark or occurs
without squeezing the
nipple
• Nipple tenderness or
pain
 Description of Major NCDs
COPD and Asthma and their risk factors
– COPD • Smoking

• Genetic predisposition,
allergens, smoking, air
– Asthma pollution, respiratory
infections
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETES ACCIDENTS &
INJURIES

Chronic Respiratory Disease

• The most common morbid conditions suffered by Filipinos are respiratory diseases.

Major causes of death Top leading

due to Respiratory Respiratory causes of
causes Morbidity
• Chronic Respiratory • Acute Respiratory
Diseases (Asthma, Infection
COPDs) • Acute Lower
• Pneumonia Respiratory Tract
Infection
• Pneumonia
• Bronchitis
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETES ACCIDENTS &
INJURIES
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETES ACCIDENTS &
INJURIES
 Accidents are unintentional, unexpected and undesirable
events while injuries are either intentional or
unintentional events that result in damage or harm to a
person (DOH, 2005).
 Most accidents and injuries can be avoided.
 Their effects can be reduced through measures like road safety
education, installation of adequate walkways, streetlights,
signages, and home safety management.
 In high-income countries, road traffic injuries, self-inflicted
injuries and interpersonal violence are the three leading
causes of death among those aged 15 to 44 years.
 In the same age group, there are twice as many suicides and
three times as many traffic-related deaths as homicides.
 Key Areas for the Primary Prevention of the
Major NCDs

 Promote Proper Nutrition

 Encourage more physical activity and exercise
 Promote smoke-free individuals and environment
 Discourage excessive alcohol drinking
 Manage stress effectively
 Maintain regular health check-up
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE SMOKE-FREE INDIVIDUALS

AND ENVIRONMENT
• Smoking cessation for active smokers to reduce risk
• Prohibit smoking inside living areas, houses and closed areas
• Avoid smoke-filled places
• Advocate for implementation of policies that support smoke-
free environment
• Support policies/ordinances/laws that limit access of cigarettes
to children and youth
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE ALCOHOL-FREE ENVIRONMENT

• Discourage excessive alcohol drinking

• Regular health check-up for early diagnosis and prompt
treatment
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE PROPER NUTRITION

• Limit intake of fatty, salty and preserved foods

• Increase intake of vegetables and fruits
• Avoid high caloric low-nutrient value food like junk food, instant
noodles, soft drinks
• Start developing healthy habits in children
Key Areas for the Primary Prevention of the
Major NCDs

ENCOURAGE MORE PHYSICAL ACTIVITY

• Moderate physical activity of at least 30 minutes for most days

• Integrate physical activity and exercise into regular day-to-
day activities
• Promote walking as one form of exercise that is possible for all
including older persons and persons with cardiovascular
disease
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE A STRESS-FREE ENVIRONMENT

• Manage stress effectively

• Regular health check-up for early diagnosis and prompt
treatment
wilmarmrnman