INTRODUCTION

CHRONIC NON COMMUNICABLE DISEASES

 OVERVIEW OF PRESENTATION

• Introduction

• Burden

• Risk Factors

• Prevention & Control

• Programs
 INTRODUCTION: DEFINITION

Chronic Non Communicable Diseases (NCDs)

• Chronic diseases: Long duration

• Not passed from person to person
• Generally Slow progression
 INTRODUCTION: DEFINITION

Commission on Chronic Illness in USA: Comprising

all impairments or deviations from normal, which
have one or more of the following characteristics

• Permanent
• Leave Residual Disability
• Non reversible pathological alterations
• Require special training of the patient for rehabilitation
• Require a long period of supervision, observation or care
 NCDS

• Cardiovascular diseases • Permanent results of

disability
• Cancer
• Metabolic and
• Diabetes degenerative diseases
• Musculoskeletal • Nervous and Mental
Diseases
Conditions
• Chronic results of
• Chronic Non specific
Respiratory Diseases Communicable
Diseases
• Senility
• Renal diseases
 BURDEN

• Leading cause of death in the world (63% of all

annual deaths: 2008)

• Problem both in Developed & Developing

Countries

• Prevalence showing an upward trend: In 2020 -

73% of global deaths, 60% of global burden of
disease
 Percentage deaths, by cause, worldwide,
GBD 2016
8%

19%

72%

Noncommunicable Diseases
Communicable, Maternal, Neonatal & Nutritional Diseases
Injuries
NCDs are the number one killer in the world
Source: Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease
Study 2016, The lancet.

04/27/2020
Ten leading causes of death by
region, SEAR 2015
Rank Cause % of total
deaths

1 Ischaemic heart disease 14.5

2 Stroke 9.8
3 Chronic obstructive pulmonary disease 8.1
4 Lower respiratory infections 6.1
5 Tuberculosis 5.0
6 Diarrhoeal diseases 3.9
7 Diabetes mellitus 3.7
8 Preterm birth complications 2.9
9 Cirrhosis of the liver 2.9
10 Road injury 2.8

Source: Global Health Estimates 2015: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2015. Geneva, World Health Organization; 2016.
NON COMMUNICABLE DISEASES (NCDS)

• Increase in incidence of NCDs

• REASONS:

 Progressive ageing of population

 Urbanization

 Change in life style

 Transitions in Society

1. Demographic transition 

2. Economic transition

3. Social transition

4. Nutrition transition

5. Epidemiologic transition
Levels of Prevention

•Primordial
•Primary
•Secondary
•Tertiary
 RISK FACTORS

• Modifiable – Behavioural Risk Factors

to Physiological/ Metabolic Risk
Factors – HTN, Obesity, Raised
Cholesterol, Raised Blood Sugar

• Non-Modifiable
 RISK FACTOR: TOBACCO USE

• Risk Factor: Any amount of use

• 6 million people die from tobacco use each year

• Causes 71% of all lung cancer

• 42% of chronic respiratory disease

• Nearly 10% of cardiovascular disease

EFFECTS OF TOBACCO
 RISK FACTOR: TOBACCO

• Promotes Atherosclerosis (CO induced)

• Carbon Monoxide reduces the oxygen carrying
capacity

• Raises Blood Pressure (Adrenergic stimulation –

Nicotine)

• Increases blood clotting factors: Fibrinogen

• Carcinogens: > 60 substances

RISK FACTOR: EXCESSIVE ALCOHOL
USE
• 2.3 million die each year from the harmful use of
alcohol (3.8% of all deaths)

• 20% of deaths due to motor vehicle accidents

• 30% of deaths due to oesophageal cancer, liver

cancer, epilepsy and homicide

• 50% of deaths due to liver cirrhosis

• > 60 types of Diseases

RISK FACTOR: EXCESSIVE ALCOHOL
USE

• High Risk Drinking:

• Men: >40gm of pure alcohol/ day
• Women: >20gm of pure alcohol/ day

• Binge drinking:
• Men: >7 standard drinks/ occasion
• Women: > 5 standard drinks/ occasion
 STANDARD DRINK

• Low-alcohol (light) beer (2.7%): 1 1/4 of a 375ml

can

• Mid-strength beer (3.5%): 1 stubby, total volume

375ml

• Regular beer (4.9%): 1 pot, 285ml

• White or red wine (12%): 1 small glass, 100ml

• Spirits or liqueurs (40%): 1 nip, 30ml

RISK FACTOR: EXCESSIVE ALCOHOL
USE
• Increase in blood pressure

• Increases blood levels of triglycerides

• Cancers: oral cancers, laryngeal, oesophageal,

breast, bowel and liver cancer

• Accidents & Injuries

RISK FACTOR: PHYSICAL INACTIVITY

• 3.2 million people die each year due to physical

inactivity

• 21–25% of breast and colon cancer burden

• 27% of diabetes
• 30% of ischaemic heart disease burden
RISK FACTOR: PHYSICAL INACTIVITY

• Risk Factor: < 150mins/ week of moderate Physical

activity
< 75mins/ week of vigorous physical activity intensity
• Obesity

• High blood pressure

• High triglycerides, a low level of HDL (good)

cholesterol

• Diabetes
 RISK FACTOR: DIETARY INTAKE

• 14% of gastrointestinal cancer deaths

• 11% of ischaemic heart disease deaths

• 9% of stroke deaths
 RISK FACTOR: DIETARY INTAKE

• Low fruits & vegetable intakes: < 400gms/ day

• High Cholesterol & saturated fats: raises blood

cholesterol, promotes atherosclerosis, breast
cancer

• High Sodium/ Salt: Raises Blood Pressure,

Stomach Cancer

• Red & Processed meat: Bowel Cancer

 RISK FACTOR: RAISED BLOOD
PRESSURE

• Risk Factor: SBP: >140 mmHg, DBP: >90mmHg

(SBP: 115 mmHg, DBP: 75mmHg)

• Cause 7.5 million deaths (12.8% of all deaths)

 RISK FACTOR: OVERWEIGHT &
OBESITY

• 2.8 million people die each year

• 44% of diabetes burden

• 23% of ischaemic heart disease burden

• 7–41% of certain cancer burdens

 RISK FACTOR: OVERWEIGHT &
OBESITY
• Risk Factor: BMI: >23 kg/ m2 (25 kg/m2)

• Causes Higher LDL (bad) cholesterol and

triglyceride levels, lower HDL (good) cholesterol
level

• High blood pressure

• Diabetes

• Cancers: Colon, Breast, uterine, pancreatic etc

 RISK FACTOR: ENVIRONMENTAL
FACTORS
• Air Pollution: Asbestos, benzene, silica – Cancer

• Outdoor air pollution: 8% of lung cancer deaths ,

5% of cardiopulmonary deaths and about 3% of
respiratory infection deaths

• Indoor smoke from solid fuels : 21% of lower

respiratory infection deaths worldwide, 35% of
chronic obstructive pulmonary deaths and about
3% of lung cancer deaths
 CANCER & INFECTION
• One in 6th cancer worldwide are caused by infection

• Accounts for 16% of all new cancer cases

• 22% of all cancer deaths are due to infection

• HPV, Hep B, C, and H. Pylori: accounts for 1.9 million

cancer cases

• Chronic hepatitis B virus infection causes about half

the world’s liver cancer deaths, killing 340 000 people
annually

• More than 250 000 women die annually from cervical

 NON MODIFIABLE RISK FACTORS

• Age: BP increases with age

• Sex: BP

• Genetic Factor: Family History

• Ethnicity: Black - Higher BP

 SHARED MODIFIABLE NCDS RISK
FACTORS

Conditions
Risk factor CVD Diabetes Cancer Resp.
conditions
Smoking √ √ √ √
Alcohol √ - √ -
Nutrition √ √ √ -
Physical √ √ √ √
Inactivity
Obesity √ √ √ √
Raised BP √ √ - -
Blood glucose √ √ √ -
 PREVENTION & CONTROL

• Primordial Prevention
• Primary Prevention:
Population Strategy, High Risk Strategy
• Health Promotion, Control of Pollution
• Specific Protection: Vaccines
• Secondary Prevention:
• Early Diagnosis & Prompt Treatment
• Case finding through Screening
• Tertiary Prevention:
• Disability Prevention & Rehabilitation
 CESSATION OF TOBACCO USE

• Information on health risks of tobacco

• Restriction on smoking in public/ work places

• Ban on advertising

• Taxes on tobacco products

• Tobacco cessation assistance

 REDUCING HARMFUL USE OF
ALCOHOL
• Limit to:
• Men: < 2 drinks, Women: < 1 drinks

• Taxes

• Regulating availability of alcohol

• Drink driving counter measures: 0.5mg/ l

• Treatment
 PROMOTING PHYSICAL ACTIVITY

• 150 minutes of physical activity/ week of

moderate intensity activity

• Public policies to encourage: walking, cycling

• Physical environment: schools/ work place/

community
 PROMOTING HEALTHY DIETS

• Fruits & Vegetable intake: 400gms/ day

• Limiting energy intake from total fats: <30%

• Saturated Fats: <10% of total energy intake

• Limiting salt consumption: < 5 gms/ day

 PREVENTING CANCER

• Immunization: Hep B, HPV

• Protection from environmental & Occupational

risk factors
 PREVENTION & CONTROL

• Primordial Prevention
• Primary Prevention:
Population Strategy, High Risk Strategy
• Health Promotion, Control of Pollution
• Specific Protection: Vaccines
• Secondary Prevention:
• Early Diagnosis & Prompt Treatment
• Case finding through Screening
• Tertiary Prevention:
• Disability Prevention & Rehabilitation
 NATIONAL PROGRAMME

National Programme for Control and Prevention of

Cancer, Diabetes, Cardiovascular Diseases, and
Stroke (NPCDCS)

Aims

• Prevention & Control of common NCD risk factors

through an integrated approach

• Reduction of Premature morbidity & mortality due

to DM, and Stroke
 NPCDCS: STRATEGIES

• Health Promotion

• Professional Education

• Diagnosis & Management Opportunistic

Screening

• Community Participation
NATIONAL CANCER CONTROL
PROGRAMME
 LEGISLATIONS

• Anti Tobacco
• The Cigarettes & Other Tobacco Products Act, 2003

• Environmental laws
• The Air (Prevention & Control of Pollution) Act, 1981
• The Water (Prevention & Control of Pollution) Act, 1974

• Occupational Health
• The Factories Act, 1948
 CIGARETTES & OTHER TOBACCO
PRODUCTS ACT, 2003

Important Provisions
• Ban in smoking in public places (including workplace)
• Ban on direct or Indirect advertising of Tobacco
products
• Ban on sales to minors
• Tobacco products cannot be sold within 100 yards of
educational institution
• Pictorial Health warning
• English and 1 or more language to be used for health
warning on tobacco packs
• Testing and Regulations: ingredients to be declared
on tobacco product packages (Tar & Nicotine)
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THANK YOU