Philippine Perspectives: Noncommunicable Diseases, Risk Factors and Health Inequalities

Albert Francis E. Domingo, MD, MScConsultant, Noncommunicable Diseases and Health Promotion Unit

8 March 2016

Philippine Perspectives:

Noncommunicable Diseases, Risk Factors

and Health Inequalities

Noncommunicable Diseases, Risk Factors and Health Inequalities2 |

Healthy population

Population at risk

Population with sickness

Sick that need hospitalization but have no access to hospital care

Sickand

Hospitalized

0-6 7-27 28-364

1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Forces of nature, war, and legal intervention Forces of nature, war, and legal in-

terventionForces of nature, war, and legal in-


















tervention

Self-harm and interpersonal vio-lence; unintentional injuries;

transport injuriesSelf-harm and interpersonal violence; unintentional injuries; transport injuries

Self-harm and interpersonal violence; unintentional injuries; transport injuries





Self-harm and interpersonal violence; unintentional injuries; transport injuriesSelf-harm and interpersonal violence;

unintentional injuries; transport injuriesSelf-harm and interpersonal violence; unintentional injuries; transport injuriesSelf-harm and interpersonal violence;

unintentional injuries; transport injuriesSelf-harm and interpersonal violence; unintentional injuries; transport injuriesSelf-harm and interpersonal violence;

unintentional injuries; transport injuriesSelf-harm and interpersonal violence; unintentional injuries; transport injuries







Major NCDs: Diabetes, urogenital, blood, and

endocrine diseases; car-diovascular diseases; chronic respiratory dis-

eases; neoplasms

Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-

diovascular diseases; chronic respira-tory diseases; neoplasms





































Mental and substance use disorders







Mental and substance use disordersMental and substance use disordersMental and substance use disordersMental and substance use disorders

Mental and substance use disordersMental and substance use disorders

Mental and substance use disordersMental and substance use disordersMental and substance use disordersMental and substance use disordersMental and substance use disordersMental and substance use disorders


Other NCDs

Other NCDs

Other NCDs

Other NCDs

Other NCDs

Other NCDs

Other NCDsOther NCDsOther NCDsOther NCDsOther NCDs

Other NCDsOther NCDs

Other NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDs

Other NCDs

Nutritionaldeficiencies

Nutritional deficiencies

Nutritional deficienciesNutritional deficiencies



Nutritional deficienciesNutritional deficienciesNutritional deficienciesNutritional deficienciesNutritional deficiencies

Nutritional deficienciesNutritional deficiencies

Nutritional deficienciesNutritional deficienciesNutritional deficienciesNutritional deficienciesNutritional deficienciesNutritional deficiencies


Maternal andneonatal disorders

Maternal and neonatal disorders

Maternal and neonatal disordersMaternal and neonatal disorders



Maternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disorders

Maternal and neonatal disordersMaternal and neonatal disorders

Maternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disorders


Neglected tropical diseases and malaria






Neglected tropical diseases and malariaNeglected tropical diseases and

malariaNeglected tropical diseases and


malaria







Neglected tropical diseases and malariaNeglected tropical diseases and


malaria

HIV/AIDS and TB

HIV/AIDS and TB

HIV/AIDS and TB

HIV/AIDS and TB

HIV/AIDS and TB

HIV/AIDS and TB

HIV/AIDS and TB

HIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TB

HIV/AIDS and TB

Diarrhea, lower respiratory, and other common infectious dis-

eases

Diarrhea, lower respiratory, and other common infectious diseases

Diarrhea, lower respiratory, and other common infectious diseasesDiarrhea, lower respiratory, and other

common infectious diseases












Diarrhea, lower respiratory, and other common infectious diseasesDiarrhea, lower respiratory, and other

common infectious diseases

Causes of Death over the Life-Course in the Philippines(2013, both sexes)

Other communicable, maternal, neonatal, and nutritional diseases Neglected tropical diseases and malaria

Data from the Global Burden of Disease (2013) as published in The Lancetdays years


The NCD Causation Pathway

Underlying determinants• Globalization• Urbanization• Population ageing• Social determinants

Common risk factors•Tobacco use•Unhealthy diet•Physical inactivity•Harmful use of alcohol•Air pollution•Age & heredity (non-modifiable)

Intermediate risk factors• Raised blood sugar• Raised blood

pressure• Abnormal blood lipids• Overweight/obesity• Abnormal lung

function

Diseases• Cardiovascular

disease• Cancer• Diabetes• Chronic respiratory

disease

Adapted from WHO (2005) Preventing Chronic Disease: a Vital Investment.


Early life environmental exposurescan lead to later-life health problems

Maternal toxic exposuresoxidative stress

Lowbirth weight

Cardiovascular disease and Diabetes Alzheimer’s,

Dementia, Parkinson’s


Who is/are the patient(s)?What are the diagnostics and therapeutics?

Figure from: GBD 2013 Risk Factors Collaborators (2015)


• NCDs and their risk factors start in higher socioeconomic status (SES) and in urban areas

• Those of higher SES respond to prevention campaigns first


• Those of lower SES continue to experience increasing NCDs

• The double burden of disease (noncommunicable and communicable) will further deplete scarce resources

• Those of lower SES are at risk of receiving inadequate care


Epidemiological Transition

1954

'55

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2008

0

100

200

300

400

500

600

0

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20

30

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50

60

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90

100

110

Communicable Diseases Malignant Neoplasm Diseases of the Heart

Year

Dea

ths

per 1

00,0

00 p

opul

atio

n (c

omm

unic

able

dis

ease

s)D

eaths per 100,000 population (non-com

municable diseases)

Source: Philippine Health Statistics, various years


Philippine Data Source and Methods

2003 National Nutrition and Health Survey– National; stratified, three-stage random sampling; n=3,307– 97% response rate– 20-65 years of age; 52.2% men, 47.8% women

Analysis done by the Food and Nutrition Research Institute

Socioeconomic Status (SES) variables:– Education (primary, secondary, at least tertiary)– Annual household income

• Low: PhP <= 53,064; Medium: PhP 53,065-92,192• High: PhP 92,193-173,387; Very high: PhP >= 173,388


From WHO (2010) Noncommunicable disease risk factors and socioeconomic inequalities – what are the risks?


How to Respond

Enhance and improve early childhood development programs and education for all social groups

Remove barriers to secure employment

Tax tobacco and alcohol, regulate their production and sales, and restrict advertising and marketing

Reduce dietary salt intake by regulation, education, and mass media campaigns for the marginalized

Adapted from: Di Cesare (2013) Inequalities in non-communicable diseasesand effective responses. The Lancet.


How to Respond

Improve financial and physical access to healthier diets (fresh fruits and vegetables, healthy fats, whole grains, etc.)

Implement universal, financially and physically accessible, high-quality primary care to reduce risk factors; enhance early detection and treatment of NCDs

Remove financial barriers to health care, reduce physical and behavioural barriers to health care use, and improve the quality of care especially in disadvantaged communities

Adapted from: Di Cesare (2013) Inequalities in non-communicable diseasesand effective responses. The Lancet.

2025 milestone: 9 voluntary global NCD targets

By 2030, reduce by one third premature mortality from NCDs

2030 milestone: NCD-related targets in the SDGs

2018 milestone: Four time-bound commitments

WHO Global NCD Action Plan 2013-

2020

2011 UN Political

Declaration on NCDs

2014 UN Outcome Document on NCDs

Governance Risk factors Health systems Surveillance

Components of national NCD responses

WHO Regional

NCD Action Plans

Getting to 2030: Global vision

Sustainable Development

Goals


HEALTH AND THE ENVIRONMENTDivision of Noncommunicable Diseases and Health through the Lifecourse

Philippine Perspectives: Noncommunicable Diseases, Risk Factors and Health Inequalities

Healthcare

Transcript of Philippine Perspectives: Noncommunicable Diseases, Risk Factors and Health Inequalities