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Charlotte Block, MS, RDGlobal Health Program Officer NCDs/Nutrition cblock@projecthope.org
NCDs and the Future of Global HealthCORE Group Fall Meeting
October 14th, 2011
Agenda
• Introduction to NCDs• The history and policy leading up to, during
and beyond the UN NCD High Level Meeting• Key messages from USAID• Examples of current approaches in NCD
programming• Q&A• If time remaining – group discussion
NCDs Defined
• Chronic Disease• Non-Communicable Disease• Chronic Non-Communicable Disease
“Diseases of long duration and generally slow progression”- WHO definition of chronic disease
Why NCDs? Why Now?
1. What are some chronic diseases?
2. Do you know someone with a chronic disease?
3. Have you seen evidence of chronic diseases where you work?
NCDs 101
4 x 4
X
Diseases Risk Factors
Some statistics
• 63% of deaths globally caused by NCDs (36 million)
• 80% in LMICs (28 million)
• 29% of NCD deaths are under the age of 60 in LMICs
• 80% of the 4 main NCDs prevented by eliminating the 4 shared risk factors.
The Big Picture
WHO Non-Communicable Disease Country Profiles 2011
Proportion of premature NCD mortality by income group of countries
The Vicious Cycle
ViciousCycle
Economic Burden
WHY?
Key Determinants
The Bigger Picture
Early Origins of Health
Mother
Fetus
Newborn
Adult
Anemia
Tobacco
Drugs
Stress
Nutrition
Diabetes
Hypertension
Infection
Obesity
http://www.c3health.org/wp-content/uploads/2011/07/NCDs_maternal-health_Prof-Luis-Cabero-Roura1.pdf
Connecting the Dots
NCDs Infectious Disease
Infectious Disease – Tuberculosis
• Diabetes triples the risk of developing TB.• Rates of TB are higher in people with diabetes• Diabetes is a common comorbidity in people with TB• Diabetes can worsen the clinical course of TB• TB can worsen glycemic control in people with diabetes
Collaborative Framework for Care and Control of Tuberculosis and Diabetes 2011
Infectious disease - HIV
• HIV+ associated with abnormal blood lipids
• High prevalence of CVD risk factors in HIV+ individuals
• Risk for heart attack is 70-80% higher in patients on ART
• CVD contributes to mortality in HIV+ patients receiving ART-> risk increases with longer exposure to treatment
• Suspected links between HIV drugs and elevated blood sugar levels/insulin resistance.
Partially adapted from FHI360 Kenya project presentation
Funding Opportunities
• Only 2.3% of public and private funding goes towards NCDs.
• Need for country-level commitments
• Bulk of funding from private sector/industry
• Concerns regarding conflict of interest
Other NCDs
• Neurological disorders: Alzheimer's, epilepsy• Mental illness• Disabilities/injuries• Skin disorders• Arthritis• Oral health• ….
Multsectoral Solutions
Private Industry
Project HOPE’s Diabetes Programs
Helping People Help Themselves
Global Diabetes Burden: Large and growingTotal #s (prevalence%)
Mexico6.8 M (10.1%)
Brazil7.6 M (6%)
China43.2 M (4.5%)
India50.8 M (7.1%)
Egypt4.8 M
(10.4%)
Kenya0.5 M (2.8%)
South Africa1.3M (4.5%)
UAE0.4 M (12.2%)
Oman0.2 M (11.1%)
Indonesia7 M (4.6%)
USA26.8 M (12.3%)
UK2.1 M (4.9%)
Australia1 M (7.2%)
Japan7 M (7.3%)
Canada2.9 M (11.6%)
Russia9.6 M (9%)
Source: IDF Diabetes Atlas 2010, MedMarket Diligence, LLC
Project HOPE Programs
Mexico2001-present
India2007-present
China1996-present
New Mexico, USA2010- present
S. Africa 2011-present
Nicaragua2010 - present
Diabetes Medical Training - China
Qingdao
Chengdu
Xi’an
Beijing
Guangzhou
Hangzhou
Shanghai Ruijin
Shanghai Huashan
Harbin
Nanjing
• Rural and Urban Training Centers
• Trained >40,000 health care providers
• Reaching >170,000 patients and families
• MoH partnership -> National Standards
Diabetes Education - Mexico
• Curriculum development:
•5 Steps for Self-Care Patient Course
• Lend a Hand in Self-Care TOT Course
• Adopted by government and community health centers
• Incorporates peer support training model
School-Based Education - Mexico
• “Diabesity” – targeting 3rd graders
• Holistic approach – school & home
• Health vs. illness focused
• Promotes 3 healthy habits
• Expanded to New Mexico & India
Layers of Obesity
HABITS for LIFE – New Mexico, USA
• Targeting health disparities using Telehealth
• US/Mexico rural border communities
• Prevention, screening & access to specialty care
• HW training to build clinical & educational capacity
Gestational Diabetes – Latin America
• Pilot project in Nicaragua & Mexico
• Training government health workers
• Trainees screen and educate pregnant patient groups at health centers.
Diabetes Educators - India
• National Diabetes Education Program• Master Trainer/ToT model
• Distance learning
• Launching DE profession
• 12 Diabetes Centers
• Healthy Habits
• Workplace Wellness
• CHW training
HOPE Center – Johannesburg, SA
• CHWs training in diabetes focused curriculum
• Peer education groups to empower patients with diabetes prevention and management activities
• Screening services including: HbA1c, lipid profile, cholesterol, retinal scan, and foot screening
References
WHO Chronic Disease and Health Promotion
http://www.who.int/chp/en/
NCD Alliancehttp://www.ncdalliance.org/
International Diabetes Federationwww.idf.org
World Heart Federationhttp://www.world-heart-federation.org/
Union for International Cancer Controlhttp://www.uicc.org/
International Union Against Tuberculosis and Lung Disease
http://www.theunion.org/
C3 Collaborating for Healthhttp://www.c3health.org/
Global Health Councilwww.globalhealth.org
Project HOPEwww.projecthope.org
Thank you! Questions?
For further information:
Charlotte Block
cblock@projecthope.org
Group Discussion
• Break into groups
• Take X amount of time to discuss where/how NCD programming would fit into your current or future programs
• Groups report back and share ideas
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