Low-income countriesGroup III - Injuries

Group II – Other deaths from noncommunicable diseasesGroup II – Premature deaths from noncommunicable diseases (below the age of 60yrs) which are preventableGroup I – Communicable diseases, maternal, perinatal and nutritional conditions

10%NCDs are the biggest cause of death

5.8 M5.8 M

10 million

20 million

30 million

40 million

50 million

60 millionTotal number of deaths in the world

26.0 M26.0 M( above the age of 60 )( above the age of 60 )

26.0 M26.0 M( above the age of 60 )( above the age of 60 )

9.0 M( below the age of 60 )( below the age of 60 )

9.0 M( below the age of 60 )( below the age of 60 )

18.0 M18.0 M

(60% of all deaths)• CVDs, • Cancer • Chr Resp Dis• DM

0 million

1

IndonesiaIndonesia 2010 2010 237.6 M population 237.6 M population - 33 Provinces, - 505 districts & towns

+ 52%

2

Causes of Death % Causes of Death %

StrokeTuberculosisHypertensionInjuryPerinatal/maternalDiabetes MellitusNeoplasm/cancerLiver diseaseIschemic Heart Dis.Lower resp. tract dis. Heart disease

15,4

7,56,86,56,05,75,75,15,15,14,6

PneumoniaDiarrheaGastric ulcerTyphoidMalariaMeningitis/EncephalitisCongenital malformDengueTetanusSepticemiaMalnutrition

3,83,51,71,61,30,80,60,50,50,30,2

Causes of Death pattern in Indonesia

NCD : 59,5% NCD : 59,5% CVD & risk factors : 28,1%CVD & risk factors : 28,1%Source: BHR, 2007Source: BHR, 2007 3

HHS=Household Health Survey

BHR =Basic Health Research

Causes of Death, All Ages in Indonesia1995, 2001, 2007

10.1

6 6

44.2

31.2

28.1

41.7

49.9

59.5

5.97.3 6.5

0

10

20

30

40

50

60

%

Maternal andPerinatal

conditions

CommunicableDisease

NoncommunicableDisease

Injury

HHS 1995

HHS 2001

BHR 2007

+ 19% / 6 yrs + 31% /10 yrsAfrica + 27%E. Mediterranean + 25%

4

Source: BHR, 2007*>10 year old; #>15 year old; ** ≥15 year old (BHR, 2010) Source: BHR, 2007*>10 year old; #>15 year old; ** ≥15 year old (BHR, 2010)

NCDs cases %

Hypertension Stroke Heart diseaseArthritis Land traffic injuries Asthma DM DM (urban population) Tumor/cancer

31.7 8.3 7.2

30.3 25,9 3.5 1.15.74.3

Prevalence of NCDPrevalence of NCDss CCaseasess

5

HYPERTENSION : PREVALENCE & COVERAGE

NO

HYPERTENSION

DIAGNOSED OR UNDER TREATMENT

NO TX

BHR 2007

7

Coverage : Proportion patients diagnosed or under medical treatment

6

Risk FactorsRisk factors %

Everyday servings salty foodsEveryday servings fatty foods < 5 servings of fruits & vegetablesLack of physical activitySmokers (> 15 yrs of age)

Overweight & obeseEmotional-mental disorderAlcohol use

24.5*12.8*93.6*

48.2*

34.7**19.1#

11.6#

4.6*

Source: BHR, 2007*>10 year old; #>15 year old; ** ≥15 year old (BHR, 2010) Source: BHR, 2007*>10 year old; #>15 year old; ** ≥15 year old (BHR, 2010)

8

80% of smokers live in the developing countries

Tobacco caused 5.4 million deaths in the world(1 death every 6.5 seconds)

Indonesia :Indonesia :

300,000 deaths each year due to tobacco300,000 deaths each year due to tobacco

INDONESIAN SMOKERS BHR2007

BHR 2010

Smoking Prevalence (>15 Th) 33,4% 34,7%

Male Smokers (>15 Th) 65,3% 65,9%

Women (>15 Th) 5,06% 4,2%

Population exposed to cigarette smoke

84,5 % 76,1%

8

Teenage Trend smoking prevalence

13.7

24.2

32.837.3

0.3 0.2 1.9 1.67.1

12.7

17.3 18.8

0

5

10

15

20

25

30

35

40

1995 2001 2004 2007

Laki

Perempuan

Total

Source: Susenas (1995, 2001, 2004) dan BHR 2007

The prevalence of teenage smokers according to age group 15-19 years, by sex - in Indonesia,

The prevalence of teenage smokers according to age group 15-19 years, by sex - in Indonesia,

MaleFemale

Global Youth Tobacco Survey in Indonesia (2007)

20,3 % junior high school student smokes

9

TOBACCO

D I E T

PHYSICALACTIVITY

ALCOHOL

10

1920 1940 1960 1980 20000

50

100

150

200

250

300

350

400

Year

Dea

th r

ate

of C

HD

(per

100

,000 Men 40-49

Men 50-59 yrs.

Women 40-49

Women 50-59

The changing rates of coronary heart disease in adults in Norway.

Note: during the Second World War there was an acute fall in total and saturated fat intake followed by a rise at the end of the war. The fall in death rates was preceeded by a progressive reduction in total and saturated fat intake and with an increase in polyunsatuated fat consumption. Blood cholesterol concentrations fell.

11

What are our prevention priorities?CVD, CANCER, COPD, DM & RISK CVD, CANCER, COPD, DM & RISK

FACTORSFACTORS

What are our prevention priorities?CVD, CANCER, COPD, DM & RISK CVD, CANCER, COPD, DM & RISK

FACTORSFACTORS Non-modifiable Risk Factors - Age - Sex - Genes

Behavioural Risk F :Behavioural Risk F : - - TobaccoTobacco - Diet- Diet - Physical Activity- Physical Activity - Alcohol- Alcohol

Socio-Econ, Cultural & Environmental Conditions, and Modernisation, Mechanisation, Urbanisation, Globalisation

- Coronary HD - Stroke - Peripheral Vascular Dis - Several cancers - COPD/ emphysema - Health, wellbeing

End Points

•Hypertension

•Blood lipids

•Obesity / Overweight

•Diabetes

•Glucose Intolerance

Intermediate

Risk Factors

12

POPULATIONSPOPULATIONS

Low RiskLow Risk

High RiskHigh Risk

Epidemiologic Epidemiologic TransitionTransition

Public Health Interventions

INDIVIDUALSINDIVIDUALS Low RiskLow Risk High RiskHigh Risk

Epidemiologic Transition

Clinical Interventions

14

GO RED FOR

WOMEN

Indonesian actions ……..Indonesian actions ……..Indonesian actions ……..Indonesian actions ……..

15

Promote Regular Physical Activities

16

No

Smok I ng

Campa I gn 17

Educational talks, seminars, radio and TV talk-shows, exhibitions, free health checks and a variety of competitions (writing, poster drawing, etc) 18

IHF quarterly newsletter

Posters, brochures, leaflets

www.inaheart.or.id

Indonesia Heart Foundation Publications

19

ThermometerMeasurement TapeStethoscopeBPMDWeighing MachineNebulizerPeak Flow MeterGlucometer Urine dipsticksECG MachineAspirin, ISDN, CPG, HCT, Nifedepine, Amlodipin, Captopril, Enalapril, Bisoprolol, Frusemide,Spirono-lacton,GlibenclamideMetformin,SimvstatnInsulin, Atorvastatin Atenolol, Broncho-dilator inhaler

Package of Essential NCD (PEN) interventions for primary care

20

(Community Based)(Community Based)

TertiaryTertiaryCV. CareCV. Care

SecondarySecondaryCV CareCV Care

Primary CV CarePrimary CV CareBasic Health CareBasic Health Care

NGO – IHF – etc.NGO – IHF – etc.

INDONESIAN INDONESIAN NCVCNCVC

PRIVATE PRACTICEPRIVATE PRACTICEPUBLIC HEALTH CAREPUBLIC HEALTH CARE

Top referal &Top referal &Quartenery careQuartenery care

INTEGRATED CV INTEGRATED CV SERVICESERVICE

IN PROVINCE IN PROVINCE HOSPITALHOSPITAL

(TYPE A & B)(TYPE A & B)CV SERVICE IN CV SERVICE IN DISTRICT HOSPITALDISTRICT HOSPITAL

(TYPE C & D)(TYPE C & D)

Public Health & Self Health CarePublic Health & Self Health Care

Improve CV

care

facilities

and referral

system

21

   POPULATION DISTRIBUTION AND

TERTIARY CARDIOVASCULAR SERVICES

Padang

- RSJPD – HK

- RSCM - RSHS -

Bdg

4

2

Samarinda

12

4

2

9

6

40

11

11

30

36

4

4

3

3.5

3

2

8

2

2Bengkulu

5

2

• RS Dr.S• RS SA - Malang

8.870 PHC, 23.163 sub-centers, 1.556 hospitals, 500 Cardiologist

4

2

3

Existing CV center

22

AGE STANDARDIZED MORTALITY CAUSE BY ISCHEMIC HEART DISEASE/100.000

INHIBITORS

UN data 2008

4

10 more cardiology & vascular medicine dept. was appointed as an education center

in 2010IHA target : 1000 cardiologist in 2020

23

IHA OBJECTIVES OF CVD PREVENTION :

1. Maintain low risk of CVD population lifelong To help those at increase total CVD risk to reduce

it.

2. To achieve the characteristics of healthy condition :

- no smoking - no alcohol - healthy food choices - low salt consumption - physical activity; 30 min of moderate

activity/day - BMI < 25 kg/m2 and avoidance of central

obesity - BP < 140/90 mmHg - Total cholesterol < 190 mg/dl (< 5 mmol/l) - LDL cholesterol < 115 mg/dl (< 3 mmol/l) - Blood glucose < 110 mg/dl (< 6 mmol/l)

24

IHA OBJECTIVES OF CVD PREVENTION :

3. To achieve more rigorous risk factor control in high risk subjects; especially those with established CVD or DM :

- BP < 130/80 mmHg if feasible - Total cholesterol < 175 mg/dl (< 4.5

mmol/l) - LDL cholesterol < 100 mg/dl (< 2.5 mmol/l) - Fasting BS < 110 mg/dl (< 6 mmol/l) & HbA1c <6.5%

4. To consider cardioprotective drug tx in these high risk subjects especially those with established atherosclerotic CVD

25

CVDs (Hypertension, stroke, HD) the leading cause of death in Indonesia exacerbates poverty

The prevalence of hypertension is high, not well treated

Parliament : Increase budget for health ! MOH : - Increase NCDs/CVDs prev. & control budget - Integrated National plans of action (for: tobacco control, diet improvement, physical activity, no

alcohol)

- Coordination & collaborative action of all sectors:

government, medical societies, civil society, private sectors and media

- Scale up packages of effective intervention - Strengthen Primary HC & improve referrals - Universal coverage Surveillance on the impact of interventions Promote & support research on CVDs prev &

control

Conclusion :

26

T H A N K Y O U T H A N K Y O U FOR YOUR ATTENTIONFOR YOUR ATTENTION

2027