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