Definition Hypertension is high blood pressure. Blood pressure is the force of blood pushing against the walls of arteries as it flows through them. ( encyclopedia)

Non-communicable diseases (NCDs)1Non-communicable diseases (NCDs)Is a disease which is not infectious. Such diseases may result from genetic or lifestyle factors. A non-communicable disease is an illness that is caused by something other than a pathogen. It might result from hereditary factors, improper diet, smoking, or other factors. Those resulting from lifestyle factors are sometimes called diseases of affluence.Examples include hypertension, diabetes, cardiovascular disease, cancer, and mental health problems, asthma, atherosclerosis, allergy etc.The non-communicable diseases are spread by: heredity, surroundings and behavior.2The risks of high blood pressure and high blood cholesterol, tobacco and alcohol consumption, obesity and physical inactivity were more commonly associated with affluent societies.

Warning: becoming dominant in all middle and low income countries and not limited to the effluent countries. NCDs, is responsible for almost 60% of world deaths (31.7 million deaths) and 43% of the global burden of diseases.3This increase is clearly related to changes in global dietary patterns and increased consumption of industrially processed fatty, salty and sugary foods.

4NCDs Situation in Palestine:NCDs are the leading cause of death among adult population in the Palestinian society, contribute to more than 50% of causes of death among adults

common Risk factors to NCDs in Palestinian population. Tobacco consumption is among the highest in the world.

Diet rich in saturated fat, and in simple sugars, with the decreased consumption of fibers and whole grain foods has lead to the increased prevalence of these illnesses.

5Health services today will not be able to meet the challenges of (NCDs) In Palestine

Weak national data is available on the overall incidence and prevalence of NCDs.In general we depend on mortality data to estimate the impacts of these diseases.

No classification by age or gender. No any information on disabilities resulting from any of the chronic diseases

The current system counts mainly the visits of the patients to PHC centers, which does not reflect the real prevalence and incidence.

Fragmentation in reporting and managing system regarding NCDs in general.

This lack of information leads to:- Inability to estimate the cost; resources required e.g. drugs, policy; and decision making regarding prevention and treatment

6Some Continuing ChallengesLack of national policies for NCD prevention and controlLow resources for NCD prevention & control.Lack of NCD surveillance systemsFragmented and uncoordinated carePHC capacity to deal with NCDs is poor7THERE ARE HOWEVER A NUMBER OF CHALLENGES THAT WE STILL HAVE TO OVERCOME:

FIRST THERE IS A CLEAR LACK OF NATIONAL POLICIES FOR THE PREVENTION AND CONTROL OF NCDs AS HIGHLIGHTED BY THE ASSESSMENT OF NATIONAL CAPACITY FOR NCD PREVENTION AND CONTROL CARRIED OUT BY WHO IN 2001. IN FACT, THIS SURVEY INDICATED THAT LESS THAN HALF THE COUNTRIES REPORTED HAVING NCD POLICIES (43%).

FEW COUNTRIES HAVE A SPECIAL GOVERNMENT BUDGET ALLOCATION FOR NCD PREVENTION AND CONTROL. AND, LESS THAN HALF OF THE COUNTRIES SURVEYED HAVE CHRONIC DISEASE TREATMENT GUIDELINES. THE AVAILABILITY AND AFFORDABILITY OF ESSENTIAL DRUGS FOR NCDs IS VARIABLE AMONG COUNTRIES. IN GENERAL, THE PRIMARY HEALTH CARE CAPACITY TO DEAL WITH NCDs IS POOR.

THERE IS ALSO A LACK OF GOOD SURVEILLANCE SYSTEMS.

FINALLY, THERE SEEMS TO BE FRAGMENTED AND UNCOORDINATED CARE. THE PRIMARY HEALTH CARE CAPACITY OF MOST NATIONS TO DEAL WITH NCDs IS POOR.

NCD CHALLENGESCost PressuresDisease burden, interventions, drugs

Quality of CareCare teams, medical records, & financial incentives

PreventionFragmentation, lack of protocols, lack of financial incentives/supportPoverty

CHANGES NEEDEDComprehensivenessWith policy/legislation supportCoordinationInformation flowsContinuityOrganized CareCommunicationOrient. on self managementCommunity linkages8How to strengthen health systems for NCDs?Financing (increased, better and sustainedRegulation (assured quality and affordability)Service Delivery (ensured access and availability)Governance (improved performance)

9Obesity10

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12Obesity is a condition in which people have an excess of body fat. According to the National Institutes of Health, almost one-third of Americans are obese.

Obesity is growing problem across the globe.

Worldwide, more than 300 million adults are obese, according to (WHO). Obesity is the second-leading cause of preventable death in the U.S, surpassed only by smoking. At least 300,000 Americans die each year as a result of factors attributed to obesity, American Obesity Association13Obesity is a major risk factor for a number of serious health conditions, including:Coronary heart disease. Cancer. Diabetes. Fatty liver disease. Gallbladder disease.High blood pressure..Osteoarthritis. Stroke. Sleep apnea and other breathing problems.

14ClassificationObesity, in absolute terms, is an increase of body adipose tissue (fat tissue) mass. BMIBody mass index or BMI is a simple and widely used method for estimating body fat mass.15BMI is an accurate reflection of body fat percentage in the majority of the adult population. It is less accurate in people such as body builders and pregnant women in whom body composition is affected.

BMI is calculated by dividing the subject's weight by the square of his or her height:

BMI = kg / m2

16ClassificationBMIunderweightLess than 18.5normal weight18.524.9overweight25.029.9 isclass I obesity30.034.9 isclass II obesity35.039.917Questions ??

18The literature breaks down "class III" obesity into further categories:

Any BMI > 40 is severe obesity A BMI of 40.049.9 is morbid obesity A BMI of >50 is super obese

Finish19Cancer

20Cancermedical term: (malignant neoplasm) is a class of diseases in which a group of cells display uncontrolled growth, invasion and sometimes metastasis (spread to other locations in the body via lymph or blood). 21Cancer may affect people at all ages, even fetuses, but the risk for most varieties increases with age. Cancer causes about 13% of all deaths. According to the American Cancer Society, 7.6 million people died from cancer in the world during 2007.

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262006 Estimated US Cancer Deaths* (last)ONS=Other nervous system.Source: American Cancer Society, 2006.Men

Women

Lung & bronchus 26% Breast 15% 10%Colon & rectumPancreas 6% Ovary 6% 4%LeukemiaNon-Hodgkin 3% lymphomaUterine corpus 3%Multiple myeloma 2% Brain/ONS 2% All other sites 23% Lung & bronchus31%Colon & rectum10%Prostate9%Pancreas6%Leukemia4%Liver & intrahepatic4%bile ductEsophagus4%Non-Hodgkin 3% lymphoma Urinary bladder3%Kidney3%All other sites 23%

27Lung cancer is, by far, the most common fatal cancer in men (31%), followed by colon & rectum (10%), and prostate (9%). In women, lung (26%), breast (15%), and colon & rectum (10%) are the leading sites of cancer death. Cardiovascular Disease

2828Introduction Non communicable disease account for a large and increasing burden of disease worldwide. It is currently estimated that non communicable disease accounts for approximately 59% of global deaths and 43% of global disease burden. This is projected to increase to 73% of deaths and 60% of disease burden by 2020. 29Introduction, cont. The worldwide burden of cardiovascular disease is substantial. In most industrialized countries, cardiovascular disease are the leading cause of disability and death. Developing countries, with previous low rate are now seeing increased rates as economic develop, infectious disease are conquered and life expectancy improves.30 Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease). Definition 3131 CVD are present in many forms and have different categories and include:-Hypertension (high blood pressure)Coronary heart disease (heart attack)Cerebrovascular disease (stroke)Peripheral vascular diseaseHeart failureRheumatic heart diseaseCongenital heart diseaseCardiomyopathies32Risk factors for cardiovascular disease Non-modifiable Risk Factors AgeGender, men under the age 64 are much more likely to die of coronary heart disease than women, although anyone can die from it. Genetic factors/Family history of cardiovascular disease.Race (or ethnicity), Studies show that blacks are twice as likely to develop high blood pressure as Caucasians.Environment, your chances can increase because of areas with a lot of smog or other form of air pollution, including passive smoking33Risk factors, cont. Modifiable Risk Factorscigarette smoking, high cholesterol and high blood Pressure, lack of exercise, diabetes, obesity, alcohol, certain infections and inflammation, estrogens, androgens, and certain psychosocial factors.

34Risk factors for CVD in PalestineThere is little published information on the cardiovascular disease risk factors of Palestinian population.

A study done to identify the most common coronary heart disease risk factors among adult population in Gaza Strip to develop preventive health education and health promotion programs

35 This study showed that the most common identified CHD risk factors were physical inactivity 53%, hypertension and obesity 43% for each, family history 38%, diabetes mellitus 34%, high LDL 34%, elevated cholesterol level 33%, smoking 29%, low HDL 27%, hyperuricemia 25%, and elevated triglycerides level 14%36The result of previous study seems to be that most of the identified CHD risk factors could be preventable.

These results may highlight the problem as a public in nature that need community-based intervention programs integrated to health education programs. 37

Global Burden of Cardiovascular Disease

Cardiovascular disease is the number one cause of death globally and is projected to remain the leading cause of death.

An estimated 17.5 million people died from cardiovascular disease in 2005, representing 30 % of all global deaths.

Of these deaths, 7.6 million were due to heart attacks and 5.7 million were due to stroke.

3838Statistics, cont Around 80% of these deaths occurred in low and middle income countries . If appropriate action is not taken, by 2015, an estimated 20 million people will die from cardiovascular disease every year, mainly from heart attacks and strokes. (WHO, 2005)3939

Cardiovascular disease in Palestine

Cardiovascular disease (CVDs), principally heart diseases is the first leading cause of death among population in Palestine in the year 2005 exactly as it is in the whole world. This involves males and females with a proportion of 18.7% and 19.9% respectively of the total number of death in Palestine.

40 There are no available data to suggest the overall prevalence or incidence of cardiovascular disease and hypertension, we depend on mortality data from the different health centers to estimate the impact of theses diseases on society.

finish41Diabetes Mellitus42Definition of DM Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or alternatively, when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar

43Glucose Tolerance CategoriesThe Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2002;25(suppl):S5

FPG2-hr PG on OGTT 126100 and