Country-Level Decision Making for Control of Chronic Diseases Workshop Summary (2012) / Chapter Skim
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2 Progress, Needs, and Lessons Learned: Perspectives from Six Countries
2 Progress, Needs, and Lessons Learned: Perspectives from Six Countries
Pages 7-28
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From page 7... ...
. Insufficient physical activity, unhealthy diets, and alcohol overconsumption are other prominent risk factors that contribute to a large portion of the global chronic disease burden globally (Alwan et al., 2011)
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These economically, geographically, and demographically diverse countries illustrated the significant variations that can exist regarding the contributions of particular diseases to national chronic disease burdens, how chronic diseases fit in with other health issues, the challenges that countries face when attempting to address chronic diseases, and the degree to which countries have or are able to address these challenges. The exploration of the progress and challenges in these countries' chronic disease efforts provided a jumping-off point to discuss the importance of local context when considering tools that might be useful to inform country-level decision making to address chronic diseases.
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From page 9... ...
Cardiovascular disease accounted for 37 percent of all chronic disease hospital deaths for the period from 2006-2010, while hypertension accounted for 26 percent, diabetes for 21 percent, and other chronic diseases for 16 percent. Cardiovascular-related deaths have increased since 2006, and diabetes deaths have increased even more sharply in that period of time.
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. NOTE: CNCD = chronic noncommunicable diseases.
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The country is politically stable and has the political will to improve in the area of health. The minister of health is "more excited about integrated primary health care than any minister had ever been in the history of Grenada," Martin said, and "we have very strong affiliations with international agencies." Looking forward, Martin concluded that the key players who can help guide progress in Grenada -- the government, the general public, the National Chronic Non-Communicable Disease Commission, the Diabetic Association, nongovernmental organizations and regional and international donors -- are in place and have begun to focus on Grenada's needs.
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From page 12... ...
Kenya has a "double burden" of disease, Yonga noted. Communicable diseases, such as malaria, HIV, and tuberculosis, are not completely under control, but the rates of noncommunicable diseases, including diabetes, heart disease, cancer, chronic injury, and neurological and psychiatric disease, have been increasing for the past two decades.
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13 PROGRESS, NEEDS, AND LESSONS LEARNED FIGURE 2-2 Estimated proportional mortality, Kenya, 2004.
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, blood pressure, and other health indicators and outcomes. In general, the common risk factors that contribute to chronic diseases in Kenya are the familiar ones: tobacco use (which is rising among schoolchildren)
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Several agencies collect data regularly: the Kenya Demographic and Health Survey, which, because of funding limitations, provides only limited health information;1 the Kenya National Health Accounts, which tracks expenditures; and the Kenya Central Bureau of Statistics, which collects vital statistics. There is currently an effort under way to broaden understanding of the significance of the chronic disease burden and to help the various stakeholders work together to develop an integrated policy on these diseases, Yonga said.
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Yonga closed with his vision for chronic disease reduction in Kenya. The nation, he hopes, will develop an integrated and coordinated national policy that provides support of public education and promotion of healthy behavior and implements cost-effective screening and intervention programs at the community level and at health institutions.
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A 2010 national survey showed that 99 percent of the population had at least one risk factor for a chronic disease, and 29 percent had three or more risk factors. Chronic diseases now account for 61 percent of the total disease burden, and underprivileged rural and urban communities bear the heaviest burden of diabetes, cardiovascular disease, hypertension, stroke, chronic respiratory diseases, and cancer.
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From page 18... ...
It also addresses occupational safety and health; climate change, water, sanitation, and other environmental health issues; emergency preparedness and response; and mental health and substance abuse. This effort will be supplemented by the Non-communicable Diseases Forum, an organization that works to reduce the burden of chronic diseases in Bangladesh by coordinating the efforts and resources of public and private health care providers and other partners such as nongovernmental organizations.2 The organization, which began its work in 2009, hopes to build awareness of these diseases, establish a database to coordinate information, and advocate for stronger policies related to chronic diseases.
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Rheumatic heart disease, for example, has a prevalence of just 0.2 or 0.3 percent. While it is important to seek data on such traditional risk factors as smoking and BMI rates, Bukhman said, it is also important to recognize that in Rwanda the noncommunicable diseases are affecting children and young adults and that they are not caused by the risk factors of affluence but rather by many of the same factors that are
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From page 20... ...
20 FIGURE 2-3 The long tail of endemic noncommunicable diseases in Rwanda. SOURCE: Bukhman (2011)
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Rwanda is known for its centralized, coordinated planning on health issues, Bukhman said, and health leaders held a summit in January 2010, with the goal of building partnerships to tackle noncommunicable diseases. A wide range of groups worked to identify national priorities based on experience in particular districts -- participants included Rwandan facilities and associations focused on particular diseases; Rwandan government; regional and international universities; and such international partners as WHO, the U.S.
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From page 22... ...
22 COUNTRY-LEVEL DECISION MAKING TABLE 2-2 Burden of Noncommunicable Diseases in Rwanda Linked to Conditions of Poverty Risk Factors Related to Condition Poverty Hematology and oncology Cervical cancer, gastric HPV, H pylori, EBV, HIV, cancer, lymphomas, hepatitis B Kaposi sarcoma, hepatocellular carcinoma Breast cancer, CML Idiopathic, treatment gap Hyperreactive malarial Malaria splenomegaly, hemoglobinopathies Psychiatric Depression, psychosis, War, untreated chronic somatoform disorders diseases, undernutrition Schizophrenia, bipolar Idiopathic, treatment gap disorder Neurological Epilepsy Meningitis, malaria Stroke Rheumatic mitral stenosis, endocarditis, malaria, HIV Cardiovascular Hypertension Idiopathic, treatment gap Pericardial disease Tuberculosis Rheumatic valvular disease Streptococcal diseases Cardiomyopathies HIV, other viruses, pregnancy Congenital heart disease Maternal rubella, micronutrient deficiency, idiopathic, treatment gap Respiratory Chronic pulmonary disease Indoor air pollution, tuberculosis, schistosomiasis, treatment gap Renal Chronic kidney disease Streptococcal disease Endocrine Diabetes Undernutrition Hyperthyroidism and Iodine deficiency hypothyroidism Musculoskeletal Chronic osteomyelitis Bacterial infection, tuberculosis Musculoskeletal injury Trauma Vision Cataracts Idiopathic, treatment gap Refractory error Idiopathic, treatment gap Dental Caries Hygiene, treatment gap NOTE: CML = chronic myeloid leukemia; EBV = Epstein-Barr virus; HIV = human immunodeficiency virus; HPV = human papillomavirus.
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From page 23... ...
Other noncommunicable diseases have similarly high rates of prevalence: 36.1 percent for hypertension, 85.6 percent for central obesity, 24 percent for adolescent obesity, and 20 percent for coronary heart disease. Kerala also has a very high suicide rate, particularly for males (44.7 per 100,000 people, as compared to 26.8 for females)
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As is the case with other low-income countries, India has the double burden of infectious disease and noncommunicable ones. Leprosy, malaria, and other diseases are largely under control, but newer ones such as hepatitis, hemolytic fevers, H1N1, and leptospirosis have brought a new burden -- and perhaps taken some attention away from chronic diseases.
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The main network goes down through the community health centers." For Hariharan, the primary conclusion from a regional perspective is "You cannot depend only on the government, only on society, or only on a single community." A multipronged approach to preventing chronic diseases is needed, one that involves a strong public health policy at the national level (to focus on changing personal behavior and improving the environment for healthy life choices) ; strong community-based programs; and clinical preventive services.
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From page 26... ...
For example, those in the lowest educational category have three times more cardiovascular disease than those in the highest education group, and they are roughly twice as likely to be obese or have diabetes. Chile has a national health service that was modeled after the one in the United Kingdom.
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From page 27... ...
The lack of resources and capacity across all aspects of the systems and areas of expertise required to manage chronic disease also complicate efforts to advocate for policies and programs. This lack of resources and capacity is especially challenging when countries face the double burden of communicable and chronic diseases.
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