GCH CHAPTER 13

Non-communicable disease

1.) cant be spread from person to person nor animal to animal 2.) Tend to last a very long time 3.) they can be disabling, cause serious impair ability of people to engage in day to day activities. (MOST COMMON PHRASES associated with these disease are CHRONIC Disease and DEGENERATIVE disease).

Where is the burden of disease more non-communicable than communicable

Africa

Tobacco Use

Costs of smoking ranges from .1 to 1.1% of GDP of high income economies. This is most likely as high in low and middle income countries. If trends continue then 150 million people will die of smoking related causes between 2000 and 2025.

Costs of NON Communicable disease generally

Costs: =direct costs of treating the disease =indirect cost of lost productivity =***Low and middle income countries face simultaneous problem of non communicable and communicable disease

Cardiovascular Disease

Ischemic heart disease caused 7 million deaths in 2010 globally. Stroke was the second leading cause of death in 2010 but it was the number one cause of death in low and middle income countries. Ischemic heart disease was also the leading cause of DALYs in all regions while stroke was the 3rd leading cause of DALYs in all regions. (For high income countries, ischemic heart D is the leading cause of DALYs and stroke is the 2nd leading cause of DALYs. RISK FACTORS= =men have higher rates =family history =aging =ethnicity =hypertension =tobacco use =bad diet(high cholesterol) =lack of physical activity =excess alcohol consumption Costs and consequences= Both direct cause of diseases and also indirect productivity costs.

Alcohol use

Makes up .7% of DALYs worldwide (.6% in low and middle income countries and 1.5% in high income countries). High risk drinking is 20 grams or more per day of pure alcohol for women and 40 grams for men. XHormonal problems, hypertension,liver damage,pancreatic damage,and heart disease.X XXEurope and Central Asia have the highest rates of high risk drinking with about 21 percent between ages 45 to 59.XX Costs and consequences: very little data exists. 2009 study says costs were greater than 1% of GDP in all countries.

Mental Disorders

Most common are= unipolar depressive disorder, anxiety disorders, bipolar affective disorder, and schizophrenia, alcohol use disorders, drug use disorders, and persuasive development disorders. Facts: 7.4% of all DALYs in low and middle income countries occurs due to mental disorders in 2010. Only four disorders contribute to the majority of the burden of disease, these are, Unipolar Depressive disorders, schizophrenia, anxiety disorders, and bipolar affective disorder. Difference between catogories: 1.) In low/middle income countries they represent 4.5 % of DALYs and in high income countries 8% of DALYs. 2.) Women suffer 7.2% DALYs from mental disorders compared to men 4.6%. 3.) For ages 15-49 mental disorders are highest cause of DALYs worldwide.

Diabetes

Two types: Type 1 and Type 2 Type 1: autoimmune disorder that attacks the cells that produce insulin Type 2: have insulin in body but not enough. Prevalence of Diabetes (International Diabetes Federation Regions): 1.) North America and the Caribbean 2.) Middle east and North Africa 3.) Western Pacific 4.) South east Asia 5.) South and Central America 6.) Europe 7.) Africa Facts: diabetes was the 8th leading cause of death in high income countries and the 10th leading cause of death in low and middle income countries. 80 percent of deaths from diabetes occur in low and middle income countries. 1/3 of people with diabetes have some disability. Diabetes Complications: 1.) blindness 2.) kidney problems 3.) circulatory problems(stroke, coronary heart disease). Risk factors: Type 1: family history, environmental factors, infections, increased weight and height development. Type 2: family history, diet and physical activity, obesity, insulin resistance, ethnicity, age. Costs and consequences: direct costs vary between 2.5 percent and 15 percent. Latin America and Caribbean region have the highest expenditure on diabetes per capita and sub Saharan Africa has the lowest expenditure. : indirect costs are loses in productivity, mostly costs as high as $39000 per year.

Adressing NON communicable Disease

United Nations held a meeting in 2011 to adress Non communicable disease and they determined that countries must take these steps 1.) Focus on prevention and the main risk factors of tobacco, alcohol, dietary risks, and lack of physical activity. 2.) Engaging all goverment parties in battle against NCDs. 3.) Increasing funding to adress NCDs. Tobacco use: 1.) Tax tobacco at higher rates 2.) Legal restrictions on smoking 3.) Ban of cigarette advertising Alcohol: 1.) Few countries have good efforts to reduce alcohol consumption 2.) Tax alcohol consumption but realize the impact of illicit or illegal consumption 3.) Limit hours of service for alcohol 4.) Step wise approach to reducing alcohol use. High Blood Pressure, High Cholesterol, and Obesity: 1.) Food labeling 2.) Reduce sugar and salt in foods 3.) Mass health education programs 4.) Public policies and community efforts that promote physical activity Diabetes: 1.) Type 1 diabetes: No evidence that type 1 diabetes can be prevented. 2.) Type 2 diabetes: avoiding being overweight is the MOST important way to prevent type 2 diabetes. 3.) Treatment of type 1 diabetes by insulin is COST EFFECTIVE. 4.) FOR DIABETICS ITS COST EFFECTIVE TO CONTROL HYPERTENSION. Cancer: 1.) FIRST PRIORITY: Tobacco control 2.) Adress infectious disease that lead to cancer like H pylori. 3.) Prevention is more cost effective along with early detection Mental Disorders: WHO recommendation: 1.) Have a unit of goverment responsible for mental health. 2.) Have a budget for mental health programs. 3.) Train primary healthcare workers in mental health. 4.) Integrate mental health into primary healthcare program. 5.) Community based approach to psychosocial support.

Vision and Hearing Loss

Vision loss: Major reasons for vision loss are near and farsightedness and astigmatism(responsible for 43% of vision loss), Unoperated cataract (33%). Leading cause of blindness is unoperated cataracts. Over 80% of vision loss can be prevented. Most people who suffer from vision loss live in low and middle income countries (90%). X 5% of worlds population has disabling hearing loss. Costs and consequences: = children miss school, difficulty finding employment

Cancer

a unique challenge since many forms exist. Leading forms of cancer= 1.) Lung cancer 2.) breast cancer 3.) colorectum cancers Incidence is highest in high income countries but death rates are still highest in low and middle income countries. Facts: cancer made up 15 percent of all deaths in the world for both genders in 2010. Cancers make up 15 % of all deaths and 7.6 % of DALYs worldwide. This means that cancer is the second leading cause of death globally after cardiovascular disease. For all forms of cancers combined, it is the second leading cause of DALYs in the world. Greatest risk factor for cancer is tobacco use.

Most common non communicable disease in low and middle income countries

cardiovascular disease, cancer, mental disorders, musculoskeletal disorders, diabetes, and chronic respiratory disease