Demography and Alzheimer’s Disease: The 21st Century Fiscal Nightmare 7th World Ageing and Generations Congress University of St. Gallen August 31, 2011

The Good News Global Health Community Committed to Action on NCDs. 2

World Economic Forum 2009 Report “Non-communicable diseases are among the most severe threats to global economic development, more likely to be realized and potentially more detrimental than fiscal crises, natural disasters, or pandemic influenza.” 3

Rate of Chronic Conditions Men Women 40 30 20 10 Rate per 1,000 Spain <18 18-49 50-64 65-74 75+ Ages Source: NCHS, 1999 4

Estimated number of people with diabetes (millions) Age as a Driver of NCDs: Diabetes Developed Countries Estimated number of people with diabetes (millions) “The number of people with diabetes in the world is expected to approximately double between 2000 and 2030, based solely on demographic changes.” Source: Global Prevalence of Diabetes, Diabetes Care, 2004 5

Projected Cumulative CVD Mortality Age as a Driver of NCDs: CVD Projected Cumulative CVD Mortality (2000 to 2030) Source: American Heart Association, FusterV et al. Circulation 2007;116:1966-1970 6

% Prevalence of Sarcopenia Age as a Driver of NCDs: Sarcopenia % Prevalence of Sarcopenia “The prevalence of sarcopenia in the population above the age of 60 years varies between 10% and 60%.” Source: Baumgartner et al. Am. J Epidemiol, 1998 7

Age as a Driver of NCD’s: Alzheimer’s and Dementia Under 65 65-74 75-84 85+ 400 350 300 250 200 150 100 50 Cases per 1,000 Source: National Center for Health Statistics, 1999 8

NCDs Related to 21st Century Transformational Change “Non-communicable diseases are intricately linked to globalization, urbanization, and demographic and lifestyle transitions — all ubiquitous forces.” - “Global Non-communicable Diseases — Where Worlds Meet,” New England Journal of Medicine 9

The Bad News: AD/Aging Gap The Good News The global health community is committed to NCDs. The Bad News: AD/Aging Gap Driven by Political Agendas Missing Key Drivers of Aging and Alzheimer’s Research and Patient Needs Unmet 1010

UN Resolution on NCDs “Underscoring the need for concerted action and a coordinated response … to adequately address the … challenges posed by non-communicable diseases, in particular the four most prominent non-communicable diseases, namely, cardiovascular diseases, cancers, chronic respiratory diseases and diabetes,…. Decides to convene a high-level meeting of the General Assembly in September 2011, with the participation of Heads of State and Government, on the prevention and control of non-communicable diseases…” 11

NCD Interest Explodes “Four major risk factors that contribute to non-communicable diseases: tobacco use; diets high in fats, salt and sugar; the harmful use of alcohol; and physical inactivity.” – Seoul Declaration on Non-communicable Disease Prevention and Control in the Western Pacific Region, World Health Organization “Six risk factors associated with non-communicable diseases as the leading global risk factors for death: high blood pressure, tobacco use, high blood glucose levels, physical inactivity, overweight or obesity, and high cholesterol levels.” – World Health Organization 2009 “Trends also suggest that the major risk factors for non-communicable diseases — hypertension, high glucose levels, obesity, and inactivity — are on the rise, especially in developing countries.” – New England Journal of Medicine, 2010 “NCDs share the common risk factors of tobacco use, unhealthy diet and physical inactivity.”                              – NCD Alliance 12

WHO Risk Factors: Potato Chips, Soda and Alcohol Deaths (millions) Percentage of Total High blood pressure 7.5 12.8 Tobacco use 5.1 8.7 High blood glucose level 3.4 5.8 Physical inactivity 3.2 5.5 Overweight and obesity 2.8 4.8 High cholesterol level 2.6 4.5 Unsafe sex 2.4 4.0 Alcohol use 2.3 3.8 Childhood underweight 2.2 Indoor smoke from solid fuels 2.0 3.3 13

OECD Weighs-In: Tobacco, Environment and Foods Leading Risk Factors, High Income Countries Source: OECD Economics of Prevention, 2011 14

Media Attention To Cost of NCDs YES, BUT… It is projected that in the next 10 years, China, India, and Britain will lose $558 billion, $237 billion, and $33 billion, respectively, in national income as a result of largely preventable heart disease, strokes, and diabetes. In the United States, cardiovascular disease and diabetes together cost the country $750 billion annually. 15

ALZHEIMER’S 16

Transforming Our Thinking New Framing: Risk Factors Prevalence/Cost New Metric: Death Healthy and Active Aging New Model: Tobacco Polio or HIV/AIDs New Impact: Silo Holistic New Motivation: Political Health/Fiscal Sustainability 17

“Landmark Report Reveals Massive Global Cost Of Alzheimer's: 1% Of Global GDP - And Growing” World Alzheimer Report 2010 revealed worldwide costs of dementia to exceed US$604 billion. The number of people with dementia will double by 2030, and more than triple by 2050. The costs of caring for people with dementia are likely to rise even faster than the prevalence - especially in the developing world. Aligned to most profound socio-economic phenomenon of the 21st century: Aging Populations 18

Building the Base Data and Research: ‘09/’10 ADI Studies Policy Elites: "Alzheimer's Disease is the 21st-Century Fiscal Crisis“ – November 2010 National Alzheimer’s Plans: France to India, Australia to Japan, Korea to Sweden and now the U.S. through NAPA NGOs Represent a Global Voice and MDGs 19

Governments and Stakeholders Getting It Right Highlight the Truth NCD Alliance UN Process Global Attention Media Data and Analysis Reporting and Editorial Pages Fiscal and Economic Concerns On Behalf of Patients and Caregivers Governments and Stakeholders 20

Outcomes Document Finds Alzheimer’s “Note also with profound concern that non-communicable diseases are among the leading causes of preventablemorbidity and of related disability”  “Recognize that mental and neurological disorders, including Alzheimer’s disease,are an important cause of morbidityand contribute to the global NCD burden...” “Recognize that...poverty, uneven distribution of wealth, lack of education, rapid urbanization and population ageing...are among the contributing factors to the rising incidence and prevalence of NCDs.” “Pursue comprehensive strengthening of health systems that…recognizes the importance of the life course approach…” 21

United Nations High-level Summit on Non-communicable Diseases Stay Tuned… United Nations High-level Summit on Non-communicable Diseases September 19-20, 2011