The World Health Assembly 66 World Health Editors Network "Enter the Stadium – Democratize Knowledge – Bring it Home" Non-communicable Diseases -- Overview Professor Kathryn Taubert Chief Science Officer World Heart Federation Geneva May 19, 2013

“Today, NCDs (mainly CV diseases, cancers, chronic respiratory diseases & diabetes) represent a leading threat to human health and development. These 4 diseases are the world’s biggest killers, causing an estimated 35 million deaths each year - 60% of all deaths globally - with 80% in low- and middle- income countries.” Non-Communicable Diseases (NCDs) Dr Ala Alwan Assistant Director-General Noncommunicable Diseases & Mental Health World Health Organization --circa 2010

Noncommunicable diseases: Infectious diseases/ injuries: Deaths by cause in the world (WHO, 2008 data) Heart disease Cancer Diabetes Other chronic diseases HIV/AIDS Tuberculosis Malaria Other Infectious Diseases Injuries Total 57 M 63% (36 million) of the total deaths/year (48% of all NCDs)

The blue bars represent communicable diseases The gold bars represent NCDs Source : WHO 2008: Global Health Observatory Data Repository Non-communicable diseases (NCDs) are leading cause of death in the world 57 million total deaths/yr globally; 63% (36 million) are from NCDs

 “ NCDs hit the poor and vulnerable particularly hard and drive them deeper into poverty“  “More than 25% of those who succumb to NCDs are in the prime of their working lives, and the vast majority of these individuals are in developing countries."  “Our collaboration is more than a public health necessity. Noncommunicable diseases are a threat to development." NCDs as a Development Issue Ban Ki-moon Secretary-General United Nations

In 2009, the World Heart Federation and its sister federations the International Diabetes Federation and the Union for International Cancer Control formed the Non ‐ Communicable Disease (NCD) Alliance, joined in early 2010 by the International Union Against Tuberculosis and Lung Disease, together currently representing a network of over 2,000 civil society organizations in more than 170 countries.

In September 2011, the United Nations held a high level meeting in New York on the prevention and control of non-communicable diseases (NCDs): only the second of its kind on a health issue in history. World Heart Federation together with its NCD Alliance disease partners in cancer, chronic respiratory diseases and diabetes were instrumental in securing this meeting. In September 2011 a Political Declaration was signed by all member states and now represents the NCD Targets roadmap. Subsequently in May 2012, the World Health Assembly adopted a global target of a 25% reduction in premature mortality from NCDs by Changing the face of global health Welcome to

Hypertension Tobacco Dyslipidemia Obesity Diabetes Physical inactivity Poor nutrition Cancer CV disease Diabetes ? Modified from Taubert Nature Clin Pract CV Med, 2007

In 2008, 80% of all deaths (29 million) from NCDs occurred in low ‐ and middle ‐ income countries, and a higher proportion (48%) of the deaths in the latter countries are premature (under the age of 70) compared to high income countries (26%). According to WHO’s projections, the total annual number of deaths from noncommunicable diseases will increase to 55 million by 2030, if “business as usual” continues. NCD Burden

Non Communicable Disease A Burden particularly on the Developing World

Global NCD Action Plan Final draft

Aligning with WHO targets

Global Coalitions WHF (Cardiovascular) – IDF (Diabetes) – UICC (Cancer) – "the Union" (Respiratory)-- working together with WHO and the UN to put a global focus on non-communicable diseases

Governments/ Policy Makers United Nations/ WHO Medical/ Scientific Community Public/ Civil Society Press Winning the war on NCDs

Thank you!

POLICY POLICY MAKERS PUBLIC AWARENESS PRIORITY INTERNATIONAL SUPPORT PRESS MEDIA MEDICAL/ SCIENTIFIC COMMUNITY SCIENTIFIC EVIDENCE Working together for WAR ON CARDIOVASCULAR DISEASE Working together for WAR ON CARDIOVASCULAR DISEASE

Working with the World Health Organization (WHO): We are the only recognized cardiovascular disease NGO partner to the WHO. Special consultative status is granted to NGOs which have a special competence in, and are concerned specifically with, only a few of the fields of activity covered by the ECOSOC.

About us Membership: 200 organizations from more than 100 countries worldwide that combines the strength of cardiology societies and heart foundations. Message: cardiovascular disease, which includes heart disease and stroke, is the number one killer worldwide causing 17.3 million deaths annually. The majority of premature deaths can be prevented through controlling risk factors such as unhealthy diets, physical inactivity and tobacco use.

Strategy and goals

Fig. 1: Results of hypothetical placebo-controlled trials of a new drug for acute myocardial infarction. Barratt A et al. CMAJ 2004;171: ©2004 by Canadian Medical Association

Figure. Barratt A et al. CMAJ 2004;171: ©2004 by Canadian Medical Association

An estimated 36 million deaths, or 63% of the 57 million deaths that occurred globally in 2008, were due to noncommunicable diseases, comprising mainly cardiovascular diseases (48% of noncommunicable diseases), cancers (21%), chronic respiratory diseases (12%) and diabetes (3.5%). These major noncommunicable diseases share four behavioural risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. In 2008, 80% of all deaths (29 million) from noncommunicable diseases occurred in low ‐ and middle ‐ income countries, and a higher proportion (48%) of the deaths in the latter countries are premature (under the age of 70) compared to high income countries (26%). According to WHO’s projections, the total annual number of deaths from noncommunicable diseases will increase to 55 million by 2030, if “business as usual” continues.

Relative risk, also known as risk ratio, is the risk of an event in the experimental group divided by that in the control group. Absolute risk reduction, also termed risk difference, is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. In a trial of 441 patients at risk of developing pressure ulcers, patients were randomised to receive a sheepskin mattress overlay (intervention group) or usual treatment (control group) during their hospital stay. The absolute risk reduction can then be calculated by subtracting the proportion of patients with ulcers in the sheepskin group from that in the control group. In the trial, 10% of patients in the sheepskin group developed ulcers compared to 17% in the control group. So the risk of getting ulcers with a sheepskin overlay was 0.58 of that in the control group. 21/218 divided by 37/223 =.58 Relative risk reduction – = 42% 37/223 minus 21/218 =.07 (70%) Absolute risk: 10% 17%

UN General Assembly Resolution on NCDs Raising the priority of cardiovascular health on the global health agenda -- UN General Assembly Resolution on NCDs ♥UN Millennium Development Goals drive global development agenda ♥The NCD Alliance mobilized civil society to campaign for a United Nations (UN) Summit on NCDs ♥In May 2010, the UN voted unanimously for passage of resolution titled "Prevention and control of non-communicable diseases" whereby the UN convenes a High Level Summit (attended by heads of state or their designee) &the Sec'y General prepares a global report on NCDs. This Summit held Sept , 2011, in NYC. A political declaration/outcomes document was approved. Called for national NCD plans by 2013 with action items e.g., goals for elimination transfats, reduction in consumption of salt, sugar & saturated fats.

“These diseases are preventable. Up to 80% of heart disease, stroke, and type 2 diabetes and over a third of cancers could be prevented by eliminating shared risk factors, mainly tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol.” Dr Ala Alwan Non-Communicable Diseases (NCDs)

25 by 25 Tobacco use 30% Tobacco use 30% Physical inactivity 10% Physical inactivity 10% Raised blood pressure 25% Raised blood pressure 25% Alcohol 10% Alcohol 10% Multidrug Therapy 50% Multidrug Therapy 50% Diabetes/ Obesity 0% Diabetes/ Obesity 0% Fat intake 15% Fat intake 15% Salt/ sodium intake 30% Salt/ sodium intake 30% Essential Med/Tech 80% Essential Med/Tech 80%