BK FOUNDATION HEALTH AWARENESS - CHRONIC DISEASES JOSEPH ANA CHAIRMAN BOARD OF TRUSTEES BK EDUCATION FOUNDATION

OBJECTIVE PARTICIPANTS TO HAVE AN INCREASED AWARENESS OF CHRONIC DISEASES AND THEIR PREVENTION AND AVOIDANCE

WHAT IS KILLING PEOPLE IN THE WORLD

Global Causes of Death (2006) CHRONIC DISEASES: -Heart disease 30.2% -Cancer 15.7% -Diabetes mellitus 1.9% -Others 15.7% The total number of people dying from chronic (58 MILLION) is double that of all infectious diseases including HIV/AIDS, tuberculosis and malaria (Nature, 2007). INFECTIOUS DISEASES: -HIV/AIDS 4.9% -TB 2.4% -Malaria 1.5% -Other inf. Dses 20.9% -Injuries 9.3%

DOUBLE WHAMMY OF KILLER- DISEASES IN NIGERIA Infections Chronic disease

Maternal death 630 per 100, 1000 Infant mortality 78 per 1000 Under 5 mortality 124 per 1000 Children under 5 stunted growth 36% Burden of disease in Nigeria IN NIGERIA 2012

High Blood Pressure Diabetes StrokeAsthma Cancer CHRONICDISEASES

ADD MENTAL ILLNESS!

Did you know?? people died from chronic diseases in 2005

COMMON DENOMINATORS smoking Lack of exercise Food abuse Alcohol abuse

10 widespread misunderstandings about chronic disease - and the reality Chronic disease epidemic is rapidly evolving Global recognition and response has not kept pace Misunderstandings can be dispelled by the strongest evidence

Reality: 80% of chronic disease deaths occur in low & middle income countries

Reality: double burden = double response

Reality: chronic diseases are concentrated among the poor and chronic disease is one of the main reasons that families are pitched into poverty

Facing illness and deepening poverty

Reality: poor and children have limited choice

The next generation

Reality: 80% of premature heart disease, stroke and type 2 diabetes is preventable, 40% of cancer is preventable Heart disease Stroke Type 2 diabetesCancer 80% 20% 80% 40 % 20% 60% preventable not preventable

Reality: inexpensive and cost-effective interventions exist

Reality: these people are the rare exceptions

Reality: death is inevitable but it does not need to be slow, painful or premature

Dying slowly, painfully and prematurely

Three risk factors Three risk factors cause four chronic diseases that cause over half of deaths worldwide. The risk factors are: Tobacco use Lack of physical activity Unhealthy diet

ADDITIONALS ALCOHOL ABUSE – complex OBESITY - complex

Old and new agendas for global health acute childhood infections maternal deaths Simple technologies Rapid impact Controlled by health services Within the remit of the health campus and the health department chronic, life long infectious and non-infectious diseases Complex interventions Decades before impacts Main levers outside health service control Takes a whole university and all government!

What works? Comprehensive and integrated action is the means to prevent and control chronic diseases

Multiple interventions are effective Cigarette smoking is influenced by Fiscal measures – high taxation Advertising bans Prohibiting smoking in public places No vending machines available Health campaigns to stop smoking Transport smoking bans Campaign groups Health warnings on packets Medical advice repeatedly

Diet – changing what we eat S ource: UN FAO, 2004 Nutrition transition Worldwide, there is an accelerating move towards a diet high in saturated fats, sugar and refined foods, but low in fibre. Average food consumption per person is likely to increase from 2,680 kcal in 1997–1999 to almost 3,000 kcal by 2030.

Diet – changing what we eat Source: The Guardian, 25 April 2006 What is driving the nutrition transition? The cost of industrial fat has fallen by 50% in the last 50 years, whereas the cost of a healthy ingredient such as fruit has increased by one third. Salt provides flavour to cheap food at around $150 (£84) a tonne. Real spices cost up to $2,000 a tonne.

Diet From this… 8oz 12oz16oz 20oz 34oz

Diet … to this! 16oz 32oz 44oz52oz 64oz  50 tsp (200g) of sugar (Coca-Cola) S ource: Brownell, 2005

There are 1,144 kcal in a McDonald’s quarter- pounder with cheese, small fries and a small chocolate milkshake This is approximately 70% of the recommended daily calorie intake of a 10- year-old girl To work off 1,144 kcal, a child weighing 87 lbs would have to walk at 3 mph for about six hours Source:McDonalds; AAFP; The fitness calculator A rough example

Physical activity transition A transition in physical activity is occurring – we lead increasingly sedentary lives: desk jobs replace manual work labour-saving devices make housework easier and less time consuming transportation options remove the need to walk or cycle safety fears keep children – and older people – indoors.

Gender Age Beliefs Abilities Self-image Knowledge/ education Motivation Motivating people/orgs Motivating factors Personal characteristics Work/school Home Environmental Media Employer Media Family Community Government Colleagues Government Architects Industry Town planners Health insurers Health professionals PE / lunchbreaks Playing fields Distance to work/school Work gym Stair access Shop location Safe streets Bike paths Pavements Access to gym Green space Stairs Housework Active games Sports equipment Influences on physical activity Changing facilities Income Time Mobility Street layout Pollution Friends Teachers School governors NGOs

Lack of physical activity Source: ‘At least five a week’ – report from the CMO of England and Wales, 2004 and CDC 2002 As a result of these trends… – UK: 69% of adults and 35% of children – US: 55% of adults and 31% of adolescents – - ? Data for Nigeria … do not reach the recommended levels of physical activity.

Recommended levels of physical activity For adults – – At least 30 minutes a day of moderate-intensity physical activity on five or more days of the week. – The 30 minutes can be made up of bouts of activity of 10 minutes or more. For children and young people – – At least 60 minutes of moderate-intensity physical activity every day.

Benefits Source: ‘At least five a week’ – report from the CMO of England and Wales, 2004 Compared with people who do not reach the recommended levels of physical activity, active people have: – almost half the risk of dying from coronary heart disease – a 27% lower risk of stroke – a 33–50% lower risk of developing type 2 diabetes – 40–50% lower risk of colon cancer, and reduced risk of other cancers, e.g. breast cancer. Plus, benefits for musculoskeletal health and mental health.

Increasing physical activity No magic bullet Many interventions will be necessary Redesigning the environment will be more important than exhortation, doctors prescribing exercise, or gyms

TAKE THE STAIRS!

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A: BP<135 – reassess every 3 years 85 B: BP – high normal values 85 – 89 - reassess yearly C: 145 – 159 – Hypertension 90 – 99 (after at least three readings) ↓ Target organ damage No target organ damage CVD complications No CVD complications Diabetes No Diabetes Ten year CHD risk > 15% Ten year CHD risk < 15% ↓ ↓ TREAT OBSERVE (reassess yearly)

HYPERTENSION - MANAGEMENT -Non pharmacological therapy (for all) -Weight reduction\salt reduction/limit alcohol -Regular exercise - increase fruit & vegetable intake -Pharmacological therapy -Diuretic -Diuretic & B-blocker -Diuretic & ACE Inhibitors (except verapramil) -Calcium antagonist & B-blocker -Calcium antagonist & ACE In hibitor -A-blocker & B-blocker