1. Noncommunicable Diseases: An Overview
Dr Ala Alwan
Assistant Director General
World Health Organization

2. What do we mean by "noncommunicable diseases"?
Magnitude and socioeconomic impact of NCDs
The global vision and the plan
Where are we now in implementing the vision
Translating the Global Action into national action

3. Scope Noncommunicable diseases (NCDs):
Cardiovascular diseases (e.g. heart diseases, stroke)
Cancers
Diabetes
Chronic respiratory diseases (e.g. asthma)
Risk factors for noncommunicable diseases:
Tobacco use
Unhealthy diet
Physical inactivity
Harmful use of alcohol

4. Main data sources
Action Plan of the Global Strategy for the Prevention and Control of NCDs
WHO Global Burden of Disease (2004 update published in October 2008)
WHO Global Health Risks (published in October 2009)
Further analysis on the burden of noncommunicable diseases based on the WHO Global Burden of Disease

5. Distribution of age at death and numbers of global deaths (2004)

6. Per cent distribution of age at death by WHO region (2004)

7. The global burden of non-communicable diseases (based on the 2004 update of the Global Burden of Disease)

8. Please download at:

9. Total number of deaths in the world
Source:
10%
Total number of deaths in the world
60 million
5.8 M
50 million
26.0 M (above the age of 60)
40 million
35 million (60% of all deaths)
30 million
9.0 M
(below the age of 60)
20 million
18.0 M
10 million
This is the current picture on the magnitude based on the 2004 GBD update. Nearly 60 per cent of all deaths in the world are due to NCDs. 35 million people die in the world every year because of NCDs % of deaths are caused by the four major groups of NCDs that are the focus of the GS. This number includes 9 million people who die from NCDs before the age of 60, most of them are I developing countries.
Group III - Injuries
Low-income countries
Group II – Other deaths from noncommunicable diseases
Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

10. Total number of deaths in the world
Source:
25 million
2.3M
6.8 M
20 million
2.3M
3.7M
15 million
10.2M
13.6M
10 million
0.5M
5.9M
0.6M
3.3 M
3.0M
3.3M
3.0M
0.9M
1.1M
My second point. This slide illustrates the same points. Most premature deaths from NCDs are in the lowest income countries.This also means that the majority of deaths from NCDs below the age of 60 are now occurring among people who live in the poorest countries.
High-income countries
Upper middle-income
Lower middle-income
Low-income countries
Group III - Injuries
Low-income countries
Group II – Other deaths from noncommunicable diseases
Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

11. 70% of the global burden of premature deaths from NCDs (22 countries)
Low- and middle-income countries which are most affected
70% of the global burden of premature deaths from NCDs (22 countries)
Afghanistan
Bangladesh
Brazil
China
DR Congo
Egypt
Ethiopia
India
Indonesia
Iran
Mexico
Myanmar
Nigeria
Pakistan
Philippines
Russian Federation
South Africa
Thailand
Turkey
Sudan
Ukraine
Vietnam

12. Total number of deaths in low- and middle-income countries (2004)
The magnitude in 144 low- and middle-income countries
60 million
10%
50 million
5.3 M
34%
28%
40 million
14.2 M
30 million
14.0 M
28%
20 million
17.4 M
Omitted from the MDGs:
14.0 million premature deaths from non-communicable diseases
10 million
Source:
Total number of deaths in low- and middle-income countries (2004)
Low-income countries
Group III - Injuries
Group II – Other deaths from non-communicable diseases
Group II – Premature deaths from non-communicable diseases (below the age of 70), which are preventable
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

13. Percentage of deaths in selected countries
Source:
Percentage of deaths in selected countries
100%
80%
60%
40%
20% 0%
Benin
Bhutan
Bolivia
Egypt
Ghana
Kenya
Nepal
Zambia
Denmark
Uganda
Nicaragua
Tanzania
Viet Nam
Bangladesh
Burkina Faso
Mozambique
In all Denmark's 15 priority countries for bilateral assistance, there are also new perspectives. The health and disease profile in these 15 developing countries is rapidly changing. You can see her that premature deaths from NCDs is significant in all of Denmark's 15 priority countries. Indeed, 5 million people die every year in these 15 developing countries. Half of them die from Group I diseases, 40% die from NCDs and 10% from injuries. If we look at the more than 2 million people dying from NCDs, more than 700,000 die every year before the age of 60 (or 1.2 million before the age of 70). In other words, one-third of the people who die from NCDs in these 15 countries die before the age of 60.
Group III - Injuries
Low-income countries
Group II – Other deaths from noncommunicable diseases
Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

14. Deaths in Africa* (2004) 7% 0.9 0.9 17% 1.4M 2.2M 2.2M (<70)
14,000,000 7%
12,000,000
0.9
0.9
17%
1.4M
2.2M
10,000,000
2.2M (<70)
11% (<60)
1.4M (<60)
65%
8,000,000
8.1M
8.1M
Lower margin
6,000,000 7%
11%
4,000,000
17% (<70)
Source:
2,000,000
65%
Upper margin
Lower margin
Upper margin
Low-income countries
Group III - Injuries
Group II – Other deaths from non-communicable diseases
Group II – Premature deaths from non-communicable diseases (below the age of 60 (left) or 70 (right))
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

15. More women aged 15-59 years die from NCDs in Africa than in high-income countries
And just to highlight this point, we can see from available data that more women aged die from NCDs in Africa than in high income countries. According to the 2004 GBD data, 2.4 m adult women died from NCDs in africal compared to 1.1 m in high income countries

16. Low- and middle-income countries
Breakdown of deaths from non-communicable diseases 6% 6% 4% 3% 3% 3%
12%
13%
50%
49%
27%
25%
All countries
Low- and middle-income countries
Cardiovascular diseases
Cancers
Respiratory diseases
Diabetes
Mental health conditions
Other NCDs

17. Age-standardized DALYs for noncommunicable diseases (2004)

18. Please download at:

19. The 10 leading risk factor causes of death (2004)

20. Key findings
High blood pressure is the leading risk factor for mortality, responsible for 13% of deaths globally
Low fruit and vegetable intake, lack of exercise, alcohol and tobacco use, high BMI, high cholesterol, high glucose, and high BP are responsible for more than half of the deaths due to heart disease
Tobacco is responsible for 5.1 million deaths. Almost 1 in 8 deaths of adults over the age of 30 is due to smoking
Being overweight or obese is the fifth leading risk for death, responsible for 7 per cent of deaths globally
Unsafe sex, which leads to transmission of human papillomavirus, is responsible for deaths due to cervical cancer. Cervical cancer is the leading cause of cancer death in Africa.

21. Attributable Mortality Attributable DALYs
Leading causes of attributable global mortality and burden of disease (2004)
Attributable Mortality
Attributable DALYs %
High blood pressure
Tobacco use 8.7
High blood glucose
Physical inactivity
Overweight and obesity
High cholesterol
Unsafe sex
Alcohol use 3.8
Childhood underweight
Indoor smoke from solid fuels 3.3
59 million total global deaths in 2004 %
Childhood underweight 5.9
Unsafe sex 4.6
Alcohol use 4.5
Unsafe water, sanitation
High blood pressure 3.7
Tobacco use 3.7
Suboptimal breastfeeding 2.9
High blood glucose 2.7
Indoor smoke from solid fuels 2.7
Overweight and obesity 2.3
1.5 billion total global DALYs in 2004

22. Deaths attributed to 19 leading factors (2004)

23. Percentage of DALYs attributed to 19 leading risk factors (2004)

24. Tobacco Rising production and consumption in developing countries
It is a shifting epidemic where both production and consumption of tobacco are progressively increasing in developing countries. The industry is skilful in marketing strategies and many countries are unfortunately doing very little to counteract.. 24

25. Tobacco: The poor and uneducated are the ones who smoke the most
Smoking prevalence in Bangladesh (1995)
We also know that smoking prevalence is influenced by social determinants. Here is an example of the impact of education and income The poor and uneducated are the ones who smoke the most
Source: Sen, B & Hulme D, 2004

26. Overweight and obesity in people over 15 selected countries
Just to provide examples of other risk factors-overweight and obesity are now showing very high rates in both industrialized and developing nations. This shows selected countries with very high rates which are still increasing particularly in LMICs. Around 22 million children under 5 are overweight today. Unlike most adults, children cannot choose the environment in which they live in or the food that they eat. You can see here countries of the regions with the highest rates of overweight and obesity

27. Eastern-Mediterranean
Prevalence of obesity, ages 30+ (2004)
male
female
South-East Asia
Western Pacific
Africa
Eastern-Mediterranean
Europe
Americas
30%
20%
10% 0%
10%
20%
30%
Source:

28. Prevalence of obesity, ages 30+ (2015)
male
female
46%
29%
30%
13% 9% 6%
32%
21%
12% 5% 3%
Americas
Europe
Eastern-Med
Africa
West Pac
SEA

29. Source: International Diabetes Federation's Diabetes Atlas
The top-10 countries reported to have the highest diabetes prevalence are countries in developing regions of the world.
( )
( )
All the ten countries with the highest rates of diabetes in the world are developing countries. In some of these countries up to 30% of the adult population suffer from diabetes. Projections for 2030 are very worrying
Source: International Diabetes Federation's Diabetes Atlas 29

30. Global projections (2004 to 2030)12
Cancers 10
Ischaemic HD
Stroke 8
Deaths (millions) 6
Acute respiratory infections 4
Road traffic accidents
Perinatal 2
HIV/AIDS TB
Malaria
2000
2005
2010
2015
2020
2025
2030

31. Projections for the future
Death from noncommunicable diseases
Increases (in percentage and millions) in 2015 vs 2004
30%
2.5M
25%
2.0M
20%
1.5M
15%
1.0M
10%
Source:
0.5M 5% 0%
Africa
Americas
Eastern
Med
Europe
South-
East
Asia
Western
Pacific
Africa
Americas
Eastern
Med
Europe
South-
East
Asia
Western
Pacific

32. Mortality: Global projections (2004 to 2030)
Intentional injuries
Other unintentional 25
Road traffic accidents
Other NCD 20
Cancers
Deaths (millions) 15
CVD 10
Mat//peri/nutritional 5
Other infectious
HIV, TB, malaria
2004
2015
2030
2004
2015
2030
2004
2015
2030
High-income
countries
Middle-income
countries
Low-income
countries

33. What will happen if nothing is done now?
Projections of estimated deaths from noncommunicable diseases (millions)
Africa
The Americas
Eastern Med.
Europe
South East Asia
Western Pacific
World
2004
2.8
4.7
2.2
8.1
7.7
9.4
35.0
2015
3.5
5.5
2.7
8.6
9.5
11.4
41.2
2030
4.9
7.1
3.8
8.5
12.6
14.6
51.6
Source: 33

35. Why low- and middle-income countries are disproportionally affected

36. Poverty contributes to NCDs and NCDs cause poverty
NCDs and Development
Poverty contributes to NCDs and NCDs cause poverty
Poverty at household level
Populations in low- and middle-income countries
Population ageing and Increased exposure to common risk factors
Loss of household income
Noncommunicable diseases
Limited access to effective and equitable health-care services
We have also managed to secure a better understanding over the past 21 months of why the epidemic of non-communicable diseases is growing faster in developing countries. First, populations in low- and middle-income countries are more exposed to four main shared modifiable risk factors for non-communicable diseases than in industrialized countries. Secondly, people in low- and middle-income countries are often faced with health systems which do not respond effectively and equitably to the health-care needs of people with non-communicable diseases. Thirdly, we have not yet fully mapped the emerging epidemic yet in low- and middle-income countries and more multidimensional and multisectoral research is needed to strengthen the evidence base for cost-effective prevention and control strategies. And that brings me to my next point.
More than 8 million people die before the age of 60
in developing countries from noncommunicable diseases

37. The poorest people in developing countries are often affected the most
The poorest people smoke the most, often spending more than 10 per cent of their household income on tobacco 45
Smoking prevalence
Lowest household income quintiles 40 35 30 25
Highest household income quintiles % 20 15 10 5
Low-income countries
Lower-middle
Upper-middle-income
High-income
Income

38. The poorest people in developing countries affected the most
The cost of caring for a family member with diabetes can be more than 20 per cent of low-income household incomes in developing countries
The cost per year of diabetes care at household level
Insulin
Syringes
Testing
Consultation
Travel
Total cost
% of per capita Income
Mali (2004)
38%
34% 8% 7%
12%
$339.4
61%
Mozambique (2003) 5%
24% 1% 9%
$273.6
75%
Nicaragua (2007) 0%
73%
27%
$74.4
Zambia (2003)
63% 6%
$199.1
21%
Vietnam (2008)
39% 3%
46%
$427.0
51%

39. Percent and number of men with and without CVD experiencing catastrophic spending and impoverishment- 2005
Number – 2.0 million million
affected
This figure illustrates the increase in life expectancy between 1960 and 2002 according to different income groupings of countries.
Source: Mahal et al 2010
Catastrophic spending >30% HH income in one year; Impoverishment from above poverty line to below during year

40. Source: Mahal et al 2010
Catastrophic spending >30% HH income in one year; Impoverishment from above poverty line to below during year

41. NCDs and Development Conclusions
The premature death, the morbidity and disabilities caused by NCDs lead to lost productivity
Families with members who have NCDs are at increased financial risk and are more likely to be exposed to catastrophic spending and impoverishment
NCDs impede poverty reduction efforts

42. The macro-economic impact of NCDs
Oil and gas price spike
Retrenchment from globalization
Asset price collapse
NCDs
Fiscal crisis
Flu pandemic
World Economic Forum: Global Risk Assessment 2009
Food crisis
Infectious disease

43. Key messages
NCDs are already leading health problems in almost all countries and their magnitude is still increasing
Shared risk factors
Premature deaths
The poor are disproportionately affected
Negative impact on socioeconomic development
As countries continue to develop, market forces will further promote unhealthy patterns.
Action is urgently needed