1. NCD in Bulgaria Assoc. Prof. Plamen Dimitrov, MD, PhD
Assoc. Prof. Zdravka Valerianova, MD, PhD

3. Mortality by causes in Bulgaria
Cancer
CVD
Digestive system
External causes
Endocrine system
Respiratory system
Symptoms, undefined conditions
Other
Source: National Statistical Institute, Bulgaria

4. Trends in mortality by selected causes in Bulgaria and EU
Source: HFA-DB, WHO/EURO, 2010

5. NCD situation in Bulgaria
Total NCD deaths (‘000s)
NCD deaths under age 70 (percent of all NCD deaths)
Age-standardized death rate per 100,000 (Males)
Age-standardized death rate per 100,000 (Females) m f
All NCDs CA
COPD
CVD and diabetes
53.2
50.6
40.0
21.0
849.2
179.1
26.3
566.6
513.9
100.6
10.8
367.7
Source: Global status report on noncommunicable diseases WHO

6. NCD situation in Bulgaria
Age-standardized mortality rates by cause
(per population)
Communicable diseases - 31
Noncommunicable diseases - 693
Injuries - 42
Distribution of years of life lost by broader causes (%)
Communicable diseases - 5
Noncommunicable diseases - 86
Injuries - 9
Source: World Health Statistics 2010

7. Change in structure of leading causes of death with the advancement of age in Bulgaria, in 2002
Source: Project HEM – Closing the Gap – funded by the European Union (grant agreement no: ) and from the Ministry of Science and Higher Education of Poland (grant agreement no:167/PUBLIC HEALTH/2006/7)

8. Prevalence of selected risk factor in Bulgaria
Men
Women
Total
Rank in WHO/EURO
Smoking
41.9
27.2
34.3
M-10
F-4
Low physical activity
24.6
31.8
28.4
M-27
F-23
Obesity
23.1
24.3
23.7
High blood pressure
52.6
50.3
51.4
M-7
F-7
Source: Global status report on noncommunicable diseases WHO

9. Proportion (%) of tobacco-related deaths by age groups among men in 2002
Lung cancer All cancers CVD
age35-44
age45-64
age64+
Source: Project HEM – Closing the Gap – funded by the European Union (grant agreement no: ) and from the Ministry of Science and Higher Education of Poland (grant agreement no:167/PUBLIC HEALTH/2006/7)

10. Structure and organization involved in prevention services and resources available
Ministry of Health
National Centers within MoH (NCPHA, NCRRP, NOC, etc.)
Regional Health Inspectorates
Resources
Financial resources - MoH funds National Programs
Human resources – Since 2001 Medical University offer MPH program. Training of staff involved in prevention activities – trainings in the National Centers, Medical Universities, international training, etc.

11. Risk factor surveys National International
National Risk factor survey
CINDI health monitor – 2002, 2004, 2008
International
GYTS
ESPAD
Childhood obesity surveillance initiative
EHIS
others

12. National strategies and programs
National Health Strategy – strategic aim 1 – Ensuring conditions for health promotion and disease prevention
CINDI - Country-wide Integrated Noncommunicable Diseases Intervention program
National Action Plan on Foods and Nutrition
National Program on Tobacco Control
National Program against osteoporosis
National Mental Health Policy
Under development –
Action plan on health enhancing physical activity
National Program on Alcohol control an prevention

13. Early detection, screening
Project of MoH for screening STOP and GO (for check-up)
Funded by Operational Program “Human resources
Activities
Establishment of National Screening Registry
Media Campaigns
Screening of breast cancer, cervical cancer and colorectal cancer.

14. Few selected achievements in tackling NCDs and their risk factors
Success in implementation of CINDI – for the period of 10 years:
Increase the percentage of persons controlling main risk factors for NCD, Decrease of population levels of blood pressure, cholesterol, Increase the percentage of persons with normal BMI, Decrease number of persons with increase BMI, Increased physical activity, Decrease of alcohol consumption
Tobacco ban legislation, National Program on tobacco control
Introduction of healthy nutrition in schools – Regulation on nutrition in schools

15. Some main challenges Intersectoral collaboration
No national strategy on NCD
No programs/plans on any of 4 main NCD (CVD, Cancer, Diabetes, COPD)
On risk factors – two national programs – tobacco and foods and nutrition. Currently Plan on Physical activity is under development; on alcohol – the plan is waiting its approval by MoH
Disproportionate funding for Public Health, comparing with funding for medical treatment.
In the last few years all preventive programs/plans have not been funded, or have been funded only very limited
No population based screening program for selected cancer sites
NCD information system is lacking and no monitoring and evaluation of the preventive programs

16. Few selected lessons learnt over the last 5 years
NCD should be put on the top agenda in the society
Integrated approach – intervention at several risk factors
Intersectoral collaboration is necessary for success of the NCD prevention and control. Health sector is leader, but other sectors has to be involved
Need to mobilize resources of the society, including NGOs, Academia, Business, Local authorities, etc.
International collaboration and usage of international experience is crucial
Combination of various strategies, including policy development, capacity building, partnership and information support at all levels

17. Few selected main next steps
National NCD strategy
Programs on Cancer/CVD/Diabetes/COPD prevention and control
Continuation of the Programs on control of the main risk factors – tobacco, alcohol, physical activity, unhealthy nutrition
Integration of prevention services into primary health care