1. Non communicable diseases Thomas Abraham

2. What are non- communicable diseases? How big a problem are they? Sources of information Challenges in reporting non-communicable diseases

3. What are NCDs? Diseases or conditions that are not transmissible, or caused by injury Cardiovascular disease, cancer, diabetes, chronic respiratory diseases ( asthma, other pulmonary diseases)

4. Distribution of deaths by leading cause groups, males and females, world, 2004

6. Leading causes of disease burden for women aged 15–44 years, high-income countries, and low- and middle-income countries, 2004

7. Poor countries face a “double burden” of disease: both infectious diseases as well as a growing burden of non-communicable diseases.

8. http://www.who.int/cardiovascular_diseases /resources/atlas/en/ http://www.who.int/cardiovascular_diseases /resources/atlas/en/

18. Cause, effect and risk factors When a direct cause and effect cannot be established, but there is a strong statistical relationship between a disease and an agent, the agent is a risk factor. Cholesterol, elevated blood pressure, and obesity are risk factors for coronary disease We do not know if they directly cause heart disease, but they increase the risk of getting heart disease. Eg. You can have low cholesterol levels and have coronary artery disease; you can have high cholesterol and not have coronary artery disease.

19. Cancer- the emperor or all maladies 7.6 million deaths (around 13% of all deaths) in 2008. -lung (1.37 million deaths) -stomach (736 000 deaths) -liver (695 000 deaths) -colorectal (608 000 deaths) -breast (458 000 deaths) -cervical cancer (275 000 deaths)

22. What is cancer? Arises from a single cell- rapid creation of abnormal cells that grow and can spread to other organs and parts of the body (metastasis) Also known as malignant tumours, neoplasms Stages: normal- pre cancerous-malignant tumours

23. Causes? Interaction between genetic factors and external agents: -physical carcinogens ie. ionizing radiation -chemical carcinogens ie asbestos, tobacco smoke -biological carcinogens ie viral and bacterial infections (eg HPV and cervical cancer)

24. Prevention Around 30% of cancers can be avoided by reducing the following risk factors: -tobacco use -excessive alcohol use -unhealthy diet -urban air pollution -indoor smoke -sexually transmitted HPV virus

25. Treatment Destroying and removing the cancer cells through -chemotherapy -radiotherapy -surgery

26. Screening and cancer Early detection through screening should lead to early detection, early treatment and fewer deaths But how effective is mass screening for breast cancer? A controversial topic, with experts on both sides. Both sides say it saves lives, but differ over the risks such as overdiagnosis.

27. Figures from one study In the UK 5.7 deaths/1,000 women were prevented over a 20 year period of screening. Absolute risk reduction 28% Over diagnosed: 2.3/1,000 over 20 years. Pro screening would argue that benefits are double the risk Sceptics would say that with women should be told benefits and risks, and decide for themselves. Screening and avoiding are both rational decisions.

28. Globalisation, business and disease Many of the risk factors for non-communicable diseases arise from the activities of large global corporation Tobacco, fast food chains, alcohol There are jobs, share prices, economic activity involved. How do you balance Large corporations would say “consumer choice” Public health would say- regulate

29. http://abcnews.go.com/Health/Wellness/wa rning-labels-highlight-statin- dangers/story?id=15810244#.T12txoFOBuo http://abcnews.go.com/Health/Wellness/wa rning-labels-highlight-statin- dangers/story?id=15810244#.T12txoFOBuo