1. Non-Communicable Diseases Control Program _________________________________
K R Thankappan MD, MPH Additional Professor and Head Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum

2. Death, by broad cause group, 1999
Noncommunicable
conditions (59.8%)
Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (31.1%)
Injuries (9.1%)
Source: WHO Report 2000

3. Global burden of disease
in disability-adjusted life years (DALYs), 1999
Noncommunicable
conditions (43.2%)
Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (42.8%)
Injuries (13.9%)
Source: WHO Report 2000

4. Deaths, by broad cause group and WHO Region, 1999%
Noncommunicable
conditions 75
Injuries
Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 50 25
AFR
EMR
SEAR
WPR
AMR
EUR
Source: WHO 2000

5. DALYS, by broad cause group and WHO Region, 1999
DALY = Disability adjusted life-year % 75
Noncommunicable
conditions
Injuries
Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 50 25
AFR
EMR
SEAR
WPR
AMR
EUR
Source: WHO 2000

6. DALYs, by broad cause group 1990 - 2020
in developing countries (baseline scenario)
DALY = Disability-Adjusted Life Year % %
Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 22 49 21
Injuries 14 15
Neuropsychiatric disorders 9 43
Noncommunicable conditions 27
Source: WHO, Evidence, Information and Policy, 2000

7. Low- and middle-income countries suffer the greatest impact on non-communicable diseases
77% of the total number of deaths attributable to NCDs
occurred in developing countries
85% of the global NCD disease burden borne by low- and middle-income countries
Source: WHO:, 2000

8. Distribution of causes of death
in South-East Asia, 1999 (000s)
Injuries (1301)
Other causes (236)
Perinatal conditions (851)
Nutritional deficiencies (159)
Malaria (69)
HIV/AIDS (360)
Noncommunicable
conditions (7370)
Tuberculosis (723)
Diarrhoeal diseases (978)
Respiratory infections (1523)
Childhood diseases (542)
Maternal conditions (158)
Source: WHO 2000

9. in disability-adjusted life years (DALYs)
Burden of disease
in disability-adjusted life years (DALYs)
in South-East Asia,1999 (000s)
Other causes (19693)
Injuries (65289)
Perinatal conditions (32715)
Nutritional deficiencies (16866)
Malaria (3071)
HIV/AIDS (8866)
Tuberculosis (14101)
Diarrhoeal diseases (30017)
Noncommunicable
conditions (156536)
Respiratory infections (38144)
Childhood diseases (19449)
Maternal conditions (7733)
Source: WHO 2000

10. -----1940-----1950-----1960-----1970-----1980-----1990-----2000-----
Cardiovascular (CVD) epidemic in countries of different stages of development
High
Income
Economies
Reach
the peak
Progressive
decline
Rapid
increase
Remains as
first cause
of death & disability
Economies in
Transition
Slow
increase
Rapid
Reach
the peak
in some
countries
First cause
of death & disability
Middle
and Low
Income
Countries
Low
rates
Slow
increase
Rapid
in most
countries
First cause
of death & disability in
most countries

11. DALYs, by broad cause group 1990 - 2020
in developing countries (baseline scenario) % 50
1990
2020 25
DALY = Disability adjusted life-year
Communicable diseases, maternal and perinatal conditions and nutritional deficiencies
Injuries
Noncommunicable
conditions
Source: WHO, Evidence, Information and Policy, 2000

12. Source: K S Reddy. Lancet 1998.

13. Coronary Heart Disease Prevalence Studies in India (Urban) Study Year Sample CHD Prevalence Agra Delhi Chandigarh Rohtak Delhi Jaipur Moradabad Trivandrum ________________________ Source: Gupta et al. Indian Heart Journal 1995.

14. Source. Hypertension study group AMCHSS of SCTIMST. WHO Bulletin 2001.
Prevalence Of Hypertension in the elderly Loacation % 95% CI Kerala Urban 69 (63-75) Kerala Rural (49-61) Maharashtra Urban 72 (69-75) Dhaka Urban (62-67) Dhaka Rural (47-59) ___________________________________
Source. Hypertension study group AMCHSS of SCTIMST. WHO Bulletin 2001.

15. Prevalence of Hypertension (40-60 Yrs) Trivandrum City Age group
Prevalence of Hypertension (40-60 Yrs) Trivandrum City Age group Prevalence Total Manu Zachariah, Thankappan K R et al. Indian Heart Journal 2003

16. Cardiovascular risk factors
Non-modifiable
Risk Factors
Age
Male gender
Genetic
predisposition
Hypertensive
heart disease
Coronary
Cerebrovascular
disease (Stroke)
Peripheral
vascular disease
Endpoints
Modifiable
Risk
Factors
Hypertension
Elevated LDL cholesterol
Decreased HDL cholesterol
Diabetes
Insulin resistance
Obesity
Smoking
Unhealthy diet
-High in saturated fat & salt
-Inadequate intake of fruits
and vegetables
Excessive alcohol use
Sedentary life-style
Behavioural
Risk Factors
Adverse
Socio-economic,
Cultural & Environmental
Conditions

17. Tobacco: deaths by World Bank regions
estimates for 1990 and 2020
8.4 million
Middle Eastern Crescent
Latin America & Caribbean
Sub-Saharan Africa
Other Asia and Islands
China
India
3 million
Former Socialist Countries
Established Market Economies
Source: Murray CJL, Lopez AD 1996

18. Tobacco use and educational level among females in Bombay 1992-1994
Users %
Source: Gupta, 1996

19. Body Mass Index in Indian Women 15-49 Years.
State BMI <18.5 BMI BMI 30+
Delhi
Punjab
Kerala
Orissa
Assam
Bihar
India
Urban
Rural
Source: NFHS

20. No National Program for NCD More than 50% of disease burden in India is due to NCDs Many National Programs for Communicable diseases

21. How to address
Monitoring of Risk factors
Tobacco Use
Diet (Fruits and Vegetables)
Body Mass Index
Physical activity
Blood Sugar
Blood Lipid levels

22. Disease Specific Program Cancer Diabetes Bronchial Asthma Hypertension?

23. Need to develop a Program Sentinel Health Monitoring Centres Assam Delhi Kerala Maharashtra Tamil Nadu

24. Address Risk factors and determinants at community level Inter-sectoral coordination

26. Legislation For example Tobacco Control Alcohol Diet, salt restriction Exercise

27. Global strategy for Diet and Physical activity

29. Primary Health Care System Need to re-orient focus Training of health workers Monitoring of blood pressure and urine sugar can be done at grass root level Health education programs

30. Capacity Building Manpower -PH specialists New Public Health Schools Social Science components MPH-SCTIMST, Allahabad PGI Chandigarh, CMC Vellore, EHA Expand the current MD programs FETP Programs- MAE at NIE

31. Start From Children

32. THANK YOU