Title PageTaking Public Health Action to

Stop CNCD

Dr. Elvira BeracocheaMIDEGO, Inc.

Presidentinfo@midego.com

141st APHA Annual Meeting Monday, November 4th, 2013

Disclosure

• Dr. Elvira Beracochea has nothing to disclose regarding chronic non communicable diseases.

Up to 80% of the NCD mortality, mainly due to cancer, diabetes, chronic lung disease and cardiovascular disease, can be prevented by improved individual care and public health programs.

80% of deaths occur in developing countries

CNCDs will account for 70% of global deaths by 2030

10 billion people will die of tobacco related conditions in the next 10 years

NCD Facts

Objectives

1. Discuss ways to take action to stop CNCD globally

2. Discuss ways to take action and stop CNCD locally

3. Choose one action to take in 2014

Why Stop CNCDs?

Globally CNCDs are …

Preventable

Reversible

Curable

Etiology

Yet

Poorly Understood….

Behavioral Risk Factors

1. Smoking

2. Alcoholism

3. Poor nutrition

4. Physical inactivity

5. Mental illness and/or stress

The Unfinished Agenda

• Rheumatic Fever

• Barker hypothesis that propose that exposure to poor nutrition in utero increases CNCD

North Karelia: Interventions

•PHC providers involved in all aspects of the program•Involvement of community organizations and residents•Training of health workforce•Media Communication: Health Literacy•Environmental changes•Partnerships with food industry

CARMEN

Conjunto de Acciones para la Reducción Multifactorial de Enfermedades No transmisibles

Concerted actions to reduce multifactorial non- transmissible or non-communicable diseases

A New Vertical Program?

Yes, disease control programs are vertical

Delivery of services, on the other hand is horizontal and must be integrated and focused on addressing the unique epidemiological profile of each community and every individual’s diagnosis

How to Stop CNCD Locally

1. Conduct a Community Epidemiological Assessment

2. Every Health Center Must have Program Based On Assessment Results

3. Train Professionals on Screening, Counseling and Treatment and Assign A Number Of Households And A Denominator to be Accountable for

4. Plan and Implement Community Programs: 1. Tobacco Dependence

2. Nutrition And Physical Activity

3. Screening, Medical Treatment And Self-care Education

How to Stop CNCD Locally

5. Develop/Adapt Patient Monitoring Tools And Epidemiological Surveillance Standard Procedures

6. Conduct Staff Meetings for Weekly , Monthly And Annual Program Reviews

7. Prepare and Deliver Regular Reports To The Community Structures, Local authorities and Sustain Community Involvement

Fagerstrom Test for Nicotine Dependence

• Apply the test in every community diagnosis

• Integrate the test in every healthcare delivery encounter with a smoker

• Explain what nicotine addiction is and how it works

• Provide tobacco dependence treatment

Fagerstrom Test for Nicotine Dependence

Is smoking “just a habit” or are you addicted? Take this test and find out your level of dependence on nicotine.

1. How soon after you wake up do you smoke your first cigarette?

¨ After 60 minutes (0)

¨ 31-60 minutes (1)

¨ 6-30 minutes (2)

¨ Within 5 minutes (3)

2. Do you find it difficult to refrain from smoking in places where it is forbidden?

¨ No (0)

¨ Yes (1)

3. Which cigarette would you hate most to give up?

¨ The first in the morning (1)

¨ Any other (0)

Fagerstrom Test for Nicotine Dependence

4. How many cigarettes per day do you smoke?

¨ 10 or less (0)

¨ 11-20 (1)

¨ 21-30 (2)

¨ 31 or more (3)

5. Do you smoke more frequently during the first hours after awakening than during the rest of the day?

¨ No (0)

¨ Yes (1)

6. Do you smoke even if you are so ill that you are in bed most of the day?

¨ No (0)

¨ Yes (1)

0-2 Very low dependence 6-7 High dependence

3-4 Low dependence 8-10 Very high dependence

5 Medium dependence

Challenges

• Lack of trained workforce• Lack of effective essential medicines supply

chains• Lack of effective surveillance systems• Lack of health centers with diagnostic facilities• Lack of chronic delivery models (ANC/PNC still

not effective)• Lack of political will• Lack of country leadershiop

Advocacy

• New MDG: post-2015 agenda• “Program Dose” matters• Sustained efforts also matter• Integrated community based programs

and health centers with trained staff do work:– Services tailored to the community needs– Community involvement and participation

References

• Hunter D, Reddy K. Non-communicable diseases. The New England Journal of Medicine. October 2013

• Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addictions 1991;86:1119-27

• North Karelia• PAHO - CARMEN

THANK YOU

1. Tweet one thing you learned today

2. Link with me

3. Email me how you will make an impact on CNCDs in 2014

DrElvira@midego.com