dr. kenneth thorpe - meeting the chronic disease challenge

8/6/2019 Dr. Kenneth Thorpe - meeting the chronic disease challenge

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Meeting the chronic disease challenge:

high-level regional workshop

Dr. Kenneth Thorpe

Jakarta, Indonesia


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ABOUT THE PFCD

The PFCD believes that rising rates of chronic health problems pose asignificant and unsustainable burden on national health care systems,

and that the viability and strengths of those systemspresently and

in the futurerelies on a willingness to enact policies that help people

better prevent and manage chronic illnesses.

OUR MISSIONEDUCATEthe public about chronic disease and potential

solutions for individuals and communities

MOBILIZE the public to call for change in how governments,

employers, and health institutions approach chronic diseaseCHALLENGE policymakers on the health policy changes that

are necessary to effectively fight chronic disease


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WHO SOUTH EAST ASIA REGIONAL MEETING

MARCH 2011

Jakarta Call for Action on Noncommunicable Diseases noted that :

Noncommunicable diseases are now the leading cause of death in the WHO

South-East Asia region member states & account for 54 percent of all deaths.

Deaths from non-communicable diseases are projected to increase by 21

percent over the next 10 years.

In the South-East Asia Region the death rates in middle-aged adults is

disproportionately higher than in high-income countries.

NCDs have a substantial economic impact as reducing the Gross Domestic

Product by an estimated1-5 per cent in low and middle income countries.

The epidemic of NCDs exacerbates poverty, is a barrier to societal

and economic development and could reverse hard won development gains.


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CAUSATION PATHWAY FOR CHRONIC

NONCOMMUNICABLE DISEASES

Source: A. Dans, et.al., The rise of chronic non-communicable diseases

in southeast Asia: time for action, The Lancet, 2011, 337:681.


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PREVALENCE NCD RISK FACTORS & BEHAVIORS:

INDONESIA

Risk Factor/Behavior Male Female Total

Daily Tobacco Smoking 53.4 3.4 28.2

Insufficient Physical Activity 31.9 27.9 29.9

Raised Blood Pressure 38.9 36.0 37.4

Raised Blood Glucose

(Fasting>7.0mmol or on meds)

6.0 6.5 6.3

Overweight (BMI>25) 16,3 25.6 21.0

Raised Total Cholesterol 32.8 37,2 35.1

Source: WHO Global Status Report on NoncommunicableDiseases 2010


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ESTIMATES OF DEATHS FROM NCDs ASEAN

COUNTRIES 2008

ASEAN Country Total NCD Deaths NCD Deaths Under

Age 70

Indonesia 1,064,000 563,700

Thailand 418,400 198,100Philippines 309,600 191,800

Malaysia 89,500 46,325

Viet Nam 430,000 160,700

Myanmar 242,400 115,000

Singapore 17,900 8,000Cambodia 56,600 38,400

Laos 23,800 13,500

Brunei Darussalam 10,000 5,300

In 2008 nearly 2.7 million people in ASEAN countries died from 4 chronic non communicablediseases: Cancers, Chronic Respiratory Diseases, Cardiovascular Diseases & Diabetes

Source: WHO Global Status Report on Non-communicablediseases 2010


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PREVALENCE ESTIMATES FOR DIABETES IN

ASEAN COUNTRIES 2010 & 2030

ASEAN Country 2010 2025

Indonesia 6,943,500 11,980,000

Thailand 3,538,000 4,956,200

Philippines 3,398,200 6,163,800

Malaysia 1,846,000 3,244,500

Viet Nam 1,646,600 3,414,900

Myanmar 921,800 1,754,900

Singapore 436,600 742,000

Cambodia 354,000 724,200

Laos 143,300 301,500

Brunei Darussalam 28,200 46,600

If current trends continue The number of people in ASEAN countries with diabeteswill grow from 19.2 to 33.3 million over the next 20 years

Source: International Diabetes Federation, World Diabetes Atlas

Fourth Edition 2010


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POVERTY CONTRIBUTES TO NCDs & NCDs

CONTRIBUTE TO POVERTY

Source: A. Dans, et.al., The rise of chronic non-communicable diseasesin southeast Asia: time for action, The Lancet, 2011, 337:681.


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RELATIONSHIP BETWEEN POVERTY & NCDs

In some countries, the lowest income households have the highest levels of

NCD risk factors. WHO

Glob

al statu

srep

orton NCDs 2010

Source: A. Dans, et.al., The rise of chronic non-communicable diseasesin southeast Asia: time for action, The Lancet, 2011, 337:681.


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WHO GLOBAL STATUS REPORT ON NCDs

NCDs are the biggest global killers. Sixty-three percent of all deaths in2008, 36 million people, were from NCDs.

Nearly 80% of NCD deaths are in low and middle-income countries,where the highest proportion of NCD deaths under age 70 occur.

The prevalence of NCDs, and the number of related deaths, areexpected to increase substantially in the future, particularly in low- andmiddle-income countries, due to population growth and ageing, inconjunction with economic transition and resulting changes inbehavioral, occupational and environmental risk factors.

NCDs already disproportionately affect low- and middle-incomecountries. Projections indicate that by 2020 the largest increases in

NCD mortality will occur in low- and middle-income countries.


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THE FIGHT AGAINST CHRONIC DISEASE

Chronic diseasesare the leadingcauses of death

and disability in theUnited States and

account for the vast

majority of healthcare spending.

They affect thequality of life for 133million Americans

and is responsible forseven out of every

ten deaths in the U.S.

killing more than1.7 million Americansevery year.

Chronic diseases

account for morethan 75 cents ofevery dollar we

spend on health carein this country. In

2007, this amounted

to $1.65 trillion ofthe $2.2 trillion

spent on health care.

The United States cannot effectively address escalating health

care costs without addressing the problem of chronic diseases.

The CDC


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PROVEN INTERVENTIONS

Personalizedaction plans

Responsibilityandaccountabilityfor outcomes

Team-based,

coordinatedcare that

supports self-management

Integrating

withcommunity-

basedresources

Regularmonitoring

and follow-up


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FILLING COSTLY GAPS

Fee-for-service (FFS) System

Gaps in continuum of care

High rate of readmission within 30 days

Disconnect among patients receivingMedicaidand Medicare


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ENHANCING ADHERENCE

One in four

Americans do not

follow directions in

taking medications

3 out of 4 Americans

admit to having not

taken their

medicines asprescribedat some

point

Nearly two-thirds ofall

medication-related

hospital admissions have

been attributed to poor

adherence

Poor medication

adherence costs more

than $100 billion a year

nationwide


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PROMOTING COORDINATED CARE

The Affordable Care Act can offerfinancial assistance to create andfoster better care coordination.

Integrated medical practices

Medical home models

Growth in Accountable CareOrganizations

Medicaid health plan models

Community Health Teams


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TURNING THE TIDE

Improving overall health is the bestway to improve our health care costs.

The smoking rate of Medicaid recipients is approximately 53percent higher than in the general US population

Smoking-attributable costs to the states under Medicaid were$22 billion in 2004

Medicaid also has a much higher prevalence of obesity thanother health insurance providers and pays more for inpatient

and outpatient services and medication for obese patients


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CAPITALIZING ON OPPORTUNITY

THE TIME IS NOW!

Advance policy changes that addresschronic disease

Work to reorient care systems tofocus on prevention


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JAKARTA CALL FOR ACTION ON NCDs- MARCH 2011

Accord a high priority to prevention & control of NCDs in national healthpolicies & programs and accordingly increase overall budgetaryallocations for NCDs.

Scale up national plans for action & implement the WHO Framework

Convention on Tobacco Control and advance health promotion, primaryprevention and develop regulations on alcohol & processed foods.

Fund and strengthen primary health care preventive, promotive andcurative care interventions to ensure access of the poor and vulnerable.

Develop surveillance programs to monitor & evaluate the impact ofinterventions & support research into the prevention & control of NCDs

Build capacity of the health workforce, including community-basedhealth workers for prevention and control of NCDs.

Calls upon governments & parliaments to:

dr. kenneth thorpe - meeting the chronic disease challenge

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