LIFESTYLE DISEASES: A SILENT DISASTER

ANTHONY C.LEACHON,MDUNIVERSITY OF THE PHILIPPINES, MANILACONSULTANT , DOH ON NONCOMMUNICABLE DISEASES

Embracing a Healthy Lifestyle

Disclosures :• Internist -Cardiologist, Manila Doctors Hospital• Retired Medical Director of Pfizer Philippines (1993-

2011)• Director of Information, Publications, and Public

Affairs,University of the Philippines, Manila• One Peso Consultant , DOH on Noncommunicable

Diseases• Secretary, Philippine College of Physicians• Preventive Health Advocate

MY HEROES

Dr. Jose RizalJune 19, 1861 – Dec. 30, 1896

National Hero

Pilar Cueto Leachon(Jan. 25, 1935 – Sept. 22, 2003)

Marita Leachon Ramirez

(June 7, 1962 – June 11, 2011 )

Flow of Presentation

• Background on NCDs• What 5 Shocking Lessons we have learned

about NCDs/lifestyle diseases• Reasons why we fail in our Health Goals• 3 DOH Pillars to address NCDs• What else can we do to step up NCD efforts ?• Summary

Epidemiologic Transition

DEVELOPMENT

MO

RTA

LIT

Y

Lifestyle/NCDs

InfectiousDisease

Omran et al 1970.

Common Risk Factors for NCDsDeaths from 4 chronic diseases

Deaths from all other causes

60% of all deaths

3 risk factors

Tobacco Poor diet Lack of exercice

4 chronic diseases

CancerType 2 diabetesChronic respiratory disease

Cardiovascular

Oxford Health Alliance 2003

10 Leading Causes of Morbidity in the Philippines (DOH)

1. Pneumonia 2. Acute Watery Diarrhea3. Malaria 4. Typhoid & Paratyphoid Fever 5. Schistosomiasis6. Measles 7. Acute Bloody Diarrhea8. Dengue Hemorrhagic Fever 9. Hepatitis 10. Leprosy

10 Leading Causes of Mortality in the Philippines (DOH)

1. Diseases of the heart 2. Strokes3. Cancer4. Chronic Obstructive Pulmonary

Diseases5. Road Accidents and Injuries6. Diabetes 7. Dengue Fever8. Maternal Deaths9. Kidney Failure10. Perinatal conditions

*All Preventable with Education and public health infrastructure (DOH 2010)

2005 DOH DataTop 10 Causes of Morbidity and MortalityPhilippines July 2010

Top 4 & #6: NCDs

Accidents: 50 % drunk driving

SEA: Epidemic of chronic non-communicable diseases 60% of mortality rates in the region

Environmental factors: promotion of tobacco use, unhealthy diet & physical inactivity

Disadvantaged sector is most affected Health care systems should be redesigned to deliver chronic care

founded on primary health care facilities, but supported by good referral systems

Surveillance of key modifiable risk factors (monitor magnitude of problem & study effects of interventions)

Involvement of government & society sectors to establish healthy environment

2.5 MILLION NCD DEATHS

IN 2005

Lesson # 1 Silent EPIDEMIC300,000 deaths in Philippines800 deaths/day !

Dans, et al Lancet 2011 and DOH data

NCD deaths per 100 thousand population

0 5 10 20 30 40 50 60 70 80

400

500

600

700

800

900

Myan Camb

Laos

VietIndoPhil

Thai Mal SingBrun

Gross National Income (International Dollars x 103)

Dans et al (Lancet 2011)

2.HIGHER NCD RISK

4.HIGHER MORTALITY1.NO ACCESS TO

PREVENTION

3.NO ACCESS TO TREATMENT

LIMITED RESERVESMORE Expenses & IMPOVERISHMENT

Heart DiseaseStrokeCancerChronic Lung Ds

Biologic Risk factors

SmokingUnhealthy DietPhys. Inactivity

Behavioral Risk Factors

Blood SugarBlood PressureCholesterolBMI

Chronic NCDMorbidity/Mortality

Lesson #2 NCDs: Diseases of the POOR

PredisposingEnvironment

GlobalizationUrbanizationPovertyLow EducationStress

The poor smoke more than the rich. In ASEAN, the lowest quintile of the population suffer more deaths due to smoking.

Lesson #2 The poor suffer the most

Poorest WealthiestFrom DANS, ET. AL,

LANCET 2010)

Pre

vale

nce

(%

)

Tobacco use > Food

2006 2009Poorest 0.029 0.027Poor 0.031 0.027Middle 0.030 0.025Rich 0.024 0.021Richest 0.018 0.015Total 0.026 0.023

Tobacco and Food Expenditure Ratio, 2008

Valerie Gilbert T. UlepPhilippine Institute for Development Studies

SOURCE: WHO Report on global tobacco epidemic:Implementing smoke free environment.Geneva,Switzerland.WHO, 2009

Lesson # 3 : Disease of the YoungThe Situation

17.5%Girls

28.3%Boys

Of the users of tobacco products:(highest in South East Asia)

Non-communicable Diseases: At a Glance

Cancer Diabetes CVD CLRD0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

49 55 34 27

5145

6673

Pre-mature Mature

Prem

atur

e de

aths

Share of premature deaths, Philippines, 2008

Valerie Gilbert T. UlepPhilippine Institute for Development Studies

Estimated deaths from heart attack and stroke (all risk factors)

Risk FactorHeart Attack

Deaths CVD Deaths Total Deaths

Smoking 19,315 29,184 48,499

Cholesterol 8,799 4,053 12,852

Obesity 14,840 20,207 35,047

HPN 15,559 25,401 40,960

Diabetes 3,326 6,864 10,190

Smoking does NOT just cause cancer and lung diseases, it is also the number 1 cause of stroke and heart attack (~50,000 deaths per year). In fact it causes more stroke and heart attacks than diabetes, hypertension, obesity and high cholesterol - National Nutrition and Health Survey, 2008

Smoking is the #1 preventable risk factor.

Lesson # 4Smoking is PH’s top

killer;obesity 3rd

Counseling or Education for Risk Factor ModificationEbrahim et al, Cochrane 2011

> 55 Clinical Trials> 163, 471 patients studied

> Did not affect longevity> Did not prevent heart disease> Did not prevent stroke> Did not reduce cholesterol> Did not lower BP> Did not lower smoking rates

Lesson # 5Education for general population is not effective.

Why do we fail at what we set out to do ?

1. Ignorance : we may err because science has given us only partial understanding ; Education is key ( not quite)

2. Ineptitude : knowledge exists, yet we fail to apply it correctly.

Gorovitz and MacIntyre, 1970

3 reasons why we fail

SmokingUnhealthy DietPhys. Inactivity

Behavioral Risk Factors

Heart DiseaseStrokeCancerChronic Lung Ds

Chronic NCDBiologicRisk factors

Blood SugarBlood PressureCholesterolBMI

SmokingUnhealthy DietPhys. Inactivity

Behavioral Risk Factors

Heart DiseaseStrokeCancerChronic Lung Ds

Chronic NCDBiologicRisk factors

Blood SugarBlood PressureCholesterolBMI

PredisposingEnvironment

GlobalizationUrbanizationPovertyLow EducationStress

DownstreamUpstream

Tobacco Healthy Diet Exercise

Learning 1. Health Education curriculum in schools; workplace wellness programs

2. Public Awareness Campaign for targeted populations through media, academe, and NGOs

LGU action • Local ordinances eg smoke free environment,

food label, exercise facilities

Legislation Sin Tax Increase on tobacco and alcohol – now at approved- Dec 20,2012

Food Certification Front -of -pack Calorie

counter Dec 2012 (FDA – DOH

approved); Belly gud, Food plate

Infrastructure eg recreational facilities

LIFESTYLE DISEASES : 3 DOH Action PillarsDec 2011

Goals of Excise Tax Law (in order of priority)1. Reduce the number of

smokers among the YOUNG (<18 years old)

2. Reduce the number of smokers among the POOR

3. Reduce the consumption of cigarettes among current smokers

***Equally important as the health objectives is the revenue gained from the excise tax.

Health is Wealth: Universal Health Care Realization

• DOH annual budget• Excise Tax • Tobacco revenue• Smoking related

expenditures1. Indirectly, through loss of

productivity and income2. Directly, household spending on

chronic medical care, often of catastrophic proportions

• Php 54 Billion• Php 35 Billion• Php 26 Billion • Php 177 Billion (Dans et al

2012)

1. Hospitals and other infrastructures2. Health Information technology3. Human resources4. Health promotions and research

initiatives

Sec Ona with Med Org Leading the Way in Sin

Tax Lobbying

Sin Tax on tobacco & alcohol Approval at Malacanan

Dec 20, 2012

Sin Tax Law Passage and DBM

• Dec 20, 2012 : Victory party after signing of the sin tax law by Pres. Benigno Simeon Aquino III

• With DBM Sec. Florencio Abad and Dr. Antonio Dans of UPCM

• Vital role in the IRR of the sin tax law

Who took the space?

Filipinos gaining weight

• 26.6 per cent of Filipino adults were overweight in 2008 (5.2 per cent are obese), a marked increase from 16.6 per cent in 1993.

• Overweight is also rising among children aged 5–10 (up from 5.8 per cent in 2003 to 6.6 per cent in 2008).

Source National Statistics Coordination Board (NSCB)

Nov 2011.

Obesity in Young Filipinos risingSept 23, 2010 Manila Bulletin• MANILA, Philippines — Obesity is now on the rise among Filipino adults

ages 20 and up, and threatens to increase the number of people having degenerative diseases like heart disease, hypertension and diabetes mellitus, as study conducted by the Department of Science and Technology (DoST) showed.

• The increase was discovered in 2008 when it registered a trend in the study

conducted by the DoST’s Food and Nutrition Research Institute.

V. Ulep, 2012 Phil Institute for Development Studies

Physical exercise Phil Institute for Development Studies,2008

Total Male Female0

5

10

15

20

25

30

26.927.9

24.8

22.5 22.4 22.822

22.7

20.8

23.5 22.924.3

23.1

21.3

24.9

Poorest Poor Middle Rich Richest

Prev

alen

ce (%

)

Prevalence of adult population with adequate exercise, Philippines, 2008

2103 DOH programs : Unhealthy Diet

• 1. Calorie counter – Front of Package (Dec 2012)

• 2.Food labeling – mandatory to declare salt, sugar, trans fats in addition; Legislation is needed for the long term ( July 2013)

• 3. Belly GUD – DOH Executives’ weight reduction , biggest loser type of program (Jan –July 2013)

• 4. Pinggan ni Pinoy – Filipino Food plate (to be launched with DOST- FNRI)

Calories per day for Males

Calories for Females

1,800 – 2000 calories per day

1,200-1,500 calories per day

Target Calories in a Day

Note: One pound of body mass represents 3,500 calories.

Calorie Checklist Eat Low Calorie Foods

(50-100 calories)

• Fish• Fruits • Vegetables• Chicken without skin• Cereals• Oatmeal • Water

Avoid High Calorie Foods

(300-800 calories )

• French fries• Burgers• Pork & beef• Ice cream• Doughnuts• Processed foods• Ice tea & softdrinks

How sweet is it ?

Bloomberg now wants all of New York state to ban big soft drinks

March 2, 2013 • New York City Mayor Michael

Bloomberg wants to trim waistlines by expanding the Big Apple’s upcoming ban on big soft drinks.

• "Kids, once they get obese, they will be obese as adults. And this year, for the first time in the world, in the history of humanity, more people will die from overeating than from under-eating."

Burger King : Calorie Count in Korea

Dec 2010

Burger King in Korea : Calories disclosed

South Korea Global Update Summary Feb 2013

• South Korea was the first Asian country to press ahead with recommendations for voluntary traffic light labels on children’s food starting 1 January 2011.

• On 25 May 2012, the Prime Minister’s Office announced its intention to progressively introduce mandatory traffic light labelling to snacks and beverages starting in 2013, making South Korea the first country globally to mandate traffic light labelling. Since then, two draft bills have been submitted to the Korean National Assembly.

• One bill recommends mandatory traffic light labelling on foods preferred by children, including chips, snacks and beverages (e.g. carbonated soft drinks, juices).

• The second bill recommends both a mandatory traffic light system and mandatory reference daily intake labelling with a colour coding system. This move could potentially have implications for other countries in the Asia-Pacific region.

Global Food Labelling

• Violet : Mandatory• Yellow: Voluntary • White: Information not found