Health Policy and Strategies to Prevent NonCommunicable Diseases in India: Options, Opportunities and Way Forward

Dr Sathyanarayana

Indian Institute of Public Health

Strategies to Prevent Non-Diseases in India: Options,

Opportunities and Way Forward

SathyanarayanaMBBS, MPH, MBA, DHA, PhD

Indian Institute of Public Health-Bangalore

Overview

• Indian Institute of Public HealthHealth Foundation of India (PHFI)

• Current healthcare status of NCDs

• Global/International Health Policies and Local • Global/International Health Policies and Local Implications related to NCDs

• NCDs prevention/barefoot nurse projecttrial experience to screen NCDs.

• NCDs Preventive strategies

Overview

Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI) role

status of NCDs

Global/International Health Policies and Local Global/International Health Policies and Local Implications related to NCDs

barefoot nurse project-a community trial experience to screen NCDs.

• Indian Institute of Public Health

• Understanding approaches to tackle NCDs (ideological construct for healthcare approach)

–Clinical medicineClinical medicine

–Public Health

–Global health

Indian Institute of Public Health-Bangalore

Understanding approaches to tackle (ideological construct for healthcare approach)

Strategies to address NCDs: A Spectrum APPROACH

• Myocardial infarction/

– Clinician/cardiologist

–Epidemiologist DIAGNOSIS

–Social scientist DIAGNOSIS

–Public health specialist

Strategies to address NCDs: A Spectrum APPROACH

Myocardial infarction/heart attack

Clinician/cardiologist DIAGNOSIS

DIAGNOSIS

DIAGNOSIS

Public health specialist DIAGNOSIS

Status of Non-Communicable DiseasesCommunicable Diseases

Current situation of • 1 out of 4 adult dying because of NCDs before the age of 70. Indian likely to loose

3.5 trillion USD before 2030 due to treatment+productivity

• 47% of hospital admission in rural India is financed through loans and sale of assets.

• About 30% of people in rural India did not opt for treatment because of financial constraints. constraints.

• 39 million Indians are pushed to poverty because of ill

• Nearly 61% of all deaths are attributed to NCDs and diabetes.

• 23% are at risk of premature death due to these diseases.

• Alcohol, tobacco, poor diet intake and lack of physical factors for NCDs.

Current situation of Health care in India1 out of 4 adult dying because of NCDs before the age of 70. Indian likely to loose

treatment+productivity loss.

% of hospital admission in rural India is financed through loans and sale of

30% of people in rural India did not opt for treatment because of financial

million Indians are pushed to poverty because of ill-health every year.

61% of all deaths are attributed to NCDs such as heart diseases, cancer

due to these diseases.

, tobacco, poor diet intake and lack of physical activity are major risk

Source: 2017 Report of the World Health Organization

58 million: total deaths globally 2015

3.8 million men and

worldwide died in 2018 from coronary heart worldwide died in 2018 from coronary heart

disease

35 million (of these) deaths due to NCDs

58 million: total deaths globally 2015

million men and 3.4 million women

worldwide died in 2018 from coronary heart worldwide died in 2018 from coronary heart

disease

35 million (of these) deaths due to NCDs

ACTUAL AND PROJECTED NUMBERS OF ACTUAL AND PROJECTED NUMBERS OF DEATHS IN INDIA BY CAUSE 1990DEATHS IN INDIA BY CAUSE 1990

4.0

6.0N

um

ber

of

dea

ths

(mil

lio

ns)

Communicable diseasesCardiovascular diseasesOther non-communicable diseasesInjuries

0.0

2.0

4.0

1990Nu

mb

er o

f d

eath

s (m

illi

on

s)

ACTUAL AND PROJECTED NUMBERS OF ACTUAL AND PROJECTED NUMBERS OF DEATHS IN INDIA BY CAUSE 1990DEATHS IN INDIA BY CAUSE 1990 AND AND 20202020

Communicable diseasesCardiovascular diseasesOther non-communicable diseasesInjuries

2020

11%

7% 2%

DEATHS IN INDIA (2015)

8%36%

29%

Cardiovascular diseases

Chronic respiratory diseases

Other chronic diseases

DEATHS IN INDIA (2015)

7%

8%

Communicable diseases,perinatal maternal conditionsand nutritional deficienciesInjuries

Cancer

Diabetes

Source : WHO

RISING CHRONIC DISEASE BURDENSRISING CHRONIC DISEASE BURDENS

WHY ARE INDIANS EXPERIENCING A GREATER RISK OF COMMUNICABLE DISEASES?

• Increased Life Expectancy

(Longer period of exposure to risk factors)

• Ethnic Susceptibility• Ethnic Susceptibility

(Experience of Indian migrants)

• Altered Living Habits

(Increased levels of risk factors)

WHY ARE INDIANS EXPERIENCING A GREATER RISK OF NON COMMUNICABLE DISEASES?

Increased Life Expectancy

(Longer period of exposure to risk factors)

(Experience of Indian migrants)

(Increased levels of risk factors)

GLOBALNATIONAL COMMUNITY

Development

(stage and speed)

Perceptions

(cultural)(stage and speed)

Distribution

(equity)

Demand- Supply

(trade)

(cultural)

Priorities(socio

Pathways

(availability, access

COMMUNITY FAMILY INDIVIDUAL

Beliefs

Behaviours

Perceptions

cultural)Behaviours

Biology

cultural)

Prioritiessocio-economic)

Pathways

availability, access)

Globalization/International health policies and LOCAL implications on NCDsLOCAL implications on NCDs

Globalization/International health policies and LOCAL implications on NCDsLOCAL implications on NCDs

Globalization - A comparison between

Country (2000) 109 USD

China

Brasil

IndiaIndia

Mexico

Argentina

Venezuela

L’Atlas. Le Monde Diplomatique, 2005.

between countries and towns revenues

USD City

900 New York

600 Osaka

400 Los Angeles400 Los Angeles

390 Paris

300 Chicago

100 Hambourg

L’Atlas. Le Monde Diplomatique, 2005.

Globalization - A comparison betweencompanies

• Total revenue of top 10 pharma companies = million USD

• Total revenue of bottom 80 countries in a list of 188 countries = 420452 million USDcountries = 420452 million USD

• Total revenue of Pfizer = 70696 million USD

• There are total 125 countries with revenue less than 69332 million USD

between countries and pharma companies revenues

Total revenue of top 10 pharma companies = 433752

Total revenue of bottom 80 countries in a list of 188 420452 million USD420452 million USD

70696 million USD

There are total 125 countries with revenue less than

Globalization = Neoliberal policies

• Free market

• Comodify even basic needs or needs to market goodsneeds to market goods

• Promote maximization and consumerism (buy -1 get one)

• Shift power centers from democratic representatives to market superpowers

Globalization = Neoliberal policies

even basic needs or use basic goods; (ex:water)goods; (ex:water)

Promote maximization and consumerism

Shift power centers from democratic representatives to market superpowers

Communication to consumers; MIS-MATCH between Science and Commerce

Occasional

NUTRITION PYRAMID

IN MODERATION

PLENTY

Colas and other sugary drinks

Chips and salted snacks

Biscuits chocolates and other candy

Fast food (Burgers, pizzas etc.)

MATCH between Science and Commerce

ADVERTISING PYRAMID

?

?

Globalization = Neoliberal

- destroy cultures/promote

(coconut water/butter milk

- Constraint / eliminate welfare

the role of State (Govt)the role of State (Govt)

Neoliberal policies

promote consumers identity;

milk vs coca cola)

welfare state/Minimize

Current policy

Govt

Disease control programs √

Health care and Health Systems

Govt

Private

√

√

√

The mechanics of disease Health system

The mechanics of disease control’s failure

Disease controll programs

Need balance between “Development” and “Road to Health”Need balance between “Development” and “Road to Health”

Donors/Politicians, international donors and agencies “helping” the health systems to achieve their objectives

Donors/Politicians, international donors and agencies – Are they really “helping” the health systems to achieve their objectives

Public-private partnerships ???Conflict of goals

‘Local solutions’ will be always more effective and sustainable than

‘international prescriptions’

‘Local solutions’ will be always more effective and sustainable than

‘international prescriptions’

Contextualize and localize international prescriptions rather than selling out local culture to international market

Contextualize and localize international prescriptions rather than selling out local culture to international market

….Be aware of False positives and false negatives while drawing poverty lines….Be aware of False positives and false negatives while drawing poverty lines

Examine which is the ‘lever’ operating from behind…….Examine which is the ‘lever’ operating from behind…….

Analyze openly the reasons for alleged public sector failure ??…….Analyze openly the reasons for alleged public sector failure

Preventive StrategiesPreventive Strategies

MOULDING

THE

GLOBAL LEVEL: International Agencies; Trans

GLOBAL COVENANTS, COMMERCE & COMMUNICATIONS

NATIONAL POLICY FRAME WORK THE

HEALTH MARKETS

INDUSTRY PRACTICES

Private-Public Partnerships; Health Dividend

WORK

Political, Economic, Social Motivators

MOULDING

THE

GLOBAL LEVEL: International Agencies; Trans-National Trade and Media

GLOBAL COVENANTS, COMMERCE & COMMUNICATIONS

CONSUMER CONSCIOUSNESSTHE

HEALTH MARKETS

INDUSTRY PRACTICES

Public Partnerships; Health Dividend

CONSCIOUSNESS

Health Professionals,

Civil Society; Media

NATIONAL/STATE LEVEL: PUBLIC HEALTH INTERVENTIONS

Policy InterventionsPolicy Interventions

Enabling Environment Health Beliefs and Behaviours(Financial, Social, Physical) (Community; Individual)

DesiredChange

NATIONAL/STATE LEVEL: PUBLIC HEALTH INTERVENTIONS

Educational InterventionsEducational Interventions

Enabling Environment Health Beliefs and Behaviours(Financial, Social, Physical) (Community; Individual)

DesiredChange

PRINCIPLES OF NCDs PREVENTION• Small reductions in risk factor

the whole population, result in

events

• Non-drug measures prevent risk

and reduce it in persons who haveand reduce it in persons who have

profile

• Drug therapy to reduce risk is

who are a high risk of adverse

• Best results are achieved through

based prevention and high

approaches.

PRINCIPLES OF NCDs PREVENTIONfactor levels, when achieved across

in a large reduction of CVD/NCDs

risk across the whole population

have already acquired a high riskhave already acquired a high risk

is most cost-effective in persons

events in the next 10 years.

through a combination of population

high risk individual management

RISK FACTORAssociation

Cause

Acting to reduce risk across the population

Acting to protect persons at high risk

NCDs PREVENTION

Address the bulk of the distribution through small shifts (Population Attributable Risk)

POPULATION BASED

+

Widespread Effect = Large Benefits

NCDs PREVENTION

Address the individuals at the highest ‘absolute’ risk of a NCDs event (Ex: Comprehensive Cardiovascular Risk)

+

HIGH RISK

High Impact = Cost-Effective use of resources

PATHWAY TO HEALTH PROMOTION

Knowledge I know

Motivation I want

Skills I can

Enabling Environment

PATHWAY TO HEALTH PROMOTION

I Act

Perform Personally

Reach & Teach Reach & Teach (Involve Others)

It is possible

Enabling Environment

Barefoot Nurse Projecttrialtrial

To Screen NCDs at community level

Barefoot Nurse Project-Community trialtrial

To Screen NCDs at community level

NCD life course approachNCD life course approach Early screen and referral

-Female

• BP• Diabetes• Haemoglobin

Barefoot nurse Trained to screen

Criteria to select barefoot nurse

Conceptualisation of sustainability of the study model

-Female-Education 10-12th stds-Local community/village-Willing to work

Prefer unemployed-nursing; pharmacy;labtechnician; home health assistant trained person

• Haemoglobin• Vision• Urine test for chronic

Kidney disease• Weight/height

Also plan to introduce in phased manner-Pregnancy test--Sanitary pads, -pain balms-Nutrition powders/millets

• BP- 15Rs• DM-25 Rs• Hb-40 Rs

• BP: 120/80 mmhg• Blood sugar:

Nominal charges Data entry

The entire money goes to BFN –creates livelihood option while screening services

Conceptualisation of sustainability of the study

Nutrition powders/millets

• Hb-40 Rs• Vision-25Rs• Urine test-

25Rs• Wt/ht-2Rs

• Blood sugar: 120gms%

• Hb:12gms%• Vision: +/-• Urine protein:+++• Pregnance:+/-• Wt/ht:• Phone number:• Age:

Benefit to barefoot NURSE

-LIVELIHOOD OPTION

• Alerting early signals of diseases

• Prevent complications, consequences of NCDs

Benefit to PUBLICBENEFIT TO

BAREFOOT nurse

BENEFIT TO STAKEHOLDERS

-LIVELIHOOD OPTION-Opportunity to work in neighbourhood area-Will be allocated 2500 houses-

NCDs• Community

members are screened for diseases at their door step: bridging last mile connect

signals

• Creation of jobs to local women

• Women

• Disease screening DATA can be utilised to optimise

BENEFIT to donor BENEFIT TO THE STATE

BENEFIT TO STAKEHOLDERS

• Women empowerment

• Sense of fulfilment responsibility to local community

to optimise preventive and promoting health care services and to frame policies

Pilot Project in

• Piloted in Doddaballapura taluka, Bangalore Rural

• 25 Barefoot Nurses trained and working in their local Covering 1.5 lakh population

• Barefoot nurses working closely with PHCs last mile connectlast mile connect

• Offering services Basic Health Screening such as

– BP, Diabetes, Anaemia, Vision

– Chronic Kidney diseases,

– Pregnancy test

– Providing access to Hygiene and wellness products at the door step of the community

in KARNATAKA

Bangalore Rural district of Karnataka

trained and working in their local communities;

working closely with PHCs in the Taluka and bridging

Screening such as

access to Hygiene and wellness products at the door step of the

Key learning-Situation Assessment

• Low-income communities are willing to pay and promotive health services.

• Ability to leverage Partners in the value to the communityvalue to the community

• Technology can be used to enhance the effectiveness of service delivery.

• Model has the potential for scalabilityand for impacting health in the

• Development of local human resource and creating livelihoods

Situation Assessment

communities are willing to pay for preventive services.

in the ecosystem to enhance

can be used to enhance the effectiveness of

scalability and sustainabilityand for impacting health in the long-term.

Development of local human resource and potential for

New wellness products planned to introduce

• Sanitary pads

• Pregnancy kits

• Urine kits for chronic kidney disease

• Nutrition powders for children• Nutrition powders for children

• Deworming tablets

• First aid kit

• Ayurveda primary care manual in local language

• Ayurvedic / Homeo/unani family kit

New wellness products planned to introduce

Urine kits for chronic kidney disease

Nutrition powders for childrenNutrition powders for children

Ayurveda primary care manual in local language

family kit

SCIENTIFIC EVIDENCE

APPROPRIATE POLICY

EFFECTIVE PROGRAMMES

SCIENTIFIC EVIDENCE

APPROPRIATE POLICY

EFFECTIVE PROGRAMMES

Progress Report

• Average earning is Rs. 8,205

• 98% of BFNs are female

• IN 3 months, 12,255 people • IN 3 months, 12,255 people expected to screen 55,000

• Following Chart shows data Individual Income Generation for the month

rogress Report

8,205/- per BFN

female and 75% are married

people are screened and people are screened and 55,000 by December 2019

Following Chart shows data for July 2019 & Individual Income Generation for the month

Name BP BS

Baby-17 265 161

Chandra devnagar 13 8

Nagamma-12 340 263

Bidyut-new-15 98 89

Chetana New vf 278 222

Chandrakala-03 149 126

Preethi vrpura 1 1

Roja-10 297 177

Uma-11 282 212

Manjula DA-06 61 47

Sunita-13 262 201Sunita-13 262 201

Leelavathi 280 203

Arunavati-02 273 177

Indrani new 192 118

Shobha vr pura 11 4

Anita-01 555 423

Manjula 175 79

Managalagowramma new 147 110

Rajini-new number 90 31

Dhanalakshmi tubgere 92 68

Chandrakala vr pura 1 1

GRAND TOTAL 3863 2722

Hb Atp Vision Total

96 117 55 12925

6 4 0 578

72 47 1 11589

11 22 2 3862

130 134 17 15293

132 149 1 10107

1 0 0 0

131 145 48 13100

77 30 1 11983

33 22 1 3292

57 248 7 1125057 248 7 11250

93 21 6 13062

111 88 9 13086

62 166 32 9257

7 0 3 540

293 380 55 31228

36 17 2 6144

51 11 0 6116

32 35 0 3128

26 45 3 3933

1 0 0 40

1458 1681 243 180513

8205

THE BAREFOOT NURSE THE BAREFOOT NURSE KIT KIT

KIT BAG

THE BAREFOOT NURSE THE BAREFOOT NURSE

MagadiMagadi Rd 1st cross, Next to leprosy hospital, SIHFW premises, Rd 1st cross, Next to leprosy hospital, SIHFW premises,

Bengaluru, Karnataka 560023Bengaluru, Karnataka 560023

Public Health Foundation of IndiaBAREFOOT NURSE PROJECT

Name:

ID Number:

Phone Number: +91

IDENTIFICATION CARD

THE KIT THE KIT CONTAINSCONTAINS

Hb METER

REFRACTIVE ERROR FOROPTER

CONTAINSCONTAINS

BP MONITOR MEASURING TAPE

CONTAINSCONTAINS

BLOOD SUGAR METER

URINE TEST

CONTAINSCONTAINS

WEIGHING SCALE

PREGNANCY TEST

THERMOMETER

HEALTH RECORD HEALTH RECORD MAINTAINENCE MAINTAINENCE

HEALTH CARD

HEALTH RECORD HEALTH RECORD MAINTAINENCE MAINTAINENCE

BAREFOOT NURSE MOBILE APPLICATION

Karnataka state

Number of Taluks in operation-9 (Spread across 6 districts)

1. Doddaballapura2. Hoskote3. Devanahalli3. Devanahalli4. Nelamangala5. Anekal6. Magadi taluk7. Hadagali taluk8. Bidar, Bidar taluk9. Gulbarga, Alanda taluk

TRAININGTRAINING

Reaching millions...millions...Saving lives …..Saving lives …..

Kit Distribution -Aland Taluk, Gulbarga Aland Taluk, Gulbarga dist

Plan for expansion Nov 2019

Ajmer Rajasthan

Aurangabad, MH

Plan for expansion Nov 2019-June 2020

Chamba HP

Bhopal, MP

Tinsukia Assam

Villupuram, Tamil Nadu

Indicators to assess the study outcomes

• % of target population visited the houses • Number of people screened for

anaemia, vision, ht/wt• Number of beneficiary requested for repeated screening• Number of beneficiary first time detection and referral of NCDs• Number of beneficiary first time detection and referral of NCDs• Average amount of money earned per week/ month, per

barefoot community nurse• % BFNs using the app• % of timeliness of data entry in app,• % of completeness of data entry into app

Indicators to assess the study outcomes

of target population visited the houses of people screened for diabetes, hypertension,

Number of beneficiary requested for repeated screeningfirst time detection and referral of NCDsfirst time detection and referral of NCDs

Average amount of money earned per week/ month, per

of timeliness of data entry in app,% of completeness of data entry into app

Way forward - Goal of the proposed project

• To promote livelihood through an entrepreneurship Model in the health & well

• Innovation in training to standardize through audio• Innovation in training to standardize through audiovisual approach

• https://www.youtube.com/watch?v=JcggEF23nPk

• https://www.youtube.com/watch?v=h_76cGwgl0A

Goal of the proposed project

livelihood through an entrepreneurship well-being space

training to standardize through audio-training to standardize through audio-

https://www.youtube.com/watch?v=JcggEF23nPk

https://www.youtube.com/watch?v=h_76cGwgl0A

Bangalore Urban slums: Proposed Plan

• Screening of all urban slums in Bangalore

• Need 500 kits• Need 500 kits

• Need 500 barefoot nurses

• 3 community coordinators

Bangalore Urban slums: Proposed Plan

Screening of all urban slums in

Need 500 barefoot nurses

community coordinators

Wisdom of Alternate systems and NCDs Prevention

• If we go back to history the Canon encyclopaedia of medicine in five books philosopher Avicenna/IbnaSina

• The Canon of Medicine remained a medical authority for centuriescenturies

• Moses Maimonides was the most prominent physician. His 10 medical treatiestranslation, show his humanism as a physician and emphasis on preventive medicine.

• His medical writings confirm his knowledge of Greek and Persian as well as contemporary medieval

Wisdom of Alternate systems and NCDs Prevention

Canon of Medicine is an five books compiled by Persian

IbnaSina and completed in 1025

remained a medical authority for

was the most prominent Jewish medieval 10 medical treaties, all now available in English

translation, show his humanism as a physician and emphasis on

medical writings confirm his knowledge of Greek and Persian as well as contemporary medieval

Philosophy of modern medicine

• Unfortunately the modern medicine grown up on war metaphor, a war against bacteria, a war against cancer, war against infectious diseases, against cancer, war against infectious diseases, so essentially you poison, destroy or pulverise

Philosophy of modern medicine

Unfortunately the modern medicine grown up a war against bacteria, a war

against cancer, war against infectious diseases, against cancer, war against infectious diseases, so essentially you poison, destroy or pulverise.

District HospitalNCD Clinic, Geriatric Clinic, Cardiac Care Unit,

Cancer Care [Health Promotion; Early diagnosis & Management; Home Based Care; Day Care Facility]

Tertiary level InstituteMedical Colleges, Tertiary Cancer

Centres of Excellence

[Tertiary care, Training, Research]

Co-existence of different systems is criticalwith in PUBLIC SECTOR services

Community Health CenterNCD Clinic, Geriatric Clinic

[Health Promotion, Early diagnosis & Management; Laboratory Investigations, Home Based Care, Referral]

Sub CenterScreening Services

[Health Promotion; Opportunistic Screening; Referral]

District HospitalNCD Clinic, Geriatric Clinic, Cardiac Care Unit,

Cancer Care Facility etc.Health Promotion; Early diagnosis & Management; Home Based Care; Day Care Facility]

Tertiary level InstituteMedical Colleges, Tertiary Cancer Centres, Regional geriatric Centres,

of Excellence

[Tertiary care, Training, Research]

Referral

existence of different systems is criticalPUBLIC SECTOR services

Community Health CenterNCD Clinic, Geriatric Clinic

[Health Promotion, Early diagnosis & Management; Laboratory Investigations, Home Based Care, Referral]

Sub CenterScreening Services

[Health Promotion; Opportunistic Screening; Referral]

Opportunities and

• Political will

• Healthy Public Policy

• Resource Mobilization

• Sustainable Infrastructure & Systems• Sustainable Infrastructure & Systems

• Human resources & their capacity building

• Convergence & Integration

• Partnership & Collaboration

• Quality assurance, M&E for evidence

and Challenges

Sustainable Infrastructure & SystemsSustainable Infrastructure & Systems

Human resources & their capacity building

Convergence & Integration

Partnership & Collaboration

Quality assurance, M&E for evidence

Choices

Legislation

Summary: CAPACITY FOR CONTROL OF NCD

Knowledge,skills

ENERGETIC PROFESSION

Resources Networks Action Plans

ENVIRONMENT

Legislation

Regulation

Information

Health Beliefs

EMPOWERED

COMMUNITY

ENABLING

Facilities

Taxation

Summary: CAPACITY FOR CONTROL OF NCD

Health Care

(Availability,Access)

Taxation

Enforcement

ENVIRONMENT

THANKSTHANKSTHANKSTHANKS

Bangalore slum status

• The number of slums in Bangalore has grown from 159 in 1971, to over 2000 slums (notified and non

• Those living in slums accounted for just over population in 1971 and an estimated lakhs live in slums)lakhs live in slums)

• Karnataka Slum Development Board in Bangalore City.

• Karnataka has seen growing unemployment, larger numbers to the unorganized work-force and deepening urban poverty.

• In Bangalore, nearly one-third of slum dwellerspoverty line, with a monthly income of less than

Bangalore slum status

number of slums in Bangalore has grown from 159 in 1971, to over 2000 slums (notified and non-notified) in 2015.

living in slums accounted for just over 10 percent of the city’s population in 1971 and an estimated 25 to 35 percent in 2015. (30

Slum Development Board 2011 says 597 slum areas are

unemployment, larger numbers to the and deepening urban poverty.

of slum dwellers fall below the with a monthly income of less than Rs 2500 ($55).

National Programs for NCDs prevention

• National Cancer Control Program

• National Blindness Control Program

• National Mental Health Program

• National Iodine Deficiency Disorders Control Program• National Iodine Deficiency Disorders Control Program

• National Tobacco Control Program

• Trauma Care Facility on National Highways

• National Deafness Control Program

National Programs for NCDs prevention

National Cancer Control Program

National Blindness Control Program

National Mental Health Program

National Iodine Deficiency Disorders Control ProgramNational Iodine Deficiency Disorders Control Program

National Tobacco Control Program

Trauma Care Facility on National Highways

National Deafness Control Program

National Programs for NCDs prevention

• National Program for Prevention and Control of

• Pilot Project on Oral Health

• National Program for Prevention and Control of Cancer, Diabetes, CVD, StrokeDiabetes, CVD, Stroke

• National Program for Health Care of the Elderly

• Pilot Program for Prevention of Burn injuries

• Disaster Management/Mobile Hospitals

National Programs for NCDs prevention

National Program for Prevention and Control of Fluorosis

National Program for Prevention and Control of Cancer,

National Program for Health Care of the Elderly

Pilot Program for Prevention of Burn injuries

Disaster Management/Mobile Hospitals

STRATEGIES1. Health Promotion for healthy life styles that preclude NCDs and their risk

factors 2. Specific prevention to reduce exposure to risk factors 3. Early Diagnosis through periodic/opportunistic screening of population and

better diagnostic facilities 4. Infrastructure Development and facilities required for management of NCDs5. Human Resources and their capacity building for prevention and treatment

of NCDs5. Human Resources and their capacity building for prevention and treatment

of NCDs6. Establish Emergency Medical Services

disability and mortality due to NCDs7. Treatment and care of persons with NCDs including rehabilitation and

palliative care 8. Health Legislation and population and evidence based interventions

wherever applicable through multisectoral9. Building evidence for action through surveillance, monitoring and research

STRATEGIESfor healthy life styles that preclude NCDs and their risk

to reduce exposure to risk factors through periodic/opportunistic screening of population and

and facilities required for management of NCDsand their capacity building for prevention and treatment and their capacity building for prevention and treatment

Emergency Medical Services with rapid referral systems to reduce

of persons with NCDs including rehabilitation and

population and evidence based interventions multisectoral approach for prevention of NCDs

for action through surveillance, monitoring and research.

DIET AND PHYSICAL ACTIVITY ARE LINKED TO

MANY DISEASES

• CORONARY HEART DISEASE

MANY RISK FACTORS

•

•• STROKE

• MANY CANCERS

• DIABETES

• OSTEOPOROSIS

•

•

•

•

•

DIET AND PHYSICAL ACTIVITY ARE LINKED TO

MANY RISK FACTORS

HIGH BLOOD PRESSURE

ABNORMAL BLOOD LIPIDS ABNORMAL BLOOD LIPIDS

HIGH BLOOD SUGAR

OVERWEIGHT & OBESITY

DISORDERED CLOTTING MECHANISMS

INFLAMMATORY PROCESSES

DIET: KEY COMPONENTS

• Low Intake of Fruits & Vegetables

• Unhealthy Fats

• Refined Carbohydrates• Refined Carbohydrates

• Low Intake of Fibre

• Excess Calories

DIET: KEY COMPONENTS

Low Intake of Fruits & Vegetables

PHYSICAL ACTIVITY: KEY ISSUES

• Settings :

• Urban Design :• Urban Design :

• Domains :

PHYSICAL ACTIVITY: KEY ISSUES

Schools

Workplace

Communities

Safe Pedestrian PathwaysSafe Pedestrian Pathways

Protected Cycle Lanes

Green Areas

Work Related At

Home

Transport Related

Leisure Time Activities

Care

Services

System levels

Global, integrated, continuous and effective

Acceptable, accessible (and affordable)

criteria

Performance or quality criteria for developing health systems

Services

Local System Integrated: no gaps, no overlaps and optimal flow of patients and information

LHS Ex:Decentralised, permanently accessible, polyvalent

Referral services

Centralised, not permanently accessible to all, specialised

Global, integrated, continuous and effective

Acceptable, accessible (and affordable)

Performance or quality criteria for developing health systems

Integrated: no gaps, no overlaps and optimal flow of patients

Ex:Decentralised, permanently accessible, polyvalent

Centralised, not permanently accessible to all,