1 การลดปัจจัยเสี่ยงต่อความดันโลหิตสูงและเบาหวาน ของประชากร ศ.นพ.ประกิต วาทีสาธกกิจวันที่ 25 มีนาคม 2555“สังคมไทยไร้โรคเบาหวานและความดันโลหิตสูง ด้วยพระบารมีปกเกล้าฯ”Action on Smoking and heath Foundation/มูลนิธิรณรงค์เพื่อการไม่สูบบุหรี่
2 4 modifiable shared risk factors cause 4 major NCDs which account for 4 — 4 — 804 modifiable shared risk factors cause4 major NCDs which account for80% of all NCD deathsShared Risk FactorsTobacco useUnhealthy dietsPhysical inactivityHarmful use of alcoholNon-communicable diseasesCardiovascular diseasesDiabetes (Type II)CancerChronic respiratory disease
3 Thailand NCDs Death (2009)Ischemic heart disease = 34,384 Stroke = 50,829 Cancer = 80,711 COPD = 18,660 DM = 26,380 Total major NCDs = 210,963 Total death (all causes) = 415,900 Death from NCDs = 50.7% Death from NCDs before 60 yrs old = 27% The Thai Working Group on Burden Attributable to Risk Factors IHPP.MOH 2009
4 2 million DALY loss in 2004 for male or 34 % of all DALY loss in males DALY Loss Thailand2 million DALY loss in 2004 for maleor34 % of all DALY loss in malesfrom NCD risk factors
5 0.9 million DALY loss in 2004 for female DALY Loss Thailand0.9 million DALY loss in 2004 for femaleor23 % of all DALY loss in femalesfrom NCD risk factors
6 Total number of major NCDs cases Hypertension = 10,000,000Diabetes = 3,200,000Cardiovascular disease = 690,000Stroke = 730,000COPD = 270,000Thailand’s 4th National Health Examination Survey 2009.
10 Tobacco control Milestone Thailand Establish NGO focal point for tobacco control (1986)National Committee for Tobacco Control 1989Tobacco Control Office MOH 1991Tobacco Product Control Act 1992Nonsmoker’s Health Protection Act 1992Increasing Tax for Health Policy 1993Health Promotion Foundation Act 2001Graphic Health Warning 2005 / 2007 / 2010Ban point of sale display of cigarette pack (2005)Ban Tobacco Company CSR activity in electronic medias (2005)100% Smoke free public & work places
12 Global Adult Tobacco Survey : Thailand Country Report Tobacco Use : Key findings 23.7 % (12.5 million adults) smoke tobacco35.7 % of smoker have the first cigarettebetween 6-30 minutes of waking up24.4 % of smoker have the first cigarette≤ 5 minutes of waking upGATS Thailand 2009
13 Key findings 6 in 10 smokers plan to or are thinking of quitting 6 in 10 smokers were asked if they smoke by health care provider5 in 10 smokers received advice to quit by health care provider“Quitting on your own” was the most common cessation methodGATS Thailand 2009
14 Use of cessation method Quit on your own88.9 %Pharmacotherapy10.6 %Counseling5.8 %Other2.9 %GATS Thailand 2009
15 Nation Capacity Assessment on the Implementation of Effective Tobacco Control Policies in Thailand November 2008By WHO
16 Key FindingsGovernment capacity for coordinating tobacco control is not strongThe government infrastructure for tobacco control is weak
17 The infrastructure of NGOs is insufficient Law enforcement is suboptimalImplementation of NGOs activities at grassroots level has been limitedFunding for tobacco control is in-sufficient especially for government activities
18 National Capacity Assessment offer help to quit tobacco use (WHO 2008) Key findings1. A national systematize, multi-level treatment and management system, integrated into the primary health care system, does not exist
19 2. The MOPH gives to tobacco dependence management a low priority than to other tobacco control strategies3. Tobacco dependence management is not funded
20 4. Utilization of current services is low 5. The tobacco dependence management approach utilizes a predominantly medical model
21 6. First – line drug for treatment of tobacco dependence are not included in essential drug list 7. Quitline exist but they need to be coordinated within on , single national quitline
22 Recommendations1. Advocate for a systems approach for tobacco dependence management2. Give priority for the development of brief treatment interventions3. Fund tobacco dependence management
23 4. Consolidate national treatment guidelines 5. Establish national quitline6. Promote quit attempts7. Monitor services
24 Thai smoker who seek cessation assistance Do you have medication to help me?No medication??Current medication being used by smoking cessation clinicsVitamin / NortriptylineHerb teaSilver Nitrate mouthwashBupropion / Varernicline / Nicotine gum / patch
25 Medication Available in Thailand Nicotine chewing gumOTCNicotine patchNortriptylinePrescription/ on national drug listBupropionPrescription/ not on national drug listVareniclinePrescription/not on national drug list
26 Puthchinaraj Hospital Smoking Cessation Clinic Patient who smokeWant to quit%OPD1,03943742.86IPD63239562.50Dr. Ratapum Champunot
27 Total cost per quitting case = 2008 baht Abstinence rate (%)6 months12 monthsPseudoephedrine (60 my x 2)N=27534.633.1Nortryptyline (10 my x 2)N=25234.935.7B.Com (1x2)N=26039.640.0Total cost per quitting case = 2008 bahtDr. Ratapum Champunot
28 Non pharmacological role of smoking cessation medication in Thai patient Satisfy patient’s believe (That I need medication to help) (50% of smoker make quit attempt but failed)Retention of patientPlacebo effect
34 Rec : Give priority for the development of brief treatment interventions (2008) Smoke-free Hospital Project Integrating 5A approach into daily practiceTraining of brief treatment interventions for staffs at “Sub-district Hospital”
35 Key findings 2009 2011 - Asked if they smoke by health care provider 60%65%- Received advice to quit50%55%
36 On going advocacyTo provide free cessation treatment for patients who attend diabetes and hypertension clinicsSmoking prevalence- Diabetic ♂ = 37% (N = 540,000 smokers)- Hypertension ♂ = 30%(N = 1.6 million smokers)รวมจำนวนผู้ป่วยเบาหวาน-ความดันสูงที่สูบบุหรี่ = 2,140,000 คน
37 On going effort :To recruit medical professional organizations to sign petition to submit to Minister of Health, to support inclusion of first line smoking cessation medication into national drug-list and include in UHI benefit
38 Initiation of NCD network in Thailand With the initiative of the WHO and the RTG, a forum of NCD control (NCD network) has been formulated since 30 June 2010 with several health experts and specialists in areas of prevention and control of NCDs in Thailand.
39 Diseases and risk factors being chosen by Thai NCD network Diseases/risk factorsTobacco useUnhealthy dietsPhysical inactivityHarmful use of alcoholOverweight & obesityCardiovascular diseases+HypertensionDiabetesCancerChronic Respiratory disease+**as a result of obesity including obstructive sleep apnea
40 Goals1. To support movements to raise the problems of NCDs as a priority on the national agenda on social and human development. 2. To control 5 main NCDs, including cardiovascular diseases, hypertension, diabetes, cancers, and chronic respiratory diseases.
41 Goals (cont.)3. To control unhealthy lifestyles, including tobacco use, unhealthy diets, physical inactivity, obesity, and harmful use of alcohol.
42 StakeholdersMinistry of Public Health, Thailand (MOPH) World Health Organization (WHO)National Health Security Office (NHSO) Thai Health Promotion Foundation(ThaiHealth)Mahidol University Chulalongkorn UniversityDiabetes Association of Thailand the Royal College of Physicians of Thailandthe Thoracic Society of Thailand the National Cancer Institute of Thailandthe Action on Smoking and Health Foundation, Thailand Center for alcohol study, Thailand (CAS)Health System Research Institute, Thailand (HSRI) International Health Policy Program,Thailand (IHPP)Ministry of Interior Ministry of EducationMinistry of Finance Ministry of CommerceMinistry of Social Development and Human Security Ministry of Agriculture and CooperativesMinistry of Transportation and Telecommunication Local governments’ representativesPrivate enterprises’ representatives Non-governmental organizations (NGO)Foundation for consumers Reporters and Media representatives