4 The 10 Essential Public Health Operations (EPHOs) 2012 …(1) Surveillance of population health and well-beingMonitoring and response to health hazards and emergenciesHealth protection, including environmental, occupational, food safety and othersHealth promotion, including action to address social determinants and health inequityDisease prevention, ……Risk Management including early detection of illness
5 The 10 Essential Public Health Operations (EPHOs) 2012 ….(2) Assuring governance for health and well-beingAssuring a sufficient and competent public health workforceAssuring sustainable organizational structures and financingAdvocacy, communication and social mobilization for healthAdvancing public health research to inform policy and practice
22 What is chronic diseases ? “ ..are mostly characterised by complex causality, multiple risk factors, long latency periods, a prolong course of illness and functional impairment or disability (AIHW 2002).The chronic diseases are the focus of the KIP set are those which are considered in the some way preventable, largely through behaviors, or those taht react favourly in terms of management and medical treatment Zif they are detected and treated in their early stages.
24 Presentation outline The situation of NCDs in Thailand Global and Thailand movement on NCDsNCD Strategic Plans and operational plans in Thailand
25 Thailand : country background Thais’ population: (sixty - six million)Income Group: Upper middleApproximate of population live in urban area: 34.1%Population proportion between ages 30 and 70 years: 54.3 %Life expectancy at birth in male 69.5 yrs.: female 76.3 yrs.The probability of dying between age years from the 4 main NCDs (DM ,CVD, cancer, chronic respiratory disease) in 2012 is 16%
26 The speed of Population Aging The expected of percentage that Thais’ population aged over 65yrs. are rising from 7% to 14% in 2030.Source : Kinsella K, He W. An Aging World: Washington, DC: National Institute on Aging and U.S. Census Bureau, 2009.
27 Estimated proportion of deaths by cause (all ages , both sexes) ,Thailand, 2009This slide shows the distribution of deaths in Thailand. NCDs are the number one silent killers in Thailand, 73% of all deaths due to NCDs.. Among NCDs, cardiovascular diseases are the leading cause of death followed by cancers, chronic respiratory diseases and diabetes.
28 10 leading causes of death among chronic NCDs,2009 MaleDeath% of total deathFemale1Stroke25,19310.426,95914.42Ischemic heart disease18,6437.7Diabetes17,5709.43Liver cancer16,8546.916,7048.94COPD14,5866.07,6294.15Bronchus & Lung cancer10,2194.2Nephritis & nephrosis7,3713.969,6434.0Cervix uteri cancer5,2762.87Cirrhosis9,4414,4132.485,3342.24,3992.39Colon & rectum cancer4,2841.84,23710Mouth & pharynx cancer3,0201.2Breast cancer3,8132.0The top ten causes of death divided by sex, stroke is the first caused of death in both sex. In female, diabetes were the second and the third were ISH. In Male, ISH were the second and the third were Liver CA.Source : Burden of disease in Thailand 2009, BOD working group
29 Top 10 causes of death by age group:2009 At forty – five to fifty – nine years Was the most people dies so prevention and control in Stroke, ISH and diabetes must due to before this age group.Source : Burden of disease in Thailand 2009, BOD working group
30 NCDs Death rate per 100,000 persons in 2002 – 2013 STROKEThis slide show the trend of rising of NCDs. Stroke is the top and trend to rise in Thailand, Follow by IHD, DM, COPD and HT too.SOURCE : B. POLICY AND STRATEGY ,MOPH
31 DALYs of Chronic non-communicable diseases The disability-adjusted life yearmeasure of population health so that nonfatal outcomes could be considered alongside mortality in the prioritization of health resources.2,3 DALYs have been used to assess the magnitude of disease, health risks, and premature death both globally4–6 and at the national and local levels.7–10 DALY estimates have also been used to make the case for primary prevention programs for disorders such as stroke11 and in recommending priorities for funding allocation
32 Top 10 causes of burden of disease in DALYs by gender :2009 RankMalesDALY ('000)%Females1Alcohol dependence/harmful use5068.78.6380Diabetes2Traffic accidents5018.0350Stroke33696.35.4236Depression4HIV/AIDS2824.84.0178Ischaemic heart disease5Liver cancer2624.53.615962504.33.5154Cataracts72183.83.1138Osteoarthritis8COPD2062.91299Cirrhosis1763.02.7117Anaemia10Bronchus & Lung cancer1332.32.6114Top ten290250.044.51955Total58081004398Source : Burden of disease in Thailand 2009, BOD working group
33 DALY Attributable to Risk Factors by Gender,2009 Thailand Alcohol beverage was the most risk factor in male, follow by tobacco, blood pressure and unsafe sex.In Female BMI was the most risk factors, Follow by unsafe sex and blood pressure.WSH = Water Sanitation HealthSource : Burden of disease in Thailand 2009, BOD working group1033
34 Chronic disease: serious implication for economic development Type of costMillion Baht%Direct medical cost47,31523.8Inpatient cost25,03712.6Outpatient cost22,27811.2Direct non-medical cost3,9892.0Transportation cost2,2961.2Out-of-pocket1,6930.9Productivity loss147,20874.2Income loss for premature death144,97573.0Income loss for patients1,4320.7Income loss for caregivers8010.4Total (Million Baht)198,512% GDP2.2Per capita3,128NCDs causes the social and economic lossProductivity loss was the main economic problem and the next was Direct medical costGDP ,051 (nine thousand and fifty – five Billion bath)CVD 78,976 Cancer 78,255 DM 24,489 COPD 16,793Source : Burden of disease in Thailand 2009, BOD working group
35 Behavioral risk factor in Thai people aged 15-74 (%) This slide I will show that the 4 behavioral risk factors such as consume of the Fruit and vegetable less than 5 standard serving per day was high as eighty – two % (WHO recommended that 5 stand serving per day), Inadequate physical activity was about eighty %, follow by Current drink and the last was current smokesource : BRFSS,BNCD
36 50% adults have abnormal lipid profile Large proportion of individuals have metabolic risk factors for NCDs and they go often undetected or untreated50% adults have abnormal lipid profileOne out of four adults have high blood pressure28 % men and 40% women are overweightupward trend in childhood obesity, particularly in urban settings6.9 % adults have diabetesClustering of multiple risk factors in individuals
37 Screening for Hypertensive Diseases & Diabetes Mellitus Trend of Crude Death rate (per 100,000) in Thailand from Stroke and Key activities inHypertension AwarenessStroke Awareness & Comprehensive CVD Risk ScreeningScreening for Hypertensive Diseases & Diabetes MellitusQuality Standard HT & DM ScreeningNon-pharmacologicCareIncrease Communication Thru Salt NetStart National Exercise CampaignStart CBI for Comprehensive risk reductionSource: BNCD (ฉ.2006) and edited in 2012
38 Population with Specific Important Risk Factors 2005 MiIllionsOverweight and Obesity~ 16.1Low fruits and vegetable Diet~ 38Physical Inactivity~ 19Hypertensive Diseases~ 7.4Diabetes~ 3.4แหล่งข้อมูล: สำนักโรคไม่ติดต่อ (ฉ.2549) คาดประมาณจาก ‘*’ TBRFSS2548 ‘**’ TNHEXAM2546