2. What is a chronic disease?
• An impairment of bodily structure and/or function that necessitates
a modification of the patient’s normal life, and has persisted over an
extended period of time
3. Characteristics of Chronic disease
• Permanent
• Leave residual disability
• Caused by a non-reversible pathology
• Required special training of the patient for rehabilitation
• Required long period of supervision, observation or care
5. THE PROBLEM STATEMENT
• NCD : Globally- around 72% of all death
• India- 63% of all death
• Among SEAR regions , India shares >2/3rd of total death due to NCD
• Leading cause of death in developed countries - Cardiovascular
diseases and cancer
6. • Increasing trend of NCD
• Changes in lifestyle
• Improved health care system
• Increase in life expectancy
7. • Impact of Chronic diseases
• Disablement (Morbidity)
• Mortality
• Economic loss to the country
8. Leading causes of NCD- Globally
• Cardiovascular diseases
• Cancer
• Chronic respiratory disease
9. Leading causes of death from NCD- Globally
• Cardiovascular diseases - 44% of NCD death
• Cancer - 16%
• Chronic respiratory disease- 9%
• Diabetes - 4%
10. EPIDEMIOLOGICAL TRANSITION RATIO
• Ratio of DALYs caused by CMNNDs to those caused by NCDs and
injuries
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• CMNNDs: Communicable, Maternal, Neonatal and Nutritional Diseases
• NCDs: Non- Communicable Diseases
11. • Ratio >1- high burden of CMNNDs
• Ratio <1- high burden of NCDs
• Kerala- 0.16
• Bihar - 0.74
15. BEHAVIOURAL RISKFACTORS
• Tobacco use
• Harmful use of alcohol
• Unhealthy diet
• Physical inactivity
METABOLIC RISKFACTORS
• Raised blood pressure
• Raised blood sugar
• Rised total cholesterol
16. Tobacco use
• Direct tobacco use and second-hand smoke
• 10% of all deaths (2020)
• 71% of Lung cancer
• Chronic respiratory diseases, Cardiovascular diseases
• Middle income countries
17. Insufficient physical activity
• 20-30% increased risk of all cause mortality (person level)
• Cardiovascular diseases(including hypertension), Diabetes, Breast
and Colon cancer, Depression
• High income countries
18. Harmful use of alcohol
• 5.9% of all deaths
• Cancer, Cardiovascular diseases, Liver cirrhosis
• Violent crime including domestic violence
• High income countries
19. Unhealthy diet
• High salt consumption - hypertension and other CVDs
• Low intake of fruits and vegetables - Cardiovascular diseases,
Stomach cancer, Colorectal cancer
• Saturated fat and trans fatty acid- heart disease
• Higher income countries, now transition+
20. Raised blood pressure
• >18 yrs - 22% prevalence (2015)
• 12.8% of all death
• Cardiovascular diseases
• All income groups
21. Overweight and obesity
• Heart disease, Stroke , Diabetes, Cancer
• 11% of men & 15% of women are obese(among >18yrs) (2016)
• Poor diet and physical inactivity
• Middle income countries
• Raised cholesterol levels- High income countries
22. Cancer associated infections
• 18% of all cancers (higher in low income countries)
• HPV - Ca cervix
• Hepatitis virus - Ca Liver
• Helicobacter pylori - Ca Stomach
• Vaccinations
23. GAPS IN NATURAL HISTORY
• Absence of a known agent
• Multifactorial causation
• Long latent period
• Indefinite onset - distinction between diseased and non diseased,
slow progression, irreversible damage while diagnosed
24. PREVENTION OF NCDs
• Smoking cessation
• Restriction of alcohol
• Reduce salt intake
• Replace trans fat with Polyunsaturated fat
• Diet modification
• Improve physical activity
• Legislations
28. NPCDCS
• National Programme for prevention and control of Cancer, Diabetes,
Cardiovascular diseases and Stroke
• 2010, integrated with NHM in 2013
• Prevention of NCD through lifestyle changes
• Early diagnose and management
• Capacity building at various levels of health care
• Training of human resources
