[MUSIC] So welcome to the first lecture this week on noncommunicable diseases, or NCDs. My name is Dr. Alessandro Demaio. I'm a post-doctorate fellow of at the Copenhagen School of Global Health at the University of Copenhagen. So over the next 10 to 12 minutes, we're going to explore what NCDs are. We're going to look at some of the epidemiology, the burden of disease. And we're also going to look at some of the major misconceptions and misunderstandings around NCDs, and get those straight for you from the start of this week. So first of all, what are NCDs? Well, NCDs cause a lot of confusion. Whether it's noncommunicable diseases, whether we call them chronic disease, whether we use a capital n, whether we have a hyphen. When it comes down to it, noncommunicable diseases are defined by what, in fact, are not. They are a group diseases defined by the fact that you cannot catch them from someone else, that is they're noncommunicable. The reason that we have such a strange name is in fact that, over the last 200 years and the last million years, the majority of disease burden in the global population has in fact been from infectious diseases, problems of nutrition, water, and sanitation. As the world has developed, and we've talked about this earlier in the course, as we've seen urbanization, globalization. We've seen economic transition. We've also seen epidemiological transition. We've seen a change in the burden of diseases and the types of diseases that affect populations. We've seen communicable diseases reduce. We've also seen food supplies become more stable. We've seen water and sanitation issues be rectified in many parts of the world, and so with that we've seen a resurgence of noncommunicable diseases. But also with the effects of globalization and urbanization, we'll talk about these later in more detail this week. We've seen a change also in the disease profiles driving up NCDs. When it comes down to it, whichever definition you use, what's important is to remember that NCDs are a group is diseases that share common risk factors, common causes and determinants and therefore share opportunities for mitigation and prevention. We all like things to be simple though, so the World Health Organization, along with a group of organizations in the last ten years outlined what they defined as noncommunicable diseases, they drew a line in the sand and said. There are four diseases with four modifiable risk factors. The four diseases you can see on the table here are diabetes, heart disease, cancer and respiratory diseases, chronic lung diseases. The four modifiable risk factors are tobacco use, unhealthy diet, Physical inactivity and the harmful use of alcohol. Now when we show you this four by four table, it all becomes very clear. What's also nice about this four by four table, is that it shows the interlinked nature of these diseases, but also the risk factors. The tobacco use is actually a risk factor for all four diseases, but unhealthy diet is a risk factor for all three. What's important to remember, though, is that whilst this table makes things simpler for us, some would argue that it leaves off some of the global agenda in NCDs. When we use noncommunicable diseases, small N, small C, small D, that is, all the diseases you cannot catch from another person. We cannot forget the global burden created by mental health and also trauma including road traffic accidents, but we'll talk about that in a moment when we get to the epidemiology. So let's start by looking at the epidemiology of diabetes. Diabetes or diabetes mellitus effects 285 million people worldwide. That actually corresponds to 6.4% of the population or more than one in 20 people everywhere around the world. And in fact, It's important to remember that in some countries the burden is indeed much higher. This is an average and in fact in the West Pacific region for example, the burden of diabetes is over 10%, more than one in ten people are affected. We also need to keep in our minds that diabetes is linked with poverty. Both in terms of the fact that 70% of cases of diabetes occur in the world's poorest populations, that is lower middle income countries, but also in countries such as Mozambique and even Vietnam, diabetes treatment could cost anything between 70 and 75% of an individuals income. So you can very quickly see, both in terms of resulting from poverty, but causing poverty, how these diseases interrelate. If we look now at stroke and heart disease, cardiovascular disease including these two above is actually the number one cause of death world wide. 17.3 million people died from cardiovascular diseases in 2008 representing approximately one in four of all people dying, and 23 million are expected to die from these diseases by the year 2030. Again, it's important to remember that 80% of these deaths actually occur in low, middle income countries, that is amongst the world's poorest populations, contrary to popular opinion. In terms of lung diseases or chronic respiratory diseases. They cause approximately 7% of deaths worldwide, and we know that most of the 250,000 deaths from asthma for example each year can be attributed to lack of proper treatment. We should also keep in mind that these diseases, NCDs, are not stand alone and a good example of this is chronic lung diseases. There are in fact deadly synergies between HIV and TB, infectious diseases, but also chronic obstructive pulmonary disease and lung cancer. So turning to cancers, cancers cause approximately one in nine deaths annually, around 11%, and we're expecting rates to further increase by 50% by 2020. And we know also, that we need to think of cancers as a mixed bag of diseases. They're not a homogenous mass. And in fact, some cancers are linked to infections, some cancers are linked to nutrition and alcohol, some cancers are linked to environmental pollutants. And although it's not one of the four by four as dictated earlier on the table from the World Health Organization and others, I think it's important to make mention of mental illness and mental health. We know that around one in five or around 20% of the world's children and adolescents are estimated to have a mental illness or mental health disorder. We know that depression is ranked as the leading cause of disability worldwide. We also know that 90 people suicide every hour of every day, and 90% of them occur in low and middle income countries. So let's have a look now at the opposite axis, and let's have a look at some of the causes the risk factors for these major diseases. So first of all tobacco, while tobacco remains legal although it kills more than 5 million people each year, and is the single biggest contributor to mortality for the twentieth century. It includes, and in fact, it includes one person who dies every minute, of every day from second had smoke exposure. In terms of alcohol, alcohol and harmful use of alcohol result in around 280 deaths every hour. We know that one in ten deaths of young people between the ages fifteen and twenty nine are as a result of alcohol related causes, and we know that alcohol is the worlds third largest risk factor for disease. But in fact, the leading cause of disease, leading risk factor for disease in the West Pacific and America's region, unhealthy diets, as dictated by the Global Burden of Disease study, which we're going to talk more about in the next lecture. Unhealthy diets are in fact the number one risk factor for disability adjusted life years lost in 2010. And the risk factor for, other risk factors such as obesity, but also for diseases such as diabetes, heart disease, and cancers, and finally physical inactivity. Physical inactivity is the main cause for approximately one in four cases of breast and colon cancer, and around a third of diabetes and heart disease worldwide, and it accounts for around one in 20 deaths globally. So there are many misunderstandings, many misconceptions about NCDs, but if you take one important thing from this lecture I want you to remember the next six key facts about NCDs. These are deep misunderstandings at a global level that continue to impact and hinder progress on the mitigation and prevention of NCDs. So let's have a closer look. First of all, NCDs are the leading cause of death now already today. These are not a problem of tomorrow. These are not a problem of the future. They caused more than 36 million deaths in 2006 alone, and this is well over half of the global burden of disease. And in fact, NCDs cause more deaths than HIV, TB, malaria, and all other diseases combined. Second, NCDs are not diseases of the rich. In fact, the vast majority of NCDs occur in the world's poorest populations. That is, low and middle income countries, but in addition, it's important to remember that even in high income countries, there is a link between poverty and NCDs. Poverty causes and is linked to NCDs, but also NCDs can cause poverty. In this sense, I like to describe it as NCDs being a poverty cycle catalyst. Number three, NCDs are not diseases just of the aged. These are not diseases just of old people. In fact increasingly, NCDs are affecting younger and younger populations. In 2008 more than 50% of the global burden occurred in people under the age of 70. Number four, NCDs do not just affect men. In fact, in 2013 NCDs are the single biggest threat to female health and development worldwide accounting for approximately 65% of all female deaths. But importantly, we need to remember that the NCDs place a disproportionate burden on women on to other levels. First of all the link between maternal and child health, and the resulting risk of chronic disease in the future generations. We'll talk about that in more detail in the later week, but also we need to remember that NCDs require usually regular and sustained care from a caregiver. Caregivers tend to be female, and this takes away opportunities for employment, education, and other social development. Number five, NCDs are not just diseases of the lazy. A common misperception worldwide is that people bring NCDs upon themselves, particularly more so than other diseases. In fact, NCDs are deeply rooted in the social determinants of health and we will have a lecture on this later on in the week. Finally NCDs are not a fay complete. They're not an Armageddon situation and in fact, we know that 80% of diabetes and heart disease and a third of cancers can in fact be prevented today with the tools, knowledge, and opportunities that we currently possess. So in closing, NCDs pose a threat, a threat to our global health, a threat to our global economy, a social, political, cultural, and geopolitical threat to the global community. But it's very important that we also remember NCDs represent enormous opportunity. They represent an opportunity for developing healthier CDs. They represent an opportunity for stronger economies, for a more sustainable way of living, and they represent opportunities for addressing not just NCDs but a number of other diseases as an integrated global health agenda. [MUSIC]
