Public health or Community Health

▪ major focus is the prevention of spread of diseases within the population.

Two categories of Diseases:

Communicable Disease
▪ refer to types of diseases that can be transmitted to human
▪ either DIRECTLY or through MEDIUMS.
▪ caused by microorganisms which can either be a bacteria, parasite, fungi,
prion or virus.
▪ “Germ Theory”
Non- Communicable Disease
▪ also known as chronic disease
• Medical condition or disease which is not infectious
• These are diseases with long duration and relatively slow progression
• Usually called ‘chronic diseases’
(WHO, May 2017)

▪ NCDs are the leading cause of death in the world

▪ The majority of these deaths - were attributed to

Cardiovascular Diseases, Diabetes, Cancers and
Chronic Respiratory Diseases.

▪ NCDs are largely preventable by means of

effective interventions that tackle shared risk
factors
 Cardiovascular Disease

Diabetes Cancer

Chronic Respiratory Disease

Tobacco use
Unhealthy Diet

Physical Inactivity

Harmful use of alcohol

▪ Cardiovascular disease is caused by disorders of the heart and blood vessels

❑ Coronary heart disease (heart attacks)

❑ Cerebrovascular disease (stroke)
❑ Raised blood pressure (hypertension)
❑ Peripheral artery disease
❑ Rheumatic heart disease
❑ Congenital heart disease
❑ Heart failure
 Contributing factors
▪ A person’s genetic make-up
▪ The foundations of adult health are laid in early life
▪ Socioeconomic group
▪ Mental health
▪ Diet
▪ Inactivity
▪ Tobacco
▪ Alcohol
▪ Diabetes
▪ Globalization and urbanization
 Prevention
▪ Focusing on a combination of risk factors for cardiovascular disease
▪ Implementing medical screening for individuals at risk
▪ Providing effective and affordable treatment to those who require it
▪ Cancer is the uncontrolled growth and
spread of cells that arises from a change in
one single cell.

▪ The change may be started by external

agents and inherited genetic factors and can
affect almost any part of the body.
 CONTRIBUTING FACTORS

▪ Physical carcinogens

▪ Chemical carcinogens

▪ Biological carcinogens
 The majority of cancer deaths

▪ Lung
▪ Breast
▪ Colorectal
▪ Stomach
▪ Liver cancer
▪ Cervical cancer
 RISK FACTORS

▪ tobacco use
▪ unhealthy diet
▪ insufficient physical activity
▪ the harmful use of alcohol
▪ Infections (hepatitis B, hepatitis C (liver cancer), human
papillomavirus (HPV; cervical cancer), Helicobacter pylori
(stomach cancer)
▪ Radiation
▪ variety of environmental and occupational exposures of
varying importance
 POLICY

WHO’s approach to cancer:

✓ Prevention
✓ Early detection
✓ Screening
✓ Treatment
✓ Palliative care
 NATIONAL CANCER CONTROL PROGRAM- WHO

▪ Focuses government attention and services on all

facets of the fight.
▪ Designed to reduce cancer incidence and
mortality and improve cancer patients’ quality of
life, through the systematic and equitable
implementation of evidence-based strategies for
prevention, early detection, diagnosis, treatment
and palliation, making the best use of available
resources.
▪ According to the WHO Global Status Report, smoking
is estimated to cause about 71% of all lung cancer
deaths and 42% of chronic respiratory disease
worldwide.

▪ Second-hand smoke causes severe respiratory

health problems in children, such as asthma
and reduced lung function

▪ Indoor air pollution from biological agents

increases the risk of respiratory disease in children
and adults.
 Prevention

▪ Most countries introduced a wide

range of comprehensive policies to
reduce and eliminate tobacco smoke.
▪ Diabetes is a chronic disease that occurs when
the pancreas does not produce enough insulin (a
hormone that regulates blood sugar) or
alternatively, when the body cannot effectively
use the insulin it produces.
 HEALTH IMPLICATIONS

Diabetic retinopathy

Diabetic neuropathy

Diabetes is among the leading

causes of kidney failure

Diabetes increases the risk of heart disease and stroke

 PREVENTION
• Achieve and maintain healthy body weight.

• Be physically active - at least 30 minutes of

regular, moderate-intensity activity on most
days.

• Early diagnosis can be accomplished through

relatively inexpensive blood testing.
 TREATMENT

• People with type 1 diabetes require insulin

• People with type 2 diabetes can be treated

with oral medication, but may also require
insulin.
 Overweight and obesity are defined as "abnormal or excessive fat
accumulation that may impair health“

Body mass index (BMI)

▪ The weight in kilograms divided by the square of the

height in meters (kg/m2)
▪ Is a commonly used index to classify overweight and
obesity in adults.
▪ WHO defines overweight as a BMI equal to or more
than 25, and obesity as a BMI equal to or more than
30.
▪ Overweight children are likely to become obese adults.
 PREVENTION
▪ Supportive environments and communities are fundamental
in shaping people’s choices and preventing obesity

▪ Individual responsibility can only have its full effect

where people have access to a healthy lifestyle, and
are supported to make healthy choices.
▪ Global levels of dietary salt intake - 9 to 12 grams/day
▪ WHO recommendation
❑ salt intake of less than 5 grams per person per day
 Current status and trends in risk factors
The prevalence of these risk factors varied between country income groups, with the
pattern of variation differing between risk factors and with gender.

▪ High-, middle- and low-income countries had differing risk profiles.

HIGH-INCOME COUNTRIES

1. physical inactivity among women,

2. total fat consumption,
MIDDLE-INCOME COUNTRIES
3. raised total cholesterol.
1. tobacco use among men,
 Parameters for estimation of risk factors
CURRENT DAILY TOBACCO SMOKING: the percentage of the population aged
15 or older who smoke tobacco on a daily basis.

PHYSICAL INACTIVITY: the percentage of the population aged 15 or

older engaging in less than 30 minutes of moderate activity per week or
less than 20 minutes of vigorous activity three times per week, or the
equivalent.

RAISED BLOOD PRESSURE: the percentage of the population aged 25 or older having
systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥90 mmHg or
on medication to lower blood pressure.
 Parameters for estimation of risk factors
RAISED BLOOD GLUCOSE: the percentage of the population aged 25 or older having a
fasting plasma glucose value ≥ 7.0 mmol/L (126 mg/dl) or on medication for raised blood
glucose.

OVERWEIGHT: the percentage of the population aged 20 or older having a body mass
index (BMI) ≥ 25 kg/m2.

OBESITY: the percentage of the population aged 20 or older having a body mass index
(BMI) ≥30 kg/m2.

RAISED CHOLESTEROL: the percentage of the population aged 25 or older

having a total cholesterol value ≥ 5.0 mmol/L (190 mg/dl).
The Non communicable disease Causation Pathway
COMMON RISK FACTORS
- Tobacco use
UNDERLYING DETERMINANTS - Unhealthy diet
- Globalization - Physical inactivity
- Urbanization - Harmful use of alcohol
- Population ageing - Air pollution
- Social determinants - Age & hereditary

INTERMEDIATE RISK FACTORS

DISEASES - Raised blood sugar
-Cardiovascular disease -Raised blood pressure
-Cancer -Abnormal blood lipids
-Diabetes -Overweight/obesity
-Chronic respiratory disease -Abnormal lung function
 10 PROGRESS MONITORING INDICATORS

WHO NONCOMMUNICABLE DISEASE PROGRESS MONITOR 2017- which charts actions by countries to set
targets, implement policies to address four main shared and modifiable NCD risk factors and build
capacities to reduce and treat NCDs

"Bolder political action is needed to address constraints in controlling NCDs.“

-Dr Tedros Adhanom Ghebreyesus, WHO Director-General

"The window of opportunity to save lives is closing. This is playing out before our eyes in many ways,
including in the increasing numbers of people, particularly children and adolescents, suffering from
obesity, overweight and diabetes. If we don't take action now to protect people from NCDs, we will
condemn today’s and tomorrow’s youth to lives of ill-health and reduced economic opportunities.“
-Dr Douglas Bettcher, WHO director
10 PROGRESS MONITORING INDICATORS

ICD or International Classification of Disease- is the international “ standard diagnostic tool for
epidemiology, health management and clinical purposes.

✓ originally designed as a health care classification system, providing a system of diagnostic

codes for classifying diseases
10 PROGRESS MONITORING INDICATORS
10 PROGRESS MONITORING INDICATORS
10 PROGRESS MONITORING INDICATORS
10 PROGRESS MONITORING INDICATORS
10 PROGRESS MONITORING INDICATORS
10 PROGRESS MONITORING INDICATORS
 PREVENTION AND CONTROL OF NCDs

GLOBAL ACTION PLAN OF 2008-2013 for the

implementation of the WHO Global Strategy on the
Prevention and Control of Noncommunicable Diseases.

▪ This Action Plan was endorsed by the 2008 World Health

Assembly.

▪ It provides countries a roadmap for taking action

against NCDs
 First global ministerial conference on healthy
lifestyles and non- communicable disease control
April 28 to 29, 2011- Moscow (The Russian Federation)

THE AIM OF THE CONFERENCE was to support Member States develop and strengthen
policies and programmes on healthy lifestyles and NCD prevention.

THE CONFERENCE HAD THREE MAIN GOALS:

▪ to highlight the magnitude and socio-economic impact of NCDs;
▪ to review international experience on NCD prevention and
control;
▪ to provide evidence on the pressing need to strengthen global and
national initiatives to prevent NCDs as part of national health plans
and sustainable development frameworks
 UN General Assembly’s commitment to fight Non-
Communicable disease
UN General Assembly adopt of the political declaration on the prevention and control of
noncommunicable diseases.

▪ Governments will integrate policies to reduce

noncommunicable diseases into health planning
processes and national development agendas.

▪ Success will depend on the engagement of non-

health sectors such as finance, agriculture,
transportation, urban development, and trade.
Thank you!