Chronic and noncommunicable diseases
- Common NCDs share the same four risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet.
- NCDs could be significantly reduced, with millions of lives saved and untold suffering avoided, through reduction of these risk factors and strengthening healthcare systems, with a focus on primary health care for people who already suffer from NCDs.
- Of the estimated 57 million global deaths in 2008, 36 million or 63% were due to NCDs.
- The leading cause of global NCD deaths in 2008 was cardiovascular disease (17 million, or 48% of NCD deaths).
- Approximately 44% of all NCD deaths occur before the age of 70.
- To devise and implement policy instruments on workers' health;
- To protect and promote health at the workplace;
- To improve performance of and access to occupational health services;
- To provide and communicate evidence for action and practice;
- To incorporate workers' health into non-health policies and projects. (1)
- In Viet Nam, WHO estimated that:
- 430,000 deaths in 2008 were caused by NCDs, accounting for 75% of total deaths.
- Of these NCD-related deaths, cardiovascular diseases made up 40%, cancers 14%, chronic respiratory diseases 8% and diabetes 3%.
- According to a national survey in 2009/10 (for those aged 25 to 64):
- The prevalence of overweight and obesity, hypertension, diabetes and raised blood lipid were 12,0%, 19.2%, 2.7% and 30.1%, respectively.
- Daily smoking among males was still very high, at 56.4%.
- Some 25% of males were binge drinkers.
- About 80% of Viet Namese people do not eat enough fruit and vegetables.
- The number of people described as physically inactive was 28.7%.
- An NCD prevention and control programme was established in 2002 with components representing each NCD – hypertension, diabetes, cancers, chronic respiratory disease and mental disorders.
- Each component of the programme was step-by-step upgraded to become a project/sub-project of the National Target Programme – the first priorities.
- However. up to now, action for prevention and control of NCDs has not yet met the need. There are a number of reasons:
- To date, Viet Nam has applied a disease specific approach to prevention and control of NCDs, where disease specific treatment institutions (e.g the K Hospital for cancer and the Endocrinology Hospital for diabetes) coordinate all elements of the national response. Viet Nam is proposing to revise this to focus more on a risk factor approach to prevention of common NCD’s.
- As a lower-resource country, Viet Nam cannot afford to provide sufficient resources for an integrated NCD prevention and control programme. As a result, the coverage of the NCD programme is small.
- The NCD programme is entirely within the health sector, with almost no multi-sectoral action for common NCD risk factors, except for tobacco, which belongs to a separate programme.
- Fragmentation of the health system, especially separation of the treatment system and the system of preventive medicine (SPM), with the potential SPM having had little involvement in NCD prevention and control, is one of the critical barriers in this field.
- However, Viet Nam has genuine strengths and opportunities to address these problems, such as strong political commitment, and a well organized health system with experience in working with other sectors for communicable diseases. This can be applied for NCD risk factor prevention.
- Efforts by the Ministry of Health to improve the primary healthcare system, mainly to reduce hospital workloads, will greatly benefit NCD prevention and control.
- WHO has assisted in establishing an NCD prevention and control programme, as well as advocating more investment for NCDs and assisting in the development of policies and strategies for their prevention and control.
- WHO advocates and supports multisectoral action for NCD risk factor prevention, including shifting from a vertical to integrated approach.
- WHO has provided guidelines and models for continuing care for NCD patients. For example, WHO has supported community-based models, especially an integrated model where a number of major NCD conditions are managed simultaneously according to WHO guidelines.
- WHO has supported the development and implementation of a National NCD surveillance system.
- WHO support has contributed to significant achievements in NCD prevention and control in Viet Nam:
- The NCD prevention and control programme has achieved the important status of the National Target Programme. The Action Plan for NCDs for 2012-2015 was approved by the Prime Minister.
- An NCD prevention sub-committee of the national steering committee for NCD prevention and control, with the involvement of other sectors, was established to promote multisectoral action for NCDs.
- Management of NCD conditions is moving from hospitals to communities and is being scaled up.
(1) WHO Global Status Report on noncommunicable diseases, 2010