Prevention & Control of Chronic Lifestyle-

Related Noncommunicable Diseases in

the Philippines
Ma. Elizabeth C. Baua, RN,MSN,DNS
St Paul University Philippines
St Paul University Philippines
St Paul University Philippines
St Paul University Philippines
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Outline of Presentation
• Key facts about chronic lifestyle related NCD’s
 Common Risk factors involved in NCDs
 DOH- National Policy on Strengthening the prevention and control of
chronic lifestyle related non – communicable diseases
 Goals and Objectives of National Program on the Prevention and
Control of Chronic Lifestyle related NCD’s
 Action Framework & Program Initiatives
 Roles of health workers and other stakeholders in the NCD prevention
& control program
 Program Implementation & Management
 Sustainable Initiatives for the Future
 Best Practices of SPUP in health promotion & illness prevention
Key Facts about NCDs
Non-communicable diseases (NCDs) kill 40 million people
each year, equivalent to 70% of all deaths globally.
 Each year, 15 million people die from a NCD between the
ages of 30 and 69 years; over 80% of these "premature"
deaths occur in low- and middle-income countries.
 Cardiovascular diseases account for most NCD deaths, or
17.7 million people annually, followed by cancers (8.8
million), respiratory diseases (3.9million), and diabetes
(1.6 million).
 These 4 groups of diseases account for over 80% of all
premature NCD deaths.
 Tobacco use, physical inactivity, the harmful use of
alcohol and unhealthy diets all increase the risk of dying
from a NCD.
 What are non communicable
diseases?(NCD’s)
 WHO has described non
communicable diseases as a
“slow moving catastrophe”
 with the potential to
overwhelm all countries
unless decisive action is
taken to address these
NCDs.
 NCDs are the leading cause
of deaths globally.
Who are at risk of such diseases?
 People of all age groups, regions & countries are affected by
NCDs.
 Evidence shows that 15 M of all deaths were due to NCDs
among people between 30-69 years
 NCDs has caused premature deaths, 80% are estimated to
occur in low and middle income countries
 Children, adults & elderly are vulnerable to the risk factors
Risk factors
 Increasing prevalence of Hypertension from 21% to 25.3 %
 Diabetes from 3.9% to 4.8%
 Overweight ( adults) 20.2 % to 26.6 %
 High Cholesterol levels – 4% to 10. 2 %
 BMI - 23, dyslipidemia, high waist circumference and waist
hip ratios.
 Dietary intake trends – increasing consumption of energy
dense foods high in fats and sugars
 Low levels of physical activity in all domains: occupation,
non-occupation, leisure & transportation
Modifiable Behavioral Risk Factors
 Modifiable behaviours, such as tobacco use, physical
inactivity, unhealthy diet and the harmful use of alcohol, all
increase the risk of NCDs.
 Tobacco accounts for 7.2 million deaths every year (including
from the effects of exposure to second-hand smoke), and is
projected to increase markedly over the coming years.
 4.1 million annual deaths have been attributed to excess
salt/sodium intake.
 More than half of the 3.3 million annual deaths attributable
to alcohol use are from NCDs, including cancer.
 1.6 million deaths annually can be attributed to insufficient
physical activity.
Metabolic Risk Factors

 Metabolic risk factors contribute to four key metabolic

changes that increase the risk of NCDs:
 High blood pressure
 overweight/obesity
 hyperglycemia (high blood glucose levels) and
 hyperlipidemia (high levels of fat in the blood).
What are the socio-economic impacts of
NCDs?
 NCDs threaten progress towards the 2030 Agenda for
Sustainable Development, which includes a target of
reducing premature deaths from NCDs by one-third by
2030.
 Poverty is closely linked with NCDs. The rapid rise in NCDs
is predicted to impede poverty reduction initiatives in low-
income countries, particularly by increasing household costs
associated with health care.
Mortality by cause of Death
Top deadliest NCDs in the Philippines
 CAD (coronary artery disease) “the silent epidemic“-most
common deadliest disease (16.86 % of total deaths)
 STROKE -12.14% of total deaths ( Stroke Society of the
Philippines )
 Diabetes -320 M people globally as predicted by experts in 2025
 Tuberculosis-5 % of total deaths
 Hypertension (38.20 % for every 100,000 population)
 Lung diseases ( emphysema & chronic bronchitis)
 Kidney Disease (3.04%) every year
 Breast Cancer – 16% of cases in every 50,000
 Asthma -2.3 % of total deaths
Prevention & Control of NCDs
 An important way to control NCDs is to focus on reducing the
RISK FACTORS associated with these diseases.
 Low cost solutions exist for government and stakeholders to
reduce the modifiable risk factors.
 Monitoring progress and trends of NCDs and their risk is
important for guiding policy and priorities
 A comprehensive & community based approach is
needed requiring all sectors to collaborate to lessen the impact of
NCDs in the society.
 Investing better management of NCDs. Management of
NCDs includes early detection, screening and timely treatment.
 Promote interventions to prevent and control these diseases to
reduce premature deaths by 2030
The 2030 Agenda for Sustainable Development
recognizes NCD as a major challenge for
Sustainable Development.
GLOBAL action plan for the prevention and
control of NCDs
The National Program on the Prevention &
Control of Chronic Lifestyle Related Non
Communicable Diseases
Goals and Objectives

To reduce mortality, morbidity & disability rates due to

chronic lifestyle related NCD’s through an
INTEGRATED AND COMPREHENSIVE PROGRAM
on the prevention and control of lifestyle related diseases.
GOALS & OBJECTIVES

 1. To develop and promote an integrated and comprehensive

program on the prevention and control of lifestyle diseases in
the Philippines.
 To engage all province – wide or city wide health systems to
adopt an integrated and comprehensive program on the
prevention & control of chronic lifestyle related NCDs.
 Action Framework for the Prevention &
Control of Chronic Diseases
Causation Pathway Model for major Chronic Diseases

Common Risk Intermediate Risk

Factors Factors
Underlying
Unhealthy Diet Increased Blood
Determinants
Physical Inactivity Sugar
Globalization Chronic
Tobacco Use or Increased BP
Urbanization Diseases
alohol use Lipidemia
Population
Air Pollution Obesity
Ageing
Age Abnormal Lung
Heredity Function

Adapted from preventing Chronic Diseases, WHO 2005)

Action Framework for the Prevention &
Control of Chronic Diseases
2.

Adapted from preventing chronic diseases, WHO 2005.

Rationale of the NCD Prevention and
Control Program

 Burden of Non Communicable diseases-

 NCD’s are major public health concern worldwide
 They account for 60 % total deaths globally ( w/ 40 M
deaths estimated occurring annually)
 These rates would increase to as high as 73 % total deaths &
60 % disease burden by 2020 (WHO, 2010).
Prevalence of NCDs among Filipinos
 Increasing trend of NCD’s
 58 % of total deaths in
2003 were caused by
NCDs
 CADs, diabetes, cancers,
COPD were on the top
list. Being linked with
preventable risk factors (
tobacco use, unhealthy
diet, physical inactivity and
alcohol use (FNRI 2009)
Prevalence of NCD’s among Filipinos
 90 % have at least one or more risk factors.
 Prevalence of risk factors :
 Smoking ( 34.8% M=56%; 12% females are current
smokers
 Overweight (20%)
 Obesity (4.9 %)
 High blood sugar (4.6%)
 Hypertension( 22.5%)
 Physical Inactivity (60%)among adults
Prevalence of risk factors in young
children
 Children are showing the propensity to becoming overweight
at an early age.
 Children 9-11 years old are overweight/obese 2.4 % in
1993; 4.8 % in 2005
 Tendency to remain obese in adulthood
 22 % of teenagers currently smoke ; 30 % are physically
inactive

(Philippine Nutrition Facts & Figures, 2005)

(Philippines Global Youth Tobacco Survey, 2007)
Integrated NCD Prevention & Control
Program Framework (INCDPCP)
Key characteristics of the INCDPCP
 It uses the integrative approach
 Provides comprehensive services along the continuum of care
 Promotes primary health care approach
 Encourages community based implementation
 Encourages partnership and advocates whole of government
and whole of society
 Ensures sustainability
Roles of Health Workers in the Program
Implementation
Key Actors :  Policy & Program
 National Level – Development
Department of Health
 Program
 Regional Level –
Centers for Health Implementation
Development  Program
 Local Level – Management
provincial, Municipality
Barangay or
Community
 National Level – Department of Health
Program PROGRAM
Policy and Implementation MANAGEMENT
Provide technical
program assistance tothe
Design & advocate
financing mechanisms to
development CHDs,LGUs and other help LGUs sustain delivery
Set overall policy partners: to include of the NCD prevention &
Formulate strategic support for the control services
plan of action following: Ensure compliance of
Advocate for the Develops LGUs
drafting and passing of Standards and protocols To standards & protocols
bills/laws to guide the program Coordinate w/
Develop national implementation; international partners for
agenda for research and Design and provide technical updates
policy actions training to address Develop guidelines on
Disseminate policies & capability gaps supervision, surveillance
guidelines Develops prototypes of system and monitoring
IEC and advocacy and evaluation
materials
Flow of Delivery of Health Care
Services

Risk factor Asses for tobacco use or

Assessment smoking status

Assess nutritional status or

Assess for physical inactivity
diet

Summarize results
Lifestyle Modification
Flow of Delivery of Health Care
Services after risk factor assessment
 If found not at risk = HEALTH
EDUCATION
 If at risk = lifestyle modification , NCD
screening & diagnostic tests
 If w/ no NCD = health education, lifestyle
modification
 If w/ NCD = lifestyle modification,
treatment, and referral to higher level of
care plus more diagnostic tests,
rehabilitation and palliative care
 LIFESTYLE MODIFICATION

 (1) promotion of smoking cessation (SERIOUS RISK

FACTOR)
 (2) promotion of proper nutrition;
 (3) promotion of physical activity and exercise;
 4) avoidance of alcohol use; and
 (5) promotion of stress management
Key Strategies in the Integrated NCD
program Implementation
 1. Promoting Healthy Lifestyle
 Engaging in regular physical activity
 Having a healthy diet and eating more fruits and vegetables
 Avoiding tobacco and alcohol use
 Healthy lifestyle expo or exhibits, fun run, green diets
 Home visits and Client education/counseling
 Client testimonials & health events (e.g., heart month,
cancer awareness month, diabetes week, etc.)
 Smoking cessation education, benefits of exercise
2. Health Promotion Activities at SPUP

 School based Healthy Lifestyle Programs include

physical fitness classes (body mind spirit approach) nutrition
& food services, & health services like hypertension &
diabetes screening, serving healthy meals at the canteen, de-
stressful massage & yoga.
 Healthy Slogans on how to prevent chronic lifestyle
related NCDs (Healthy Lifestyle is always the best style, Eat
to live not live to eat, He who runs daily adds another day to
his life)
3. Building Healthy Public Policies &
Supportive Environments
 1. Development of policies & legislations to improve the
health of the people
 ANTI – TOBACCO LAW RA 9211
 Sanitation Code –enforcing food establishments to observe
 Sanitary and hygiene requirements
 Ensure that health care facilities comply with license
requirements of DOH.
4. Establishing Coalitions &
Partnerships
 Identify local partners in the implementation of the program
 Support groups and health clubs, such as: Diabetes Club,
Asthma Club, Exercise Clubs etc.
 Schools and universities act as coalition partners
 Local Government officials and Barangay Health workers
 Non government or private sectors- private agencies and
medical practitioners are invited to join medical community
outreach programs
 Student volunteers among health science courses
 Government and non government officials and volunteers
5. Making Health Services Available
and Accessible
 Basic Health Care Package of services are made available and
accessible for each levels of care
 1. Primary level – barangay health stations or rural health
centers, school clinics at the community level w/ health
promotion activities like health education, risk factor assessment,
lifestyle modification, referrals
 2. secondary level-district hospitals, provincial hospitals – offer
primary health care services plus laboratory examinations & blood
chemistry, provide medications,
 3. Tertiary level- hospitals in the urban setting with
sophisticated and advanced diagnostic tests, radiotherapy,
chemotherapy and palliative care
6. Strengthening Program
Management
To ensure effective and efficient implementation of
the program:
 Training & capacity building- conduct healthy lifestyle
training among health workers ( e.g. risk factor assessment )
 Provide special training to selected service providers such as
smoking cessation, nutrition & diet counseling,
 Supervision of health workers on a continuous basis
7. Ensuring Stable Financing
 Advocate for LGUs to increase budget allocation for NCD
prevention and control
 Conduct resource generation from development agencies,
private sectors and other partners
 Expand PhilHealth membership for the support of some
clinical packages in NCD
 Design a local financing scheme as needed and develop
corresponding guidelines and protocols for its
implementation
 Monitor the collection and utilization of finances to ensure
that these are prioritized for promoting healthy lifestyle
SCREENING AND DIAGNOSIS

Individual and mass screening tests for risk

factors ( hypertension, elevated blood
cholesterol
diabetes, cancer, COPD,Asthma )
 Screening & Diagnosis
 If there are risk factors present …..

CONFIRM EXPLAIN

EDUCATE
Management of Major NCDs following
Protocols
 Hypertension – BP screening
 Stage 1 – (SBP 140/90) ACE inhibitors, calcium channel blockers
or Beta Blockers
 Stage 2 –(SBP 150 or more) 2 drug combination usually thiazides
w/ diuretics and ACE inhibitors
 CAD – angina pectoris, myocardial infarction –drug therapy
(prevention /treatment of anginal attacks) isordil sublingual
Strokes /TIA – prevention of paralysis , surgery & drug therapy
 Cancers - Chemotherapy, Brachytherapy and Radiation Therapy
 Diabetes – HEALTH EDUCATION, diabetes self care
management, OHA drugs, Insulin therapy
1990 – 1995 1996 – 2000
NCD specific programs RA 8191: National Diabetes Act
Philippine Cancer ControlProgram Integrated NCD P&C Program
National CVD P&C Program Tobacco Control Program
Diabetes Mellitus P&C Program
Framework and National Action Plan
Tobacco & Alcohol Use
Yosi Kadiri RA 8749 Clean Air Act
Diet & Physical Exercise IWAS SAKIT DIET
2001 – 20
Edi Exercise

2005-2009
2001 – 2004
Assessment of the Updated Framework for
Integrated NCD P&C Program
Philippine Coalition for the P&C NCD
of NCD Prevention & Control
“Mag HL tayo campaign” Presidential Proclamation 958
Global Youth Tobacco Survey Decade of Healthy Lifestyle against Cancer
RA 9211: Tobacco Regulation Act Outstanding Healthy Lifestyle Awards
Tobacco Cessation program Advocacy for Healthy Foods
Philippine Nutrition Plan of Action Only healthy rich nutritious foods to be sold
in school canteens
04 Integrated NCD P&C Program piloted
in Pateros and Guimaras Philippine
Prevention and Control of NCDs
2009-2014
 National Policy on Strengthening the Prevention & Control
of Chronic Lifestyle Related NCD
 Implementing Guidelines on
 PhilPEN for Primary Health Care Facilities
 TamaTseKa Program
 Belly Good Program
 Filipinas GO4 HEALTH
 CONCLUSION
 Globally, the epidemic of non-communicable chronic diseases
threatens economic and social development, and the lives and
health of millions of people.
 Deaths due to chronic lifestyle –related NCDs are projected
to increase globally by 17% by 2030.
 The Philippines through DOH has been visionary in leading
various projects and programs to fight NCDs and its efforts
are paying off slowly.
 NCD mortality including premature deaths over the last 5
years, prevalence of behavioral risk factors generally remain
high.
Conclusion
 The prevalence of major NCDs continues to grow, and countries cannot be
complacent. I encourage all entities concerned, particularly the nurses and
health care workers to act now on the prevention and control of NCDs.
 Promotion of healthy lifestyles, lifestyle modification are important aspects of
disease prevention & control.
 The Philippines need to accelerate the whole society (public and private
sectors) actions to sustain the gains and achieve its targets.
 There is a need to strengthen the Philippine Health Care System interventions
and promote accountability of various sectors in addressing NCD and its risk
factors.
 The development of multi-sectoral action plan on NCD prevention & control is
imperative to halt the rise of NCD in the Philippines


 TERIMA KASIH
THANK YOU
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