5.8 M
50 million 40 million 30 million 20 million 10 million 0 million
26.0 M
( above the age of 60 )
9.0 M
18.0 M
Low-income countries
Group III - Injuries Group II Other deaths from noncommunicable diseases Group II Premature deaths from noncommunicable diseases (below the age of 60yrs) which are preventable Group I Communicable diseases, maternal, perinatal and nutritional conditions
Indonesia 2010
237.6 M population
- 33 Provinces, - 505 districts & towns
+ 52%
Stroke 15,4 Tuberculosis 7,5 Hypertension 6,8 Injury 6,5 Perinatal/maternal 6,0 Diabetes Mellitus 5,7 Neoplasm/cancer 5,7 Liver disease 5,1 Ischemic Heart Dis. 5,1 Lower resp. tract 5,1 4,6 dis. Heart disease
Source: BHR, 2007
60
49.9
50 40
44.2 41.7
30 20
10.1
31.2 28.1
10 0
5.9 6 6
Communicable Disease
oncommunicable Disease
Injury
%
1.7 8. 7.2 0. 25,9 .5 1.1 5.7 .
5
Source: BHR, 2007 *>10 year old; #>15 year old; ** 15 year old (BHR, 2010)
NO NO TX
HYPERTENSION
Risk Factors
Risk factors
Everyday servings salty foods Everyday servings fatty foods < 5 servings of fruits & vegetables Lack of physical activity Smokers (> 15 yrs of age) Overweight & obese Emotional-mental disorder Alcohol use
%
2 .5* 12.8* 9 . * 8.2* .7** 19.1# 11. # . *
Source: BHR, 2007 *>10 year old; #>15 year old; ** 15 year old (BHR, 2010)
Indonesia :
300,000 deaths each year due to tobacco
INDONESIAN SMOKERS Smoking Prevalence (>15 Th) Male Smokers (>15 Th) Women (>15 Th) Population exposed to cigarette smoke BHR 2007 33,4% 65,3% 5,06% 84,5 % BHR 2010 34,7% 65,9% 4,2% 76,1%
8
30 25 20
15 10
18.8
Female Pe re mpuan
Total
5 0
0.2
2001
1.9
1.6
2004
2007
TOBACCO
DIET
PHYSICAL ACTIVITY
ALCOHOL
10
50
150
Note: during the Second World War there was an acute fall in total and saturated fat intake followedy a rise at b the end of the war. Thefall in death rates was preceededby a progressivereductionin total and saturated fat intake and with an increase in polyunsatuated fat consumption. Blood cholesterol concentrations fell.
100
50
0 1920
19 0
19 0 Year
1980
2000
11
End Points
- Coronary HD - Stroke - Peripheral Vascular Dis - Several cancers - COPD/ emphysema - Health, wellbeing
12
Epidemiologic Transition
Low Risk
POPULATIONS
Public Health Interventions
Epidemiologic Transition
High Risk
Low Risk
INDIVIDUALS
Clinical Interventions
High Risk
14
Indonesian actions ..
15
16
N
o
S
m o k I n g
C
a m p a I g n
17
Educational talks, seminars, radio and TV talk-shows, exhibitions, free health checks and a variety of competitions (writing, poster drawing, etc)
18
Essential Equipmens
Thermometer Measurement Tape Stethoscope BPMD Weighing Machine Nebulizer Peak Flow Meter Glucometer Urine dipsticks ECG Machine
PEN
WHO/ISH Risk Charts Provide Essential Medicines
Aspirin, ISDN, CPG, HCT, Nifedepine, Amlodipin, Captopril, Enalapril, Bisoprolol, Frusemide,Spironolacton,Glibenclamide Metformin,Simvstatn Insulin, Atorvastatin Atenolol, Bronchodilator inhaler
20
Secondary CV Care
INDONESIAN NCVC INTEGRATED CV SERVICE IN PROVINCE HOSPITAL CV(TYPE A & IN SERVICE B) DISTRICT HOSPITAL (TYPE C & D) PRIVATE PRACTICE PUBLIC HEALTH CARE
3 6 4 2 9 11
11 Samarinda
Padang 5 Bengkulu 2 2
3.5 30 36
2 2
40
Existing CV center
3 RS Dr.S RS SA - Malang
22
10 more cardiology & vascular medicine dept. was appointed as an education center in 2010 IHA target : 1000 cardiologist in 2020
UN data 2008
23
Conclusion :
CVDs (Hypertension, stroke, HD) the leading cause of death in Indonesia exacerbates poverty The prevalence of hypertension is high, not well treated Parliament : Increase budget for health ! MOH : - Increase NCDs/CVDs prev. & control budget - Integrated National plans of action
(for: tobacco control, diet improvement, physical activity, no alcohol)
- Scale up packages of effective intervention - Strengthen Primary HC & improve referrals - Universal coverage Surveillance on the impact of interventions Promote & support research on CVDs prev & control
26
27
20