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Cardiovascular Disease Program

Submitted by april2011 on June 18, 2012 - 15:40 I. Rationale: Cardiovascular diseases (CVD),cancers, chronic respiratory diseases and diabetes (DM) are among the top killers in the Philippines, causing more than half of all deaths annually. Hypertension and diseases of the heart are among the ten leading causes of illnesses each year. These diseases are collectively known as Lifestyle Related Non-Communicable Diseases (NCDs), as defined in the National Objectives for Health 2005-2010, particularly because these diseases have common risk factors which are to a large extent related to unhealthy lifestyle. The risk factors involved are tobacco use, unhealthy diet, physical inactivity and alcohol use. The Food and Nutrition Research Institute (FNRD National Nutrition and Health Surveys in 1998 to 2008 (Acuin and Duante, 2010) showed that there is increasing prevalence in the associated risk factors between 1998 to 2008: hypertension from 2l%o to 25.3 %; diabetes from 3.9%o to 4.8%; among adults who are overweight, there has been a significant increase from 24.2% to 26.60/o; and those with high blood cholesterol levels had increased from 4Yo to 10.2%. Furthermore, the study found out that the following groups arc at risk for NCDs: age group from the 40's onwards and those with Body Mass Index (BMI) > 23, dyslipidemia, high waist circumference and waist hip ratios. Moreover, dietary intake trends show increasing consumption of energy dense foods high in fats and sugars, while almost the entire adult population has low levels of physical activity in all domains: occupation, non-occupation, leisure, transportation. Children and adolescents are also exposed to the above-mentioned risks. Latest data from the Global Adult Tobacco Survey in 2009 shows prevalence of tobacco use (current smokers) among population 15 years old and above tobe28.3%o (17.3 million Filipinos); 47.7% of these are men (14.6 million) and 9%o are women (2.8 million). On the other hand, the prevalence of overweight among adolescents 9-11 years old has increased two folds from 2.4oh in 1993 to 4.8%;oin2005. Similarly, the prevalence rate of overweight for children 6-10 years old doubled from 0.8% in 2001 to 1.6%o in 2005. (Source: Philippine Nutrition Facts and Figures 2005). About 30Yo of teenage students are physically inactive, spending three or more hours per day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities. (Source: Philippines Global School-based Student Health Survey, 2007). And, data shows that in 2008 hazardous alcohol intake stands at26.90/o (FNRI-NNHeS 2008).

The Philippine Renal Disease Registry (PRDR) illustrates that for 2009, diabetic nephropathy, a complication of diabetes remained the most common etiology of end stage renal disease while clinical hypertensive nephrosclerosis, a complication of hypertension ranked as the second most common etiology of end stage renal disease. Unless something is done to control these non-communicable diseases, renal complications will escalate to a degree that will compromise the current capacity to care for these types of patients.

The cost of care of lifestyle-related non-communicable diseases may cause people to fall into poverty and create a downward spiral of worsening poverty and illness. They also undermine the country's economic development. In response to the increasing prevalence of lifestyle related diseases in the country, vertical programs on the prevention and control of cardiovascular diseases, cancers and diabetes were put in place in the mid 1990's. The individual programs however, were focused on treatment and management of those who were already sick and thus were competing with each other for resources and for attention upon field implementation. A. Policy Statement: The prevention and control of chronic lifestyle related non communicable diseases shall be guided by the following policy statements. 1. The country shall adopt an integrated, comprehensive and community based response for the prevention and control of chronic, lifestyle related NCDs. 2. Health promotion strategies shall be intensified to effect changes that would lead to a significant reduction in mortality and morbidity due to chronic lifestyle related NCDs. 3. Complementary accountabilities of all stakeholders must be ensured and actively pursued in the implementation of an integrated, comprehensive and community based response to chronic,lifestyle related NCDs. B. Objectives: 1. 2. Decrease of morbidity and Mortality Decrease in the economic burden of CVDs to the individual, family and community.

Mission: To ensure that quality prevention and control and LRD services are accessible to all, especially to the vulnerable and at-risk population. Vision: A nation of Filipinos with Healthy Lifestyle and habits, living and working in clean and safe environment and with access to adequate medical care for CVD. II. Scenario

A. Global Situation The leading causes of NCD deaths in 2008 were: cardiovascular diseases (17 million deaths, or 48% of NCD deaths); cancers (7.6 million, or 21% of NCD deaths); and respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), (4.2 million). Diabetes caused an additional 1.3 million deaths. Over 80% of cardiovascular and diabetes deaths, and almost 90% of deaths from COPD, occurred in lowand middle-income countries. Behavioural risk factors, including tobacco use, physical inactivity, and unhealthy diet, are responsible for about 80% of coronary heart disease and cerebrovascular disease. These important behavioural risk factors of heart disease and stroke are discussed in detail later in this chapter.

Population growth and improved longevity are leading to increasing numbers and proportions of older people, with population ageing emerging as a significant trend in many parts of the world. As populations age, annual NCD deaths are projected to rise substantially, to 52 million in 2030. Whereas annual infectious disease deaths are projected to decline by around 7 million over the next 20 years, annual cardiovascular disease mortality is projected to increase by 6 million, and annual cancer deaths by 4 million. In low and middle-income countries, NCDs will be responsible for three times as many disability adjusted life years (DALYs)and nearly five times as many deaths as communicable diseases, maternal, perinatal and nutritional conditions combined, by 2030. B. Local Situation: Seven (7) out of 10 leading causes of mortality (death) are to Non-Communicable Diseases. 1st : Diseases of the Heart (CAD) 2nd : Diseases of the Vascular System (Stroke) 3rd : Malignant Neoplasm (Cancer) 4th : Injuries (Accidents) 7th : Chronic Obstructive Pulmonary Disease (COPD) 10th : Nephritis, Nephrotic Syndrom NEC, Department of Health III. Strategies implemented by DOH Adopted in the context of health promotion in order to decrease the chances of the targeted population to adopt high risk behaviors and habits that may lead to the development of cardiovascular disease.

Will be implemented by setting: Community-Based School-Based Industry-Based Hospital-Based Training, Research, Environmental support system are important components of the progress. IV. Status of Implementation/Accomplishment Program is well in place and its implementation is continuous. Locus of implementation is in the community level and other settings. Complicated cases shall be referred to hospitals and rehabilitation can be community and hospital based. Development of Administrative Order on the National Policy on the Integrated Chronic NonCommunicable Disease Registry System (Cancer, Stroke, DM, and COPD). 1st Public Hearing on the Administrative Order on the National Policy on the Integrated Chronic NonCommunicable Disease Registry System (Cancer, Stroke, DM, and COPD) with CHD-NCR, Government and Private Hospitals and Non-Government Agencies. Trained Hospitals for the Registry System entitled Users training for the Unified Registry System. Trained CHDs for the Registry System entitled Users training for the Unified Registry System (NonCommunicable Diseases). Establishment of Philippine Coalition on the Prevention and Control of NCD. A Training Manual for Health Workers on Promoting Healthy Lifestyle. (Non-Communicable Diseases). Twenty Years of Non-communicable Diseases (NCD) Prevention and Control in the Philippines (1968-2006). Healthy Lifestyle Advocacy Campaign. Manual of Operations on the Prevention and Control Lifestyle-Related Non-Communicable Diseases in the Philippines. Training Manual for Health Workers: WHO/DOH Smoking Cessation Clinic: Helping Smokers Quit. IV. Future Plan/Action: Implement the program through the institutionalized integrated program of NCD-Lifestyle related diseases control program. Development of Service Package for Cardiovascular Disease (CVD) Development of Clinical Practice Guideline for Cardiovascular Disease (CVD) Development of Strategic Framework and a five Year Strategic Plan for Cardiovascular Disease

(2012-2016). Program Manager:

Dr. Franklin Diza Department of Health-National Center for Disease Prevention and Control (DOH-NCDPC) Contact Number: 651-78-00 local 1750-1752

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San Lazaro Compound, Sta. Cruz, Manila (+632) 651-7800

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