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Integrated Prevention and Control for Non-communicable Disease in China

Dr. Jixiang Ma, National Center for Chronic and Non-communicableDisease Control and Prevention (NCNCD)China CDC

Situation Analysis

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Chinese Center for Disease Control and Prevention, PR. China

NCD Prevention and Control System in China

NCNCD

Division of NCD Risk Factors Surveillance

Division of Integrated NCD control and Prevention

Division of Cancer Control and Prevention

Division of CVD Control and Prevention

Division of Vital Registry & Death Cause Surveillance

Division of Obesity & Metabolic Diseases Control and Prevention

Division of Mental & Psychological Health

Division of Oral Health

Division of Elderly Health

WHO Collaborating Center on Community-based Integrated NCD Control & Prevention

Society of NCD Control & Prevention, Chinese Preventive Medicine Association

Division of Injury Control & Prevention

China CDC

Main working areas for NCNCD

• NCD Surveillance

• Integrated NCD control and Prevention

Disease Surveillance Points system(DSPs)

NCD Risk Factor SurveillanceSince 2004

Death Cause RegistrySince 2002

CVD Registryto be initiate

NCD Surveillance

Geographic Distribution of DSPs System

Urban(64)Rural (97)

Questionnaire based survey• Tobacco use, alcohol consumption• physical activity• diet• Control and treatment for NCDs

Physical measurements• Height• Weight• Hip circumference• Blood pressure

Lab tests• Fast Blood glucose• Lipid• insulin• HbA1c

• 31 provinces ， 79 surveillance points

• 30,000 participants ， resident population

•31 provinces ， 162 surveillance points

•100,000 ， resident population

2010

2004

Funded by central finance

•31 provinces ， 160 surveillance points

•50,000 participants ， resident population

2007

Development of NCDs and RF Surveillance

•31 provinces ， 170 counties/districts

•50,000 participants ， floating population

2012

Questionnaire based survey• Tobacco use, alcohol consumption• physical activity• diet• Control and treatment for NCDs

Physical measurements• Height• Weight• Hip circumference• Blood pressure

Lab tests• Fast Blood glucose• Lipid• insulin• HbA1c

• 31 provinces ， 79 surveillance points

• 30,000 participants ， resident population

•31 provinces ， 162 surveillance points

•100,000 ， resident population

2010

2004

Funded by central finance

•31 provinces ， 160 surveillance points

•50,000 participants ， resident population

2007

Development of NCDs and RF Surveillance

•31 provinces ， 170 counties/districts

•50,000 participants ， floating population

2012

Facts about NCD in China

CVD38%

Cancer26%

Chronic Respi-ratory Diseases

12%

Other NCDs9%

Injuries10%

Communicable, maternal, neonatial, and nutritional

disorders6%

In total, NCDs accounted for 70.1 million deaths (85%), 18.7% up from 1990*

*Yang G, Wang Y, Zeng Y, et al. Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2013. 381(9882): 1987-2015.

Deaths from NCDs in China, 2010

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Prevalence of NCD risk factors in adults aged>18 in 2010

Current male smoker Salt intake above 5g/d Oil intake over 25g/d Vegetable & Fruit intake <400g/d

Excessive alcohol consumption Regular Physical exercise

47.0%

80.9% 83.4%

52.8%

17.4%11.9%

Source ： 2010 PRC BRFSS

Epidemic of Biological Risk Factors of NCDs

Overweight

Source ： 2010 China Annual Cardiovascular Report （ Hypertension ） ;2010 PRC BRFSS （ Overweight 、 Obesity 、 Raised cholesterol 、 Diabetes ） .

305 million

120 million

236 million

32.9 million

97 million

Obesity Hypertension Raised cholesterol Diabetes

Trends of Salt Intake in adults

数据来源： 1982 、 1992 、 2002 年营养调查（称重法）； 2010 年中国慢病行为危险因素监测（食物频率法）Sources: China National nutrition survey 1982, 1992, 2002; National BRFSS 2010

Salt Soy Sauce

(g/d)

23millon 50million 110milliono 180million

Prevalence of hypertension

患病率： %

The national behavior risk factor surveillance indicated 20.5% , 25.1% , 30.7% of hypertension prevalence in adults aged 18-69 in 2004, 2007, 2010

Prevalence of hypertension in Chinese adults from 2004-2010

健康危害—糖尿病患病率持续增长

%

Prevalence of Diabetes

2010

Prevalence of diabetes and prediabetes in adults aged 18-69 in 2010

JAMA. 2013;310(9):948-958. doi:10.1001/jama.2013.168118

Awareness of diabetes

Diabetes control in Chinese adults, 2010

Diabetes control in Chinese adults, 2010

Treatment rate of Diabetes

East Middle West05

1015202530354045

30.4

40.235.935.2 36.3 34.2

Urban Rural

Control of Blood Glucose for diabetes

Diabetes control in Chinese adults, 2010

Trends of Oil intake in adults

Recommendation by WHO

克

Trend of Smoking Rate in adults

Prevalence of smoking in adults 15-69

Male Female Urban Rural（年）

来源：杨功焕，胡鞍钢 . 《控烟与中国未来》

Prevalence of alcohol harmful using

%

Prevalence of inadequate vegetable and fruit intake in 2010

Prevalence of physical inactivity in Chinese adults, 2010

Continuous increasing of overweight and obesity in adults

24.3%, 27.7%, 31.0% of adults aged 18-69 were overweight in 2004, 2007, 2010

%

Prevalence of overweight in Chinese adults

2004 、 2007 和 2010 年我国 18-69 岁居民肥胖率比较（ % ）

7.5% , 8.1% , 12.6% of adults aged 18-69 were obesity in 2004, 2007, 2010

%

Prevalence of obesity in Chinese adults

Major Activity and Program

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Five Priorities of Health Care Reform (2009-2011)

Affordable treatment

Basic Health Insurance System

Affordable medicine

Convenient service

Free from disease

Better services

Essential

Medicine Primary Health Care System

Essential Public Health Services

Public Hospital Reform Pilots

Opportunities: Health Care Reform for NCD Prevention and Management

NCD Management—Health Financing

Chinese Center for Disease Control and Prevention, PR. China

Coverage of Basic Health Insurance System

Essential Medicine Policy Public Health Services Programs

Health insurance schemes coverage NRCMS

3.1US$

31.3US$

780 000 US$

38.5 Million US$

Essential public health services programs: 3.9US$ per personlowering down the price of common essential drugs by 30 to 40 percent

Priority public health services (NCDs ） investment

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National Plan for NCD Prevention and Treatment (2012-2015)

issued by 15 Ministries and Commissions.

• MOH• National development and Reform Commission• Ministry of Education• Ministry of Science & Technology• Ministry of industry and information technology• Ministry of Civil Affairs • Ministry of finance• Ministry of human resources and social security• Ministry of environmental protection• Ministry of Agriculture • Ministry of Commerce• The State Administration of Radio Film and Television• General Administration of Press and Publication • General Administration of sport• State Food and Drug Administration

Promoting regulation & laws for tobacco control at national level

Criteria for smoke-free medical and health institutions, was issued by MOH and Patriotic Health Campaign Committee in March, 2008.Ban on Smoking in Public Places becomes an important task of the 12th Five Year Plan (March 2011). The Public Place Hygiene Management Regulation Implementation Plan stipulate smoke free in indoor public places (March 2011). The Evaluation System of Civilized City stipulates smoking free environment is one of the indicators of evaluating civilized city (February 2011). Smoke free environments becomes one of the key indicators of the accreditation of civilized city.

Promoting regulation & laws for tobacco control at provincial level

Regulations on Areas of Public Place for Banning Smoking in Beijing Municipality was took effect in 2008.Regulation on Banning Smoking in Public Place was issued by Shanghai, Hangzhou, Guangzhou in 2011.Harbin passed the legislation named “Preventing Hazards of Secondhand Smoke” in 2011.Tianjin passed the legislation named “Prohibiting Smoking in the Public Place” in 2011. Under the way: Guangdong Province, Luoyang, Qingdao, Lanzhou, Jinan. Shenyang, and Shenzhen

• Initiated by MOH and Shandong Province Government• Goal: by 2015, the average daily salt intake per person in Shandong reduced to 10

grams;

Shandong salt reduction & hypertension control program(2011-2015)Shandong-Moh Action on Salt and Hypertension (SMASH)

• Advocacy: leadership building; food industry and food catering• Health communication for salt and hypertension• Community-based behavior change communication • Setting-based intervention

• Schools• Healthcare setting• Supermarkets• Food catering

• Nutrition labeling to include sodium contents• Evaluation: Population-based survey pre- and post-interventions

总体思路 Strategy

Shandong provincial progress of salt reduction intervention

• Social mobilization and public health education campaign

– Issued 2.03 million copies of health education material, hold 190 thousand

times health lectures and mass media propaganda

• Restaurant salt reduction action

– 8308 restaurants have taken salt reduction measures

• Promotion of Food nutrition label of processed food

– 1783 enterprises has indicated the sodium content on packages

• Training of key populations (chefs, teachers,doctors)

• Healthy kitchen campaign

• Supermarket salt reduction actionShandong-Moh Action on Salt and Hypertension

Shandong-Moh Action on Salt and Hypertension (SMASH)

Pilot sites salt reduction action

• Chose Fushan district in Yantai and Gaomi city in Weifang as pilot sites

– Launched the pilot salt reduction program officially by ministry of health,

China CDC and local government

– Distribute the intervention protocol by local government and define the multi-

sector duties on salt reduction

Shandong-Moh Action on Salt and Hypertension (SMASH)

目标群体Target

population

山东省居民膳食盐食用量偏高Salt Intake: High

Male Female Urban Rural

Average Daily Salt Intake (g)

Distribution of Daily Salt Intake (g)

Grams of Salt per Day

GramsPercent

2 18-69图 山东省 岁居民钠摄入量来源

, 10. 24%酱油

, 4. 82%咸菜

, 1. 29%酱类

, 0. 94%味精

, 0. 34%醋

, 2. 04%蛋类

, 1. 23%畜肉类

, 2. 93%其它

, 7. 78%其他, 1. 58%鱼虾类

, 63. 38%精盐

, 11. 21%谷类

调味品占膳食钠总摄入量的 81.0% ，加工食品占膳食钠总摄入量的 10.0%81.0% sodium from condiments, and 10% from processed food

成人钠摄入来源Source of Sodium (adult)

salt

soy sauce

pickles

sauces

MSG

cereal

egg

fish and shrimp

meat

others

vinegar

others

• A national wide project launched in 2010 with financial support from central government.

• Aiming to establish demonstrative districts/counties nationwide in 3-5 years, to cover more than 10% of the counties nationwide by 2015

• Strategies include government leading, community involved, partnership building, and comprehensive prevention.

Establishment of Non-communicable Disease Control and Prevention Demonstrative Districts

140 counties/districts from 30 provinces by 2012

• Local government takes the leadership

• Multi-sectors gets involved

• Comprehensive prevention-oriented services, promote healthy lifestyles

• Collect and disseminate best practices

Thanks for your attention!

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