David Walker

Resilience Challenges of

Communicable and

Non-Communicable DiseasesNon-Communicable Diseases

David Walker

Deputy Chief Medical Officer

Decline in mortality due to Coronary

Heart Disease

The UK population is projected to increase by

4.3 million from an estimated 63.7 million in

mid-2012 to 68.0 million by mid-2022 and to

73.3 million over the 25 year period to mid-

2037.

The UK population is projected to reach 70 The UK population is projected to reach 70

million in 2027.

The population of the UK is projected to

continue ageing with the number of people

aged 80 and over in the UK to more than double

to 6 million by mid-2037.

Population growth by age group

Long-term conditions are more prevalent in older people (58

per cent of people over 60 compared to 14 per cent under 40)

and in more deprived groups (people in the poorest social

class have a 60 per cent higher prevalence than those in the

richest social class and 30 per cent more severity of disease).

People with long-term conditions now account for about 50 People with long-term conditions now account for about 50

per cent of all GP appointments, 64 per cent of all outpatient

appointments and over 70 per cent of all inpatient bed days.

Treatment and care for people with long-term conditions is

estimated to take up around £7 in every £10 of total health

and social care expenditure.

(Department of Health (2012). Report. Long-term conditions compendium of

Information: 3rd edition)

Resilience Challenge

• Prevention of long term conditions (NCDs)

• Increase disease free survival

• Improving health of deprived populations

• Health and care services need to cope with • Health and care services need to cope with

increasing demand.

• Model of care

• Economic considerations

MMR

MMR

MMR

It is not difficult to make microbes resistant to penicillin in the laboratory, and the same has occasionally happened in the

Antimicrobial resistance

occasionally happened in the body.

Alexander Fleming, 1945Nobel Prize Acceptance Speech

Susceptibility to antimicrobials used to treat gonococcalinfection in England and Wales


Graph taken from 2011 CMO Annual Report, Vol 2”

History of antibiotic discoveryDiscovery

void

No new class ofantibiotics has

been discovered

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Based on diagram from World Economic Forum, “Global Risks 2013”

Antimicrobial Resistance

• Resistance to antibiotics is natural and inevitable.

• It is increased by the use of antibiotics.

• Multi-drug resistant bacteria are spreading, here and

• world wide.• world wide.

• Increasing resistance and a lack of new drugs means a risk

of infections that cannot be treated and more deaths.

• AMR is a threat to many areas of medicine (Cancer

treatment, transplantation, joint replacement etc.)

Antimicrobial Resistance and Good

Stewardship – 26 September 2013

UK preparations for Ebola

• Plans in place and regularly exercised.

• Command and control arrangements.

• Flexible resource for deployment in UK or

abroad through PHEabroad through PHE

• Level 4 laboratory service

• Secure ID beds with capacity for expansion.

• Facility for port health screening.

Year Country Ebolavirus species Cases Deaths Case fatality

2012 Democratic Republic of Congo Bundibugyo 57 29 51%

2012 Uganda Sudan 7 4 57%



2008 Democratic Republic of Congo Zaire 32 14 44%

2007 Uganda Bundibugyo 149 37 25%


2005 Congo Zaire 12 10 83%

2004 Sudan Sudan 17 7 41%

2003 (Nov-Dec) Congo Zaire 35 29 83%

2003 (Jan-Apr) Congo Zaire 143 128 90%

2001-2002 Congo Zaire 59 44 75%

2001-2002 Gabon Zaire 65 53 82%

2000 Uganda Sudan 425 224 53%

1996 South Africa (ex-Gabon) Zaire 1 1 100%

1996 (Jul-Dec) Gabon Zaire 60 45 75%

1996 (Jan-Apr) Gabon Zaire 31 21 68%


1994 Cote d'Ivoire Taï Forest 1 0 0%

1994 Gabon Zaire 52 31 60%

1979 Sudan Sudan 34 22 65%


1976 Sudan Sudan 284 151 53%


8000

10000

12000

14000

16000

Cumulative

Ebola 2014 Epidemic Curve

cases

0

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6000

date

cases

deaths

Conclusions

• The threats from infectious diseases are

constantly changing.

• Healthcare systems will have to withstand

changes in patterns of disease, demography, changes in patterns of disease, demography,

human behaviour and advances in medical

science.

• Resilience of countries is interdependent and

influenced by economic factors.

Athens 430 BC

Liberia 2014 AD

Presentations & Public Speaking

David Walker