C.

Strong support & guidance from local governments &

NON-COMMUNICABLE DISEASE PREVENTION & technical experts
D. Multi-sectoral collaboration
CONTROL
DALY [ DISABILITY ADJUSTED LIFE YEAR ]
3. Integrated Approach
 Most widely used summary measure of the burden
Key Intervention Strategies:
of disease
1. Establishing program direction & infrastructure
 Combines the number of years of healthy life lost to
2. Changing environments
premature death with time spent in less than full
3. Changing lifestyle
health
4. Reorienting health services
 One lost DALY can be thought of as one lost healthy
year of life
The Role of the PHN in NCD Prevention & Control
 The projected burden of disease of these diseases is
 Health Advocate
approximately half / 48% of the global burden of
1. Informing the people about the rightness of the cause
disease
2. Thoroughly discussing with the people the nature of
 Based on current trends, by the year 2020 these
the alternatives, their content & consequences
diseases are expected to account to 73% of deaths &
3. Supporting people’s right to make a choice & to act on
60% of the disease burden
the choice
4. Influencing public opinion
Risk Factors Associated with Chronic, Non-
Communicable Diseases
 Health Educator
A. Physical Inactivity - 60.5%
1. Inform the people
B. Smoking - 34.8%
2. Motivate the people
C. Hypertension - 22.5%
3. Guide people into action
D. Hypercholesterolemia - 8.5%
E. Obesity - 4.9%
 Health Care Provider
F. Diabetes - 4.6%
 Community Organizer
 Raising the Level of Awareness of the Community
HEALTHY LIFESTYLE
 Organizing & Mobilizing the Community
 Is operationally defined as a way of life that
 Influencing Executive & Legislative
promotes & protects health & well-being
 Among these are:
Causes & Risk Factors of Major NCDs
- healthy diet & nutrition
A. Diseases of the Heart & Blood Vessels
- regular & adequate physical activity & leisure
[ CARDIOVASCULAR DISEASES ]
- avoidance of substances that can be abused such as:
1. HYPERTENSION
 Tobacco, Alcohol & other Addicting Substances
 Defined as a sustained elevation in mean arterial
- adequate stress management & relaxation
pressure
- practices that offer protection from health risks such
 It is not a single disease state but a disorder with
as safe sex & immunization
many causes, a variety of symptoms, & a range of
responses to therapy
Approaches that can be utilize in order to control NCD:
1. Comprehensive Approach Focused on Primary
Etiology / Cause
Prevention
 In terms of etiology, HPN is classified into primary &
A. Prevention of Emergence of Risk Factors referred to as
secondary hypertension
primordial prevention
B. Specific protection from NCD by removal of the risk
PRIMARY HYPERTENSION
factors / reduction in their levels
 Has no definite cause
 It is also called as Essential HPN / Idiopathic HPN
2. Community-Based Approach
A. Active community participation
B. Involvement of community leaders, community
committees & other community groups
SECONDARY HYPERTENSION
 Is usually the result of some other primary dses. 7. Stress
leading to HPN such as Renal Disease
B. Non-Modifiable
Risk Factors: 1. Heredity / Family History
1. Family History 2. Male Sex
2. Advancing Age 3. Increasing Age
3. Race
4. High Salt Intake Key Areas for Prevention of CAD:
Other Lifestyle Factors that Interact with these Risk 1. Promotes physical regular activity & exercise
Factors are: 2. Encourage proper nutrition
1. Obesity 3. Maintain body weight & prevent obesity
2. Excess Alcohol Consumption 4. Advise smoking cessation
3. Intake of Potassium, Calcium & Magnesium 5. Early diagnosis, prompt treatment & control of
4. Stress diabetes & hypertension
5. Use of Contraceptive Drugs
3. CEREBROVASCULAR DISEASE / STROKE
Key Areas for Prevention of HPN  The loss / alteration of bodily function that results
 Encourage Proper Nutrition from an insufficient supply of blood to some parts of
 Prevent becoming Over Weight / Obese the brain
 Smoking Cessation  It is one of the leading cause of disability
 Identify People with Risk Factors Encourage Regular  Can lead to weaknesses / paralysis usually of one
Check-Ups for possible HPN & modification of Risk side of the body
Factors  Often the person has slurring of speech / inability to
talk [ aphasia ]
2. CORONARY ARTERY DISEASE [ CAD ]  If severe can cause death
 Is a heart disease caused by impaired coronary blood
flow Etiology / Causes:
 It is also known as Ischemic Heart Diseases Three [ 3 ] Types of Strokes based on Cause:
 When the Coronary Arteries become narrow / 1. THROMBOTIC STROKE
clogged, supply of blood & oxygen to the heart 2. EMBOLIC STROKE
muscle is affected 3. HEMORRHAGIC STROKE
 When there is ↓ O2 supplied to the heart muscle,
chest pain [ called angina ] occurs  Almost all strokes are caused by occlusion / cerebral
 CAD can cause MI [ heart attack ], arrhythmias, heart vessels by either thrombi / emboli
failure & sudden death
THROMBI
Etiology / Causes:  Usually occurs in atherosclerotic blood vessels
 Atherosclerosis [ most common cause ]  Usually seen in older people & may occur in a person
 Thickening of the inside walls arteries due to disposition at rest
of a fat-like substance
 Usually occurs when a person has high levels of EMBOLIC STROKE
cholesterol in the blood  Is caused by a moving blood clot usually from a
thrombus in the left heart that becomes lodged in a
Risk Factors of CAD small artery through which it cannot pass
A. Modifiable  Its onset is usually sudden
1. Elevated blood lipids & cholesterol levels
[ hyperlipidemia ] INTRACEREBRAL HEMORRHAGE
2. Hypertension  Most fatal stroke, that is rupture of intracerebral
3. Smoking blood vessels
4. Diabetes Mellitus
5. Obesity
6. Physical Inactivity / Sedentary Lifestyle Predisposing Factors:
- hypertension [ most common ] - radiation
Other causes of Hemorrhage: - viruses
- aneurysms
- trauma A. Chemicals & Environmental Agents
- erosion of vessel by tumors POLYCYCLIC HYDROCARBONS
- arteriovenous malformations  Are chemicals found in cigarette smoke, industrial
- blood disorders agents / in food such as smoked foods

Risk Factors of Stroke: AFLATOXIN

1. Increasing Age [ 55 & ↑ ]  Is found in peanuts & peanut butter
2. Sex [ more women die of stroke ]
3. Heredity [ family history ] & Race [ african-american BENZOPYRENE
have much higher risk ]  Produced when meat & fish are charcoal broiled /
4. Hypertension [ most important risk factors for stroke ] smoked [ e.g. tinapa / smoked fish ]
5. Cigarette Smoking [ nicotine & carbon monoxide in  Also produced when food is fried in fat that has been
cigarette smoke damage the cardiovascular system ] reused repeatedly. Avoid reusing cooking oil
6. Diabetes Mellitus [ independent risk factors for
stroke ] NITROSAMINES
7. Heart disease  Powerful carcinogens used as preservatives in foods
8. High Red Blood cell count [ more red blood thicken the like tocino, longganisa, bacon & hotdog
blood & make clots ]
9. Season & climate [ extremely hot / cold temperatures ] RADIATION
10. Socioeconomic factors [ lower income & educational  Ultraviolet rays from sunlight, x-rays, radioactive
level ] chemicals & other forms of radiation
11. Excessive alcohol intake
12. Certain kinds of drugs abuse [ cocaine ] VIRUSES
 A virus can enter a host cell & cause cancer
Keys Areas for Prevention of Stroke
- treatment & control of hypertension  Cervical Cancer - human papilloma virus
- smoking cessation & promoting a smoke-free  Liver Cancer - hepatitis B virus
environment  Leukemias, Lymphoma & Nasopharyngeal Cancer -
- prevent thrombus formation in RHD & arrhythmias with epstein-barr virus
appropriate medications
- limit alcohol consumption Risk Factors of Cancer:
- avoid IV drug abuse & cocaine 1. Age
- prevent all other risk factors of atherosclerosis 2. Sex
3. Family Medical History
B. CANCER
 Is not a single disease CANCER RISK FACTORS
 Develops when cells in a part of the body begin to LUNG CANCER  Tobacco use, including
grow out of control cigarettes, cigars,
 Cancer cells often travel to other parts of the body chewing tobacco &
where they begin to grow & replace normal tissue snuff
[ process called metastasis ]  Radiation exposure
 Second-hand smoke
Causes of Cancer ORAL CANCER  Tobacco use
1. Heredity / Family History [ ex. Breast CA ] [ cigarette, cigar, pipe,
2. Carcinogens smokeless tobacco ]
 Is an agent capable of causing cancer  Excessive alcohol use
 They may be a  Chronic irritation [ e.g.
- chemical ill-lifting dentures ]
- an environment agent
  Vitamin A deficiency
LARYNGEAL CANCER  Tobacco use
[ cigarette, cigar, pipe,
smokeless tobacco
 Poor nutirition
 Alcohol
 Weakened immune
system
 Occupational exposure
to wood dust, paint
fumes
 Gender: 4 - 5 times
more common in men
 Age: more than 60
years
BLADDER CANCER  Tobacco use
[ cigarette, cigar, pipe,
smokeless tobacco ]
 Occupational
exposures: dyes,
solvents
 Chronic bladder
inflammation
RENAL CANCER  Tobacco use
[ cigarette, cigar, pipe,
smokeless tobacco ]
increase risk by 40%
 Obersity
 Diet: well-cooked meat
 Occupational
exposure: asbestos,
organic solvents
 Age: 50 - 70 years old
CERVICAL CANCER  Tobacco use
[ cigarette, cigar, pipe,
smokeless tobacco ]
 Human papilomavirus
infection
 Chlamydia infection
 Diet: low in fruits &
vegetables
 Family history of
cervical cancer
ESOPHAGEAL CANCER  Tobacco use
[ cigarette, cigar, pipe,
smokeless tobacco ]
 Gender: 3 x more
common in men
 Alcohol
 Diet: low in fruits &
vegetables
BREAST CANCER  Early menarche / late
menopause
 Age - changes in
hormone levels
throughout life, such
as age at first
menstruation, number
of pregnancies & age
at menopause
 High fat diet
 Obesity
 Physical inactivity
 Some studies have also
shown a connection
between alcohol
consumption & an
increased risk of breast
cancer
 Women with a
mother / sister who
have had breast cancer
are more likely to
develop the disease
PROSTATE CANCER  Advancing age, race, &
diet
 Race: more common
among African-
American men than
among White Men
 High fat diet
 Men with a father /
brother who has had
prostate cancer are
more likely to get
prostate cancer
themselves
LIVER CANCER  Certain types of viral
hepatitis
 Cirrhosis of the liver
 Long term exposure to
aflatoxin [ carcinogenic
substance produced by
a fungus that often
contaminates peanuts,
wheat, soybeans, corn
& rice ]
SKIN CANCER  Unprotected exposure
to strong sunlight
COLONIC CANCER  Personal / family
history of polyps
 High fat diet and/or
 low fiber diet  More common, occuring in about 90-95% of all
 History of ulcerative persons with diabetes
colitis  More preventable because it is associated with
 Age: >50 years obesity & diet
UTERINE / ENDOMETRIAL  Estrogen replacement  Characterized by fasting hypergyycemia despite
CANCER therapy availability of insulin
 Early menarche / late  Possible causes include impaired insulin secretion,
menopause peripheral insulin resistance & increase hepatic
glucose production
Keys Areas for Primary Prevention of Cancers  Usually occurs in older & overweight persons [ about
 Smoking cessation 80% ]
 Encourage proper nutrition
- increase intake of dietary fiber  GESTATIONAL DIABETES
- limit consumption of smoked, charcoal-broiled, salt- - diabetes that develops during pregnancy
cured & salt-pickled foods - it may develop into full blown diabetes
 Drink alcoholic beverages in moderation
 Avoid / control obesity though peoper nutrition & Risk Factors of Type II DM
exercise  Family history of diabetes [ parents / siblings with
 Early diagnosis & treatment diabetes ]
 Overweight [ BMI 23 kg/m ] & obesity [ BMI >30
C. DIABETES MELLITUS [ DM ] kg/m ]
 Is not a single disease  Sedentary lifestyle
 It is genetically & clinically heterogenous group of  Hypertension
metabolic disorders characterized by glucose  HDL cholesterol < 35 mg/dl [ 0.90 mmol/L ] and /or
intolerance, with hyperglycemia present at time of triglyceride level > 250 mg/dl [ 2.82 mmol/L ]
diagnosis  History of GDM / delivery of a baby weighing 9 lbs.
 Is one of the leading causes of disability in persons [ 4.0 kgs ]
over 45  Previously identified to have Impaired Glucose
 More than half of diabetic persons will die of Tolerance [ IGT ]
coronary heart disease
Complications:
Etiology / Causes Acute complications:
 Specific cause depends in the type of diabetes,  Diabetic Ketoacidosis [ DKA ]
however it is easier to think of diabetes as an  Hyperosmolar Hyperglycemic Nonketotic Coma
interaction between two factors: [ HHNK ]
1. Genetic predisposition [ diabetogenic genes ]  Hypoglycemia especially in Type I diabetics
2. Environment / lifestyle [ obesity, poor nutrition, lack of
exercise ] Chronic Complications:
 Chronic Renal Disease [ nephropathy ]
Types of Diabetes  Blindness [ retinopathy ]
1. TYPE I - [ IDDM ] INSULIN DEPENDENT DIABETES  CAD
MELLITUS ]  Stroke
 Characterized by absolute lack of insulin due to  Neuropatics
damaged pancreas, prone to develop ketosis, &  Foot Ulcers
dependent on insulin injections
 Genetic, environment, or may e acquired due to
viruses [ e.g. mumps, congenital rubella & chemical
toxins [ e.g. nitrosamines ] Keys Areas for Prevention & Control of Diabetes
 Maintain body weight & prevent obesity
2. TYPE II - [ NIDDM ] NON INSULIN DEPENDENT  Encourage proper nutrition
DIABETES MELLITUS  Promote regular physical activity & exercise
 Advise smoking cessation
 Risk Factors & Causes:
D. CHRONIC OBSTRUCTIVE PULMONARY DISEASE A. Host Factors - predispose individuals to / protect them
[ COPD ] from developing asthma
 Is major cause of chronic morbidity & mortality  Genetic predisposition
throughout the world  Atophy / Allergy
 4th leading cause of death in the world  Airway Hyperresponsiveness
 Is a desease state characterized by airflow limitation  Gender
that is not fully reversible  Race / Ethnicity
 The airflow limitation is usually both progressive &
associated with an abnormal inflamatory response o B. Environmental Factors
the lungs to noxious particles of gases  Indoor Allergens
 The lungs undergo permanent structural change,  Outdoor Allergens
which leads to varying degrees of hypoxemia &  Occupational Sensitizers
hypercapnea  Tobacco Smoke
 Air Pollution
Risk Factors & Causes:  Respiratory Infections
 Is usually due to chronic bronchitis & emphysema,  Parasitic Infections
both of which are due to cigarette smoking  Socioeconomic Factors
 Cigarette smoking is the primary cause of COPD  Family Size
 Diet & Drugs
Diagnosis:  Obesity
 Should be considered in any patient who has
symptoms of: ASTHMA TRIGGER
1. Cough TRIGGER
2. Sputum production  Are risk factors for asthma exacerbations [ allergens
3. Dyspnea & occupational agents ]
4. History of Exposure to Risk Factors the Disease  Others Forms of Triggers:
 Diagnosis is confirmed by spirometry - irritant gases & smoke
- house dustmite found in pillows
Complications: - mattresses
1. Respiratory Failure [ in advance COPD ] - carpets
- peripheral airways obstruction - respiratory infection
- parenchymal destruction - inhaled allergerns
- pulmonary vascular abnormalities [ reduce the lungs’s - weather changes
capacity for gas exchange ] - cold air
- producing hypoxemia - exercise
- [ later ] hypercapnea - certain foods
- additives
2. Cardiovascular Disease - drugs
- pulmonary hypertension [ severe COPD ]
- it is major cardiovascular complication of COPD Keys Areas for Primary Prevention & Exacerbation of
Asthma
E. BRONCHIAL ASTHMA  Recognize triggers that exacerbate asthma
 Asthma is a chronic disease  Avoid these triggers if possible [ smoking ]
 It is an inflammatory disorder of the airways in  Promote exclusive breastfeeding as long as possible
which many cells & cellular elements play a role
 Chronic inflammation causes an associated increase
in airways hyper-responsiveness that leads to Common Risk Factors of Leading Non-Communicable
recurrent episodes of wheezing, breathlessness, Diseases
chest tightness & coughing particularly at night /
early in the morning
 Condition
Cardio
Risk Factors vascula Cancer Respiratory
r dses. Diabetes Condition ++
+
Smoking    
Nutritional / Diet    
Physical Inactivity    
Obesity    
Alcohol    
Raised Blood    
Pressure
Blood Glucose    
Blood Lipids    

Risk Assessment & Screening Procedures

Risk Factor Assessment:
A. Cigarette Smoking
- assess by asking individuals whether they smoke / not
- smoking status should be recorded & updated at
regular intervals

B. Nutrition / Diet
- Diet - is a combination of related behaviors, which are
often culture-specific
- Comprehensive Nutritional Assessment involves
detailed recall methods [ 24 hr. Food diary ]

Guidelines for Adequate Vegetable & Fruit Intake

 Eat 2 - 3 servings of vegetables each day, one serving
of which is green / yellow leafy vegetables
 One serving means: raw vegetables 1 cup cooked
veg. ½ Cup
 Eat at least 2 servings of fruit per day. 1 serving is a
vitamin C rich fruit

C. Overweight / Obesity
Body Mass Index [ BMI ]
 Use in assessing body fat
 Correlates closely with total body fat in relation to
height & weight
 The use of wt-for-age / wt-for-ht will help determine
the desirable wt. according to age [ children ] /
height

BMI is calculated using the ff. formula

BMI = weight in kgs / height in meters
Waist Circumference [ WC ]
 Is an accurate measure of the amount of visceral fat