Call to action on NCDs:

Challenges and Way Forward

for Maternal and Child Health

Dr. Niloufer Sultan Ali

Professor, Family Medicine
Aga Khan University, Karachi

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 ‘Each year, millions of
women & children die
from preventable causes.
These are not mere statistics.
They are people with names & faces.
Their suffering is unacceptable in the
21st century’,

Ban Ki-moon,
United Nations Secretary-General
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 A neglected dimension of
women’s health
NCDs are the world’s number one killer

• 35 million people die every year

18 million are women

NCDs represent the biggest threat to women’s

health worldwide

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WHO report 2008
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 Total deaths
around the world:
58 million
Deaths from NCDs:
35 million
Deaths from NCDs
in developing
countries:
28 million

Countdown to 2015, Maternal Child and Newborn survival, the 2012 report

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 Urgent priority for women’s
health
NCDs are no longer diseases of the rich and
elderly

Increasingly impacting on women in developing

countries during the prime of their life

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Source: WHO Chronic Disease Report, 2005

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 Ratio of Non-Communicable/ Communicable Deaths,
India, China, Other Asia-Pacific, 1990-2020

10 Deaths due to NCDs are 3 times more as compared to

9 communicable diseases in Asia Pacific
8
7
6
Ratio

5
4
3
2
1
0
1990

2000

2000

2000

2000

2010
2010

2020

1990

2010

2020

1990

2010

2020

1990

2020
Latin America
China India Other Asia-Pacific & Carribean
Source: WHO Chronic Disease Report, 2005
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 NCD Diseases
4 Diseases, 4 Modifiable Shared Risk Factors
Tobacco Unhealthy Physical Harmful
Use diets Inactivity Use of
Alcohol
Cardio-
vascular

Diabetes

Cancer

Chronic
Respiratory

Source: WHO Chronic Disease Report, 2005

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 NCD in Pakistan

WHO report 2008

10
 NCD in Pakistan…Cont

WHO report 2008

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IMPACT OF NCD
NCDs macro-economic impact
Lost National Income
Lost national income from
premature deaths due to
2005 2006-2015 (cumulative)
heart disease, stroke and
diabetes

Lost national income Lost national income

Countries
(billions) (billions)

Brazil 3 49
China 18 558
India 9 237
Nigeria 0.4 8
Pakistan 1 31
Russian Federation 11 303
Tanzania 0.1 3

Source: WHO Chronic Disease Report, 2005

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 Women & Diabetes
• Currently,143 million women are suffering from
diabetes
• By 2030, this number is expected to rise to 222
million
• Diabetes is the ninth leading cause of death in women
globally
• Gestational diabetes develops in one in 25
pregnancies worldwide.

Source: WHO Chronic Disease Report, 2005

Source: Countdown to 2015, Maternal Child and Newborn survival, the 2012 report
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 Women & Cancer
• Over 3 million women die of cancer each year
• Breast & lung cancers are the most common cancer
killers of women
• An estimated 1.7 million women will be diagnosed
with breast cancer in 2020—a 26% increase from
current levels—mostly in the developing world

Source: WHO Chronic Disease Report, 2005

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 Women & CVD
• CVD is the number one killer of women worldwide
• Causes 9.1 million deaths among women annually
• In 2008, CVD killed 1.2 million women aged
between (20-59 years) the most productive years of
life
• Developing countries are more affected

Source: WHO Chronic Disease Report, 2005

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 Offspring CVD Risk by Parental CVD
Status: Framingham Study Parental CVD
Risk Ratio <55 men, <65 Women
2.5 NONE
MATERNAL
22 PATERNAL
2.2
1.5
1.5
1.7 1.7 1.7

11
1.0 1.0
0.5
0.5

00
Male offspring
MEN Female offspring
WOMEN
Source: International Society of Hypertension

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 NCDs in women compromises
child health
NCDs not only affect the health of women but also the
health of their children

• Being born to a malnourished mother increases the

chances of the infant suffering from under-nutrition,
late physical and cognitive development and NCDs in
adulthood

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 Childhood Obesity
• 43 million children under five years are overweight

• Girls are more likely to be overweight

> Restrained from regular physical activity
and sport
>Lack of safe and supportive environments

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Source: The Growth Assessment and Surveillance Unit, Department of Nutrition
for Health and Development, World Health Organization, Geneva, Switzerland.
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Current Challenges & Barriers
to Women’s Health

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 Socio-cultural Barriers
Women Education & Empowerment
– Young women & girls are unable to make
decisions about care for themselves or for their
children without the permission of their husbands

– Higher rates of illiteracy among women results in

less access to information about NCD risk factors,
prevention & treatment

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 Health System Barriers
• Women are less likely to seek medical care from male
health providers due to cultural taboos

• Shortage of female health care providers

• Lack of NCD component in existing health systems

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Health System In Pakistan

Source: WHO, country profile 2008

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A Way Forward

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 Fight for NCDs

Reduce modifiable risk factors among

individuals & populations
•Tobacco use
• Unhealthy diet
• Physical inactivity
• Harmful use of alcohol

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 A CALL FOR ACTION

We need to move away from the fragmented

approach to health and move towards taking a
holistic view of the health of girls and women

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 A call for Action…Cont
• Enhance women education and empowerment

• NCD component to be integrated into existing health

systems

• Link information of NCDs to reproductive health

programs

• Involvement of women in identifying problems,

solutions & implementing policies in the fight against
NCDs
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We can act

TOGETHER, LET’S MAKE NCDs

A
PRIORITY FOR WOMEN’S
HEALTH
AND DEVELOPMENT

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Act now on NCDs
for girls,
women
and
future
generations

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 We all have a role to play

Everyone has a critical role to play in improving

the health of women and children

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 Role of Family Physicians
• Promote healthy lifestyle
• Provide opportunistic care
• Share information regarding NCDs
• Address modifiable risk factors
• Conduct public awareness sessions
• Emphasize on regular check-ups

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Thank You