Professional Documents
Culture Documents
Diseases in the
South-East Asia Region
2011
Noncommunicable
Diseases in the
South-East Asia Region
2011
Noncommunicable diseases in the South-East Asia Region: Situation and response 2011.
1. Mortality. 2. Chronic Disease - prevention and control. 3. Risk Factors. 4. Cost of illness. 5. Risk factors.
6. Epidemiologic surveillance. 7. Delivery of Health Care. 8. Health Care Sector
ISBN
978-92-9022-413-6
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Printed in India
Contents
Acknowledgments
Foreword
Acronyms
ii
iii
iv
1. INTRODUCTION
EXECUTIVE SUMMARY
9
10
12
13
14
15
17
18
19
43
43
44
47
47
48
48
3. RISK FACTORS
Behavioural Risk Factors
Tobacco use
Unhealthy diet
Physical inactivity
Harmful use of alcohol
Metabolic Risk Factors
Overweight and obesity
Raised blood pressure
Raised cholesterol
Cluster of risk factors
Other risk factors
23
24
24
30
31
32
33
33
35
36
37
38
51
51
52
59
59
60
62
65
68
69
75
75
76
ANNEXES
Tables
Note on data sources and limitations
71
71
71
72
72
72
72
73
79
79
80
80
81
81
82
85
85
92
2011
ii
Acknowledgements
We thank the Member countries of the South-East Asia Region for providing the latest data on risk
factors, morbidity and mortality, as well as updates on national responses and key achievements. We are
grateful to national experts from Member countries of the Region for contributing to selected sections of
the report. We acknowledge the assistance of staff in the World Health Organization country offices for
their contribution in preparing this report. We are grateful to Dr Anton Fric for preparing an earlier
version of the report and Dr Abhaya Indrayan and Dr Niki Shrestha for extensive inputs to the report as
well as data verification, review of literature and references checking. Mr Ravinder Kumar prepared
charts and graphs. Ms Vani Kurup edited and designed the Report.
2011
iii
Foreword
Dr Samlee Plianbangchang
2011
iv
Acronyms
BMI
BP
CHD
COPD
CRDs
CURES
CVDs
DALYs
DBP
FCTC
GATS
GDP
GYTS
HDL
HDSS
ICMR
IGT
INR
LDL
MDGs
MONICA
NCDs
NFHS
NPHF
NTCC
PEN
SEA-ACHR
SEANET
SEAR
SEARO
TFA
UNHLM
WC
WEF
2011
Executive Summary
2011
2011
Way forward
2011
Chapter 1
Introduction
2011
2011
REFERENCES
1. The global economic burden of non-communicable diseases. A report by the World Economic Forum and the Harvard
School of Public Health. September 2011
http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf
(accessed 28 December 2011).
2. World Health Organization. Global status report on noncommunicable diseases 2010. Geneva, 2011
http://whqlibdoc.who.int/publications/2011/9789240686458_eng.pdf. (accessed 28 December 2011).
3. World Health Organization. Scaling up action against noncommunicable diseases. How much will it cost? Geneva,
2011 http://whqlibdoc.who.int/publications/2011/9789241502313_eng.pdf. (accessed 28 December 2011).
2011
Chapter 2
2011
10
NCD Mortality
Fig 2.1: Estimated percentage of deaths by cause, South-East Asia Region, 2008
Injuries 11%
Cardiovascular
disease 25%
Communicable diseases,
maternal and perinatal
conditions, nutritional
deficiencies 35%
Chronic respiratory
diseases 9.6%
Cancers 7.8%
Other
NCDs 10%
Source: Global Health Observatory. World Health Organization 2011.
Note: percentages do not add up to 100% due to rounding off.
2011
Diabetes 2.1%
11
Fig 2.2: Estimated percentage of deaths, by cause, Member countries of the South-East Asia
Region, 2008
NCDs account
for more than
half of all deaths
in most SEAR
countries
100
Percent
80
60
40
20
0
Ti
te
es
-L
r
mo
ar
nm
a
My
pa
Ne
Ba
sh
de
la
ng
an
ut
Bh
Ind
ia
sia
ne
o
Ind
RK
DP
Sri
nk
La
Communicable diseases/
maternal conditions/
nutritional deficiencies
Noncommunicable
diseases
nd
ila
a
Th
ive
ld
Ma
Injuries
Fig 2.3: Estimated percentage of premature deaths (under 60 years of age), by cause,
South-East Asia Region vs rest of the world, 2008
South-East Asia Region
50
Percent
40
30
SEAR has a
higher
proportion of
premature NCD
deaths than the
rest of the world
20
10
0
All NCDs
Cancer
Diabetes
Cardiovascular
diseases
Chronic
respiratory
diseases
2011
12
Fig 2.4: Age-standardized mortality rates per 100 000 population by sex, South-East Asia
Region, 2008
Age-standardized death rates per 100 000
800
700
600
500
400
300
200
100
0
All NCDs
Cardiovascular
diseases
Cancer
2011
NCD mortality
rates are
higher in males
than females
Male
Female
Chronic
respiratory
diseases
Diabetes
13
Bhutan saw a 31% increase in alcoholrelated diseases (from 1217 in 2005 to 1602
cases in 2009); a 20% increase in circulatory
system-related diseases (from 21 345 in 2005 to
26 937 cases in 2009); and an alarming 63%
increase in diabetes (from 944 in 2005 to 2605
in 2009) (8).
Fig 2.5: Trends in estimated percentage of deaths by cause of death, South-East Asia
Region, 2004 and 2030
2004
80
2030
70
60
Percent
50
40
30
20
10
0
Communicable
diseases/maternal
and perinatal conditions/
nutritional deficiencies
NCDs
Injuries
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine 2006, 3(11):e442.
Increasing
trend in NCD
deaths in
Indonesia
HHS 1995
HHS 2001
60
BHR 2007
Percent
50
40
30
20
10
0
Maternal and
perinatal condition
Communicable
disease
Noncommunicable
disease
Injury
2011
14
Fig 2.7: Trends in hospitalization rates per 100 000 population, by selected diseases,
Sri Lanka, 19712008
Intestinal infectious diseases
Malaria
Hypertensive diseases
Ishaemic heart diseases
Diabetes mellitus
1200
1000
800
Consistent
increase in
hospitalization
due to NCDs
and reduction
in infectious
diseases
600
400
200
200708
200406
200103
199800
199597
199294
198991
198688
198385
198082
1997-79
197476
197173
Fig 2.8: Trends in hospitalization rates per 100 000 population, by selected diseases,
Thailand, 19852006
700
Significant
increase in
hospitalization
due to NCDs in
Thailand
Diabetes
Heart diseases
Cancer
600
500
400
300
200
100
2005
2003
2001
1999
1997
1995
1993
1991
1989
1987
1985
Cardiovascular diseases
2011
15
Cancers
Fig 2.9: Percentage of deaths due to CVDs*, by type of CVD, South-East Asia Region, 2008
Percent
35
30
25
Cerebrovascular diseases
20
15
10
5
DPRK
Indonesia
Sri Lanka
Bhutan
Bangladesh
Thailand
Maldives
Nepal
India
Myanmar
Timor-Leste
Ischaemic heart
disease is the
commonest type
of CVD death in
most SEAR
countries
2011
16
Fig 2.10: Incidence of selected cancers per 100 000 population, by sex, South-East Asia
Region, 2008
Incidence/100 000 population
30
20
10
10
20
30
Lung
Breast
Cervix uteri
Lip/oral cavity
Oesophagus
Stomach
Colorectum
Liver
Non-Hodgkin lymph
Larynx
Ovary
Bladder
FEMALES
MALES
Brain/Nervous
Leukaemia
Thyroid
Hodgkins lymphoma
Kidney
Prostate
Corpus uteri
Testis
Gallbladder
Pancreas
Source: GLOBOCAN 2008. International Agency for Research on Cancer and World Health Organization
2011
17
Diabetes mellitus
2011
18
Fig 2.11: Percentage of adult population with raised blood glucose level*, South-East Asia
Region, 2008
14
Male
Female
12
Nearly one in
10 adults in the
Region has
raised blood
glucose
Percent
10
8
6
4
2
Thailand
Sri Lanka
Nepal
Myanmar
Maldives
Indonesia
India
Bhutan
Bangladesh
2011
19
Other NCDs
REFERENCES
1.
2.
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4.
Sri Lanka health at a glance. Medical Statistics Unit. Ministry of Healthcare and Nutrition, Colombo, Vol 1, 2008.
Thailand health profile 20052007. Bureau of Policy and Strategy, Ministry of Public Health. Ministry of Public Health:
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(accessed on 21 September 2011).
2011
20
5.
6.
7.
8.
9.
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS
Medicine 2006, 3(11):e442.
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0030442 (accessed on 21
September 2011).
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Diseases in the South-East Asia Region, Jakarta, Indonesia. Ministry of Health, Indonesia. March 2011
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Diseases in the South-East Asia Region, Jakarta, Indonesia. Ministry of Health, Sri Lanka. March 2011
Country report to the Regional Meeting on Health and Development Challenges of Noncommunicable
Diseases in the South-East Asia Region, Jakarta, Indonesia. Ministry of Health, Bhutan. March 2011
Joshi R et al. Global inequalities in access to cardiovascular care: Our greatest challenge. Journal of the
American College of Cardiology 2008;52:181725.
10. Ghaffar A et al. Burden of non-communicable diseases in South Asia. British Medical Journal 2004;328:807
10. http://www.bmj.com/content/328/7443/807.full.pdf (accessed on 21 September 2011).
11. Country Report, Ministry of Health, DPR Korea. March 2011
12. Indrayan A. Forecasting vascular disease cases and associated mortality in India. Background papers: Burden
of disease in India. New Delhi: National Commission on Macroeconomics and Health, 2005:198215.
13. World Health Organization. Global status report on noncommunicable diseases 2010. Geneva, 2011.
http://www.who.int/nmh/publications/ncd_report2010/en/ (accessed on 21 September 2011).
14. GLOBOCAN 2008. International Agency for Research on Cancer and World Health Organization
http://globocan.iarc.fr/ (accessed on 21 September 2011).
15. National cancer control strategy and plan of action 2009-2015. Bangladesh, Ministry of Health and Family
Welfare, 2008. http://www.whoban.org/LinkFiles/Publication_Cancer_Strategy.pdf.pdf (accessed on 21
September 2011).
16. Marimuthu P. Projection of cancer incidence in five cities and cancer mortality in India. Indian Journal of
Cancer 2008;45:47.
17. India National Council of Medical Research. IMCR Bulletin, Vol 40, No. 2, February 2010.
http://www.icmr.nic.in/bulletin/english/2010/ICMR%20Bulletin%20February%202010.pdf (accessed on 9 July
2011).
18. Pradhananga KK et al. Multi-institution hospital-based cancer incidence data for Nepal: an initial report.
Asian Pacific Journal of Cancer Prevention 2009;10:25962. http://www.ncbi.nlm.nih.gov/pubmed/19537894
(accessed on 21 September 2011).
19. International Diabetes Federation. http://www.idf.org/ (accessed on 21 September 2011).
20. Katulanda P et al. Prevalence and projection of diabetes and pre-diabetes in adults in Sri Lanka Sri Lanka
Diabetes, Cardiovascular Study (SLDCS). Diabetes Medicine 2008;25:10629.
http://www.ncbi.nlm.nih.gov/pubmed/19183311 (accessed on 21 September 2011).
21. Chhetri MR, Chopman RS. Prevalence and determinants of diabetes among the elderly population in the
Kathmandu valley of Nepal. Nepal Medical College Journal 2009;11:348.
http://www.ncbi.nlm.nih.gov/pubmed/19769235 (accessed on 21 September 2011).
22. Mihardja L et al. Prevalence and determinants of diabetes mellitus and impaired glucose tolerance in
Indonesia (a part of basic health research/Riskesdas). Acta Medica Indonesia 2009;41:169-74.
http://www.inaactamedica.org/archives/2009/20124611.pdf (accessed on 21 September 2011).
23. Rahim MA et al. Rising prevalence of type 2 diabetes in rural Bangladesh: A population based study. Diabetes
Research and Clinical Practice 2007;77:3005.
24. Illangasekera U et al. Temporal trends in the prevalence of diabetes mellitus in a rural community in Sri
Lanka. Journal of the Royal Society for the Promotion of Health 2004;24:92.
25. Ramachandran A. Epidemiology of diabetes in Indiathree decades of research [review]. Journal of the
Association of Physicians India 2005;53:348.
26. Pradeepa R, Mohan V. The changing scenario of the diabetes epidemic: implications for India [review]. Indian
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27. Ramachandran A et al. Temporal changes in prevalence of diabetes and impaired glucose tolerance
associated with lifestyle transition occurring in the rural population in India. Diabetologia 2004;47:8605.
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28. Porapakkham Y et al. Prevalence, awareness, treatment and control of hypertension and diabetes mellitus among
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29. Liwsrisakun CC, Pothirat C. Actual implementation of the Thai Asthma Guideline. Journal of the Medical Association
of Thailand 2005;88:898-902.
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and Development, Republic of Indonesia, 2008.
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7_English.zip / (accessed on 21 September 2011).
31. Murthy KJR, Sastry JG. Economic burden of asthma. Burden of Diseases in India. Background papers: National
Commission on Macroeconomics and Health. New Delhi: WHO India, 2005
http://www.whoindia.org/LinkFiles/Commision_on_Macroeconomic_and_Health_Bg_P2_Economic_burden_of_asth
ma.pdf (accessed on 21 September 2011).
32. Rahman MM et al. Detection of chronic kidney disease (CKD) in adult disadvantageous population in Bangladesh.
Chronic Kidney Disease 2006, MP281, iv393. http://ndt.oxfordjournals.org/cgi/reprint/21/suppl_4/iv390.pdf
(accessed on 21 September 2011).
33. Varma PP et al. Prevalence of early stages of chronic kidney disease in apparently healthy central government
employees in India. Nephrology Dialysis Transplantation 2010;9: 3011-7; Epub 2010 Mar 15.
34. Prodjosudjadi W. Incidence, prevalence, treatment and cost of end-stage renal disease in Indonesia. Ethnicity &
Disease 2006;16 (Suppl 2):S2-14-16. http://www.ncbi.nlm.nih.gov/pubmed/16774003 (accessed on 22 September
2011).
35. Ong-ajyooth L et al. Prevalence of chronic kidney disease in Thai adults: a national health survey. BMC Nephrology
2009;10:35. http://www.biomedcentral.com/content/pdf/1471-2369-10-35.pdf (accessed on 22 September 2011).
36. Maldives. New Delhi: United Nations Office on Drugs and Crime, 2005.
http://www.unodc.org/pdf/india/publications/south_Asia_Regional_Profile_Sept_2005/11_maldives.pdf (accessed
on 22 September 2011).
37. Colah R et al. Epidemiology of beta-thalassaemia in Western India: mapping the frequencies and mutations in subregions of Maharashtra and Gujarat. British Journal of Haematology 2010;149:739-47.
38. Timan IS et al. Some hematological problems in Indonesia. International Journal of Hematology 2002;76 (Suppl
1):286-90.
39. Bangladesh Thalassemia Foundation. http://www.thals.org/ (accessed on 22 September 2011).
40. The world health report 2006. Geneva: World Health Organization, 2006. www.who.int/whr/2006/en/ (accessed on
22 September 2011).
2011
Chapter 3
23
Risk Factors
Hypertension, raised blood glucose and tobacco use are the top three
risk factors responsible for 3.5 million deaths in the Region every
year.
2011
24
Noncommunicable diseases
Cardiovascular
diseases
Diabates
(Type II)
Cancers
Chronic
respiratory
diseases
Tobacco
use
Unhealthy
diet
Physical
inactivity
Harmful use
of alcohol
4 modifiable
shared risk
factors cause
4 major NCDs
which account
for 80% of all
NCD deaths
Fig 3.2: Estimated number of attributable deaths by risk factor, South-East Asia
Region, 2004
Hypertension,
high blood
glucose and
tobacco use are
top three risk
factors for death
2000
1500
1000
500
Overweight
and obesity
Harmful use
of alcohol
Suboptimal
breastfeeding
Unsafe water,
sanitation, hygiene
Indoor smoke
from solid fuels
High cholesterol
Physical activity
Childhood and
maternal underweight
Tobacco use
Risk factors
Source: Global health risks: mortality and burden of diseases attributable to selected major risks.
Geneva: World Health Organization, 2009.
2011
25
2011
26
Table 3.1: Prevalence of tobacco use, among adults by sex, South-East Asia Region, 20062009
Age-standardized prevalence of smoking
DAILY
Bangladesh
Bhutan
DPR Korea
India
Indonesia
Maldives
Myanmar
Nepal
Sri Lanka
Thailand
Timor-Leste
Males
42
53
20
54
38
31
30
21
39
N.A.
Females
2
3
4
9
6
25
<1
2
N.A.
Total
22
12
29
24
18
28
11
20
N.A.
CURRENT
Males
46
57
26
61
43
40
36
27
45
N.A.
Females
2
4
5
11
8
29
0.4
3
N.A.
Prevalence of smokeless
tobacco*
Total
24
15
33
27
24
32
14
24
N.A.
Males
26.4
21.1**
N.A.
32.9
N.A.
N.A.
51.4
31.2
24.9***
1.3
N.A.
Females
27.9
17.3**
N.A.
18.4
N.A.
N.A.
16.1
4.6
6.9***
6.3
N.A.
Total
Year
27.2
19.4**
2009
2007
25.9
2009
29.6
18.6
15.8***
3.9
N.A.
2009
2008
2006
2009
2011
27
Fig 3.3: Prevalence of current tobacco use among students aged 1315 years by sex, SouthEast Asia Region, 20062009
Variable, but
high tobacco
use among
youth in the
Region
60
Boys
Girls
50
Percent
40
30
20
10
2007
Maldives
2007
Bangladesh
2207
Sri Lanka
2007
Nepal
2006
India
2009
Thailand
2007
Myanmar
2009
Bhutan
2009
Indonesia
2006
Timor-Leste
Source: Global Youth Tobacco Surveys in Member countries of South-East Asia Region
Fig 3.4: Prevalence of smoking among students aged 1519 years, by sex, Indonesia,
19952004
40
35
Smoking among
Indonesian boys
has more than
doubled over a
decade
Boys
Girls
Both sexes
30
Percent
25
20
15
10
5
0
1995
2001
2004
Sources: National Socio-Economic Survey 1995, 2001, 2004. Ministry of Health Indonesia
2011
28
Fig 3.5: Prevalence of current tobacco use among students aged 13-15 years, by sex,
Myanmar, 2001 and 2007
25
2001
2007
20
Percent
15
10
Boys
Girls
Boys
Girls
Reduction in
cigarette
smoking but
increase in use
of other tobacco
products
Fig 3.6: Percentage of adults, who are current users of tobacco products, by education,
India, 2009
80
Male
Female
70
60
The less
educated are
more likely to
use tobacco
Percent
50
40
30
20
10
0
No formal
schooling
Less than
primary
Primary but
less than
secondary
Education
Secondary
and above
2011
29
Fig 3.7: Percentage of adults, who are current users of tobacco products, by wealth index,
Bangladesh, 2009
Any smoked tobacco product
40
Tobacco use is
highest
among the
poorest
Percent
25
20
15
10
5
0
Lowest
Low
Middle
High
Highest
Wealth index
Source: Bangladesh Global Adult Tobacco Survey 2009
2011
30
Unhealthy diet
2011
31
Table 3.2 Percentage of male and female adults eating less than five
servings of fruits and vegetables, South-East Asia Region, 20042010
Member countries
Bangladesh
Bhutan
Male (%)
Female (%)
Year of survey
65
69
67
2007
94
93
India
NR
NR
Maldives
97
93
Indonesia
Myanmar
Nepal
Sri Lanka
Thailand
Total (Range)
94
94
90
91
61
64
81
83
6597
83
82
6493
93
2010
86
2007-08
97
2004
94
90
62
82
82
6297
2007
2009
2007
2007
2005
Physical inactivity
2011
32
Fig 3.8: Percentage of adults with insufficient physical activity*, South-East Asia Region,
2008
70
Males
Females
60
Percent
50
40
30
20
10
0
Bangladesh Bhutan
India
Nepal
Source: World Health Organization. Global status report on noncommunicable diseases 2010. Geneva, 2011.
Data adjusted for 2008 based for comparability
2011
Many people
are not
sufficiently
physically
active
33
Fig 3.9: Percentage of adults consuming alcohol*, by sex, South-East Asia Region,
20072010
50
Alcohol
consumption is
higher in males
than females
Males
Females
Percent
40
30
20
10
Bangladesh Bhutan
2010
2007
DPR Korea
2008
India
2007
Indonesia Myanmar
2007
2009
Nepal
2007
Sri Lanka
2007
2011
34
Indonesia
Maldives
Myanmar
Male
Female
Both sexes
25
24
7.6
10
16
29
14
7.8
13
25
53
24
Nepal
9.8
8.9
Thailand
26
36
Sri Lanka
17
27
Female
Both sexes
24
4.7
6.6
5.5
21
2.5
6.9
4.7
7.7
11
41
19
1.0
1.3
6.5
2.0
1.3
2.5
26
16
4.1
7.3
5.0
1.4
1.6
31
4.9
12
2.6
1.9
6.1
22
1.1
1.5
8.5
Source: World Health Organization. Global status report on noncommunicable diseases 2010. Geneva, 2011.
Data adjusted for 2008 for comparability
2011
35
Overweight
2
BMI 25 kg/m
Waist circumference
90.8 cm
2004
2009
40
Percent
30
20
10
Male
Female
Male
Female
Increasing
obesity in
Thailand
* Systolic BP>40 mmHg and stroke or diastolic BP>90 mmHg or using medication
to lower BP
2011
36
Fig 3.11: Percenatge of adult population with high blood pressure*, South-East Asia Region,
2008
50
High blood
pressure is
common in
both sexes
Females
Males
Percent
40
30
20
10
Thailand**
Sri Lanka**
Nepal*
Myanmar**
Maldives*
Indonesia**
India**
DPR Korea*
Bhutan**
Bangladesh*
Source: World Health Organization. Global status report on noncommunicable diseases 2010. Geneva, 2011.
Data adjusted for 2008 for comparability
Systolic BP>40 mmHg and stroke or diastolic BP>90 mmHg or using medication to lower BP
2011
Raised cholesterol
37
Fig 3.12: Percentage of adult population with raised total cholesterol, South-East Asia
Region, 2008
60
Males
Females
50
Percent
40
30
20
Thailand**
Myanmar**
Maldives*
Indonesia**
India**
Bhutan**
10
Source: World Health Organization. Global status report on noncommunicable diseases 2010. Geneva, 2011.
Data adjusted for 2008 for comparability
2011
38
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1.
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31. Singh RB et al. Association of trans fatty acids (vegetable ghee) and clarified butter (Indian ghee) intake with higher
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2011
41
57. Kalra S et al. Prevalence of risk factors for coronary artery disease in the community in eastern Nepala pilot study.
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Cancer 2006;118:3030-3044.
2011
Chapter 4
43
Drivers of NCDs
Population Ageing
2011
44
NCDs
Metabolic
risk factors
Behavioural
risk factors
Social
determinants
Urbanization
2011
Cardiovascular diseases
Cancers
Chronic respiratory diseases
Diabetes
45
Fig 4.2: Population projections for Bangladesh and India, 2011, 2025 and 2050
Bangladesh, 2011
Male
Bangladesh, 2025
Female
100+
9094
8589
Male
0 0
10
10 8 6 4 2
Population (in millions)
Female
100+
9094
8589
0 0
0 0
Male
10
10 8 6 4 2
Population (in millions)
10
10 8 6 4 2
Population (in millions)
Female
100+
9094
8589
0 0
0 0
10
India, 2050
Male
8084
7579
7074
6569
6064
5559
4549
4044
3539
3034
2529
2529
2529
2024
1519
1014
59
04
Female
100+
9094
8589
8084
7579
7074
6569
6064
5559
4549
4044
3539
3034
2529
2529
2529
2024
1519
1014
59
04
India, 2025
8084
7579
7074
6569
6064
5559
4549
4044
3539
3034
2529
2529
2529
2024
1519
1014
59
04
10 8 6 4 2
Population (in millions)
Male
8084
7579
7074
6569
6064
5559
4549
4044
3539
3034
2529
2529
2529
2024
1519
1014
59
04
India, 2011
Male
Female
100+
9094
8589
8084
7579
7074
6569
6064
5559
4549
4044
3539
3034
2529
2529
2529
2024
1519
1014
59
04
10 8 6 4 2
Population (in millions)
Bangladesh, 2050
Female
100+
9094
8589
8084
7579
7074
6569
6064
5559
4549
4044
3539
3034
2529
2529
2529
2024
1519
1014
59
04
2 4
10
10 8 6 4 2
Population (in millions)
0 0
10
compared to
categories (5).
medium-
and
high-urban
2011
46
Fig 4.3: Projected mid-year population, residing in urban areas, South-East Asia Region,
2010-2050
100
Dramatic
increase in
urbanization
expected
2010
2050
80
Percent
60
40
20
Timor-Leste
Thailand
Sri Lanka
Nepal
Myanmar
Maldives
Indonesia
India
DPR Korea
Bhutan
Bangladesh
Source: World Urbanization Prospects. The 2007 Revision. Highlights. Department of Economic and Social Affairs Population Division.
United Nations New York, 2008.
Fig 4.4: Prevalence of NCD risk factors in urban and rural areas, by sex, India, 2003-2006
80
NCD risk
factors are
more prevalent
in urban areas
Urban
Rural
70
60
Percent
50
40
30
20
BMI30
Increased WC
Physical
inactivity at
work
Blood glucose
126 mg/dl
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
10
Total
cholesterol
200 mg/dl
WC = waist circumference; BMI = body mass index; increased WC (Men 90 cm; Women 80 cm)
Source: Shah B, Mathur P. Surveillance of cardiovascular disease risk factors in India: the need & scope. Indian Journal of Medical Research
2010;132:634-42.
2011
47
Globalization
Poverty
2011
48
Illiteracy
2011
49
REFERENCES
3. Allender S et al. Level of urbanization and noncommunicable disease risk factors in Tamil Nadu, India. Bulletin of
the World Health Organization 2010; 88:297-304.
4. Shah B, Mathur P. Surveillance of cardiovascular disease risk factors in India: the need & scope. Indian Journal of
Medical Research 2010;132:634-42. http://icmr.nic.in/ijmr/2010/november/1122.pdf (accessed 28 December 2011).
5. Allender S et al. Quantifying Urbanization as a Risk Factor for Noncommunicable Disease. Journal of Urban Health
2011;88:906-18.
6. Equity, social determinants and public health programmes. Geneva, World Health Organization 2010.
7. National Institute of Health Research and Development, Ministry of Health. Report on Result of National Basic Health
Research, 2008.
8. de Silva V, Samarasinghe D, Hanwella R. Association between concurrent alcohol and tobacco use and poverty. Drug
and Alcohol Review 2011;30:69-73.
9. Yach D, Hawkes C, Gould CL, et al. The global burden of chronic diseases: overcoming impediments to prevention
and control. Journal of the American Medical Association 2004;291:2616-22.
10. Ilangho RP. Review series: lung disease around the world: lung health in India. Chronic Respiratory Disease
2007;4:107-10.
11. World health statistics 2010. Geneva, World Health Organization 2011.
2011
Chapter 5
51
2011
52
Member countries
2006
2015
Bangladesh
0.08
0.14
Indonesia
0.33
0.53
India
Myanmar
Thailand
1.35
0.03
0.12
2015 as proportion
of 2006 estimates
1.96
175%
1.1
158%
4.2
145%
0.06
200%
0.18
150%
17
0.43
1.5
Source: Abegunde DO, et al. The burden and cost of chronic diseases in low-income and middle-income countries.
Lancet 2007;370:1929-38.
*GDP: Gross Domestic product
2011
53
Fig 5.1: Projected cost of treatment for chronic obstructive pulmonary disease (COPD) by
residence, India 1996-2016
6000
COPD
treatment cost
is expected to
increase in
urban and
rural areas
alike
Total
Rural
Urban
Rupees in million
5000
4000
3000
2000
1000
1996
2001
2006
2011
2016
Source: Economic burden of chronic obstructive pulmonary disease, NCMH Background Paper Burden of Disease in India.
2011
54
The poorest
spend about 10
times as much
on tobacco as on
education in
Bangladesh
12
10
1
(poorest)
10 11 12
13
14
15 16 17
18
(richest)
Source: Efroymson D et al. Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh.
Tobacco Control 2001;10:212-7.
2011
55
Health 12%
Other expenses 2%
Education 3%
Tobacco 11%
Food 72%
Source: Ministry of Health, National Institute for Health, Research and Development, Indonesia
Loss of wages
2011
56
Fig 5.4: Annual income loss from missed work, time for care giving, and premature death
among households with a member suffering from an NCD, India, 2004
140
Missed work
Caregiving
NCDs lead to
huge loss in
household
wages
Premature death
120
100
80
60
40
20
0
Cardiovascular
disease
Hypertension
Diabetes
Asthma
Respiratory
illness
Injuries
Source: Mahal A et al. The economic implications of non-communicable diseases for India. Health, Nutrition and Population (HNP) Discussion Paper.
2010.
REFERENCES
1. The global economic burden of non-communicable diseases. A report by the World Economic Forum and the Harvard
School of Public Health. September 2011
http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf
(accessed 28 December 2011).
2. Stuckler D. Population causes and consequences of leading chronic diseases: a comparative analysis of prevailing
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3. Abegunde DO et al. The burden and cost of chronic diseases in low-income and middle-income countries. Lancet
2007;370:1929-38.
4. Chatterjee S et al. Cost of diabetes and its complications in Thailand: a complete picture of economic burden.
Health and Social Care in the Community 2011;19:289-98.
5. National Institute for Health, Research and Development, Indonesia. Soewarta Kosen. Ministry of Health, Republic of
Indonesia, 2009.
6. Murty KJR, Sastry JG. Economic burden of chronic obstructive pulmonary disease. NCMH Background Paper-Burden
of disease in India. Mahavir Hospital and Research Centre
http://whoindia.org/LinkFiles/Commision_on_Macroeconomic_and_Health_Bg_P2_Economic_burden_of_chronic_obs
tructive_pulmonary_disease.pdf (accessed 28 December 2011).
7. Efroymson D et al. Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in
Bangladesh. Tobacco Control 2001;10:212-7.
2011
57
8. Ali Z et al. Appetite for nicotine. An economic analysis of tobacco control in Bangladesh. Health, Nutrition and
Population (HNP) Discussion Paper. Economics of Tobacco Control Paper No. 16. Nov 2003
http://www.searo.who.int/LinkFiles/NMH_ApetiteforNicotine.pdf (accessed 28 December 2011).
9. Kyaing NN. Tobacco economics in Myanmar. Health, Nutrition and Population (HNP) Discussion Paper. Economics of
Tobacco Control Paper No. 14. October 2003. http://www.searo.who.int/LinkFiles/NMH_EconomicsMyanmar.pdf
(accessed 28 December 2011).
10. John RM. Crowding out effect of tobacco expenditure and its implications on household resource allocation in India.
Social Science Medicine 2008;66:1356-67. Epub 2008 Jan 9.
11. Saxena S et al. Alcohol and drug abuse. New Age Publishers and National Book Trust, New Delhi, 2003.
12. Karki Y et al. A study on the economics of tobacco in Nepal. Washington, DC:The World Bank; 2003.
13. World Health Organization. World Health statistics 2011. Geneva, 2011.
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14. Perera M et al. Equity in health carethe case of diabetes in Sri Lanka. Marga Institute
http://www.margasrilanka.org/reading_equity.htm (accessed 28 December 2011).
15. Kasturiratne A et al. Morbidity pattern and household cost of hospitalisation for non-communicable diseases (NCDs):
a cross-sectional study at tertiary care level. Ceylon Medical Journal 2005;50:109-13.
16. Ramachandran A et al. Increasing expenditure on health care incurred by diabetic subjects in a developing country:
a study from India. Diabetes Care 2007;30:2526.
17. Mahal A et al. The economic implications of non-communicable diseases for India. Health, Nutrition and Population
(HNP) Discussion Paper. 2010.
http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/2816271095698140167/EconomicImplicationsofNCDforIndia.pdf (accessed 28 December 2011).
2011
Chapter 6
59
2011
60
Policies/plans/programmes
2011
61
programmes.
Legislation
serves
to
institutionalize NCD control programmes and
creates, legitimizes and finances an authority to
implement and direct a policy programme for
NCD control in a country. In Member countries,
tobacco has been addressed almost universally
by legislation. Tobacco legislation is available in
10 countries, five countries have alcohol
legislation, two countries address legislation on
diet and nutrition and only one country has
physical activity legislation. Legislative support
for other risk factors is yet to be fully developed
in Member countries. The WHO Framework
Convention on Tobacco Control (FCTC) is the
first legally binding international treaty to
reduce harm due to tobacco. In SEAR, all
Policy
Integrated
Strategy
Plan
9
Programme Any of
these
8
11
Heart diseases
Diabetes
Cancer
6
5
7
8
Source: World Heath Organization. Assessment of capacity for prevention and control of chronic noncommunicable diseases.
New Delhi, 2011.
Availability of national
level guidelines
services
Available
Diabetes
Overweight/obesity
Hypertension
Dyslipidemia
Alcohol dependence
Tobacco dependence
Dietary counselling
Physical inactivity
8
3
5
4
6
4
Implementation
Under
development
Full
Partial
1
1
5
2
1
1
2
1
1
1
3
2
4
3
4
2
2
3
3
1
Source: World Heath Organization. Assessment of capacity for prevention and control of chronic noncommunicable
diseases. New Delhi, 2011.
2011
62
Table 6.3: Status of implementation of Framework Convention on Tobacco Control in South-East Asia
Region, 2011
FCTC Implementation
Bangladesh Bhutan
DPRK
Myanmar Nepal
Sri Lanka
Thailand
Timor-Leste
X
Global Youth Tobacco
Survey (GYTS)
X
X
X
X
X
X
X
X
X
X
X
X
X
X
NA
X
X
X
X
X
X
X
X
X
X
X
X
32%
50%
29%
73%
69%
NIL
X
Ban at point of sale
X
Ban on billboards and
outdoor advertising
X
Raise taxes on tobacco
Taxation rate on cigarettes
68%
NA
NA
46%
54%
Source: Narain, et al. Noncommunicable diseases in the South-East Asia Region: strategies and opportunities. NMJI 2011 (in press)
Implemented
X not implemented
NA information not available
2011
63
2011
64
Table 6.4: Type of risk surveys conducted and the latest year, countries of
WHO/SEA Region
Country
STEPS*
Latest
Bangladesh
2010
DPRK
2009
Bhutan
India
Indonesia
Maldives
Myanmar
Nepal
Sri Lanka
Thailand
Timor Leste
2007
2006
2006
2004
2007
2007
2007
NA
NA
No. of
rounds
2
1
3
GATS**
Latest No. of
rounds
2009
NA
NA
NA
NA
NA
2007
NA
NA
NA
NA
NA
2009
NA
NA
2009
NA
NA
NA
NA
2009
NA
2007
Latest
NA
2009-2010
on-going
Latest No. of
rounds
GSHS****
NA
GYTS***
NA
1
NA
2009
2007
2007
2007
2009
2009
No. of
rounds
NA
NA
NA
2009
2010
2006
2007
2003
2008
2009
2009
Sources:
*
STEPS Country reports http://www.who.int/chp/steps/reports/en/index.html
**
http://www.searo.who.int/en/Section2666/Section2670_15825.htm#GATS
*** http://www.searo.who.int/LinkFiles/TFI_FCTC-2009.pdf;
http://www.searo.who.int/en/Section2666/Section2670_15825.htm#GYTS
**** World Heath Organization. Assessment of capacity for prevention and control of chronic noncommunicable diseases. New
Delhi, 2011.
NA = Not available
GYTS: Global Youth Tobacco Survey
GSHS :Global School-based Student Health Survey
GATS : Global Adult Tobacco Survey
STEPS: Stepwise approach to NCD risk factor surveillance
2011
65
Indicator
Cancer
National
Sub-national
Source of data
Population-based
Hospital-based
Diabetes
Myocardial
infarction
Stroke
Chronic
respiratory
diseases
9*
5
4
2
3
1
2
2
2
2
1
3
8
1
4
1
2
1
3
1
2
2011
66
Box 6.2: Integrating NCD prevention and control into primary health care services, Sri Lanka
2011
67
Table 6.6: Availability of NCD tests and procedures (in more than 50% of
facilities) at primary health care level, SEAR, 2010
Diabetes
Cardiovascular
diseases
Chronic
respiratory
diseases
No. of countries
where available
Weight measurement
Height measurement
Waist circumference
Cervical cytology
Acetic visualization
Faecal occult blood test
Digital examination for
bowel cancer
Breast cancer by palpation
Mammogram
Colonoscopy
Blood glucose
Oral glucose tolerance test
Glycosylated haemoglobin
(HbA1c)
Fundal examination
Foot vibration perception
by tuning fork
Foot vascular status by
doppler
9
8
4
0
0
5
3
8
0
1
2
1
9
7
3
1
1
2
2
1
8
2
0
6
2
1
4
9
3
6
4
3
2
2
3
3
3
0
2
Electrocardiogram
Blood pressure
Lipids including LDL, HDL
and triglycerides
5
11
5
0
0
0
Spirometry
Source: World Heath Organization. Assessment of capacity for prevention and control of chronic noncommunicable diseases.
New Delhi, 2011.
NCD-related drugs
2011
68
Health Financing
The commitment of Member countries to
NCD prevention and control is reflected in NCD
programmes being funded largely by regular
government budgets. All 11 Member countries
have allocated for NCD prevention and control
in their respective regular health ministry
Innovative financing,
Thailand
Box 6.3: Innovative financing for NCD prevention and control, Thailand
The Thai Health Promotion Foundation (ThaiHealth), established in 2001, is
the first organization of its kind in Asia and has been created under the Health
Promotion Foundation Act B.E. 2544 (2001). ThaiHealth gets funded from sin
taxes. These 'sin taxes' are a revenue source for innovative projects and
activities to promote public health. ThaiHealth receives 2% of total national
tax revenue on alcohol and tobacco products equivalent to about US$ 35
million per year. There are 12 programmes funded by ThaiHealth which
include tobacco consumption control, alcohol consumption control, physical
activity and sports for health, as well as health risk factors control such as
nutrition, traffic injuries and disaster prevention.
In 2008, ThaiHealth financed tobacco control campaigns (105 million baht or
US$ 3 million), smoke-free projects (38 million baht or US$ 1.08 million) and
other tobacco control projects, as well as research (40 million baht or US$
1.14 million). Sin tax has helped generate additional funds for health
promotion and led to a significant reduction in smoking prevalence. During the
Funds ten years of existence, the percentage of regular smokers was reduced
by 10%, with an 30% increase in excise tax.
Trends in smoking prevalence and excise tax, Thailand, 1990-2010
25
100
80
20
60
15
40
10
20
5
0
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
Source: National Statistics Office 2010; Excise Department, Ministry of Finance, Thailand.
2011
30
Consistent
reduction in
smoking
prevalence
with increase
in
tobacco tax
69
2011
Chapter 7
71
72
2011
73
2011
Chapter 8
75
Global initiatives
May 2000
May 2003
May 2004
December 2006
May 2008
The World Health Assembly endorsed the Action Plan for the
Global Strategy for the Prevention and Control of NCDs
(20082013).
2011
76
May 2010
May 2010
April 2011
May 2011
September 2011
Regional Initiatives
Some of the recent regional events and initiatives for prevention and control of NCDs are listed
below:
2011
November 2005
October 2006
September 2007
77
June 2009
September 2009
September 2010
The Sixty-third session of the WHO Regional Committee for SouthEast Asia discussed progress in prevention and control of NCDs in
the Region.
January 2011
March 2011
July-September 2011
September 2011
2011
Chapter 9
79
2011
80
2011
81
Cancers
Interventions
Source: World Health Organization. Global status report on noncommunicable diseases 2010. Geneva, 2011.
2011
82
I
I
I
I
I
Responsibility of
civil society
I
I
I
Responsibility of
academia
I
I
I
I
Responsibility of
media
I
I
I
I
Responsibility of
private sector
(except the
tobacco industry)
Reponsibility of
development
partners
2011
I
I
I
I
I
I
Raise public awareness among the general population about prevention of risk factors
for NCDs.
Create an enabling environment for behaviour change.
Sensitize political leadership about the importance of multisectoral actions for NCD
prevention and control.
Act as a watchdog to offset commercial interests against healthy policies.
Work closely with the government to promote healthy lifestyles, for example by
reformulation to reduce salt, trans fats and sugar in their products.
Improve health of their employees through workplace wellness programmes.
Ensure responsible marketing by helping to make essential medicines more
affordable and accessible.
Prioritize NCD prevention and control in aid programmes.
Strengthen support for full and effective implementation of global strategies to address
NCDs.
Coordinate and pool technical expertise to strengthen normative guidance to achieve
the best results at the country level.
83
2011
Annexes
Females
313.3
1.7
61.5
2967.6
582.3
0.5
125.8
48.8
66.8
227.1
1.4
4396.7
Males
All NCDs
598.8
3.1
132.9
5241.4
1063.9
0.9
242.5
91.7
117.9
418.4
2.4
7913.9
Total
54.6
0.3
15.1
312.5
104.8
0.2
24.1
11.1
8.5
35.1
0.2
566.5
48.9
0.3
11.9
321.9
110.7
0.2
21.8
8.9
8.5
35.6
0.3
568.9
Cancers
Females Males
Bangladesh
285.5
Bhutan
1.4
DPR Korea
71.4
India
2273.8
Indonesia
481.7
Maldives
0.4
Myanmar
116.6
Nepal
42.8
Sri Lanka
51.1
Thailand
191.3
Timor-Leste
1.0
SEAR total 3517.2
Country
103.5
0.5
26.9
634.4
215.5
0.4
45.8
20.0
17.0
70.7
0.5
1135.4
Total
9.4
0.0
3.6
80.4
25.7
0.0
4.5
1.6
3.8
22.5
0.0
151.6
Females
10.2
0.1
2.3
96.3
22.6
0.0
4.2
1.6
3.3
13.3
0.0
153.8
Males
Total
19.6
0.1
5.9
176.7
48.3
0.0
8.7
3.2
7.1
35.8
0.1
305.4
Diabetes mellitus
148.9
0.7
36.9
1002.5
235.6
0.1
61.1
20.6
22.8
75.8
0.5
1605.6
Females
166.9
0.9
29.9
1330.6
277.5
0.2
64.2
24.5
30.6
84.4
0.7
2010.3
Males
315.8
1.6
66.8
2333.1
513.1
0.3
125.3
45.1
53.5
160.2
1.2
3615.9
Total
Cardiovascular diseases
31.4
0.1
7.2
472.1
45.5
0.0
12.3
4.1
6.5
10.3
0.1
589.7
Females
37.4
0.2
7.0
618.7
73.8
0.1
14.7
5.6
8.8
30.0
0.2
796.4
Males
Total
68.8
0.3
14.1
1090.8
119.4
0.1
27.0
9.7
15.3
40.3
0.3
1386.1
85
2011
2011
654.7
667.2
477.4
582.3
547.8
564.5
591.5
543.5
490.5
563.2
476.8
Females
751.2
801.0
644.4
793.0
762.7
621.9
755.6
711.0
781.4
811.3
649.6
Males
All NCDs
701.7
735.2
547.6
684.6
647.0
593.7
667.1
620.2
623.1
675.0
559.7
Total
106.2
119.0
98.9
72.0
109.4
228.8
116.3
118.8
79.0
97.6
95.0
104.5
131.8
122.0
78.9
136.5
290.9
124.5
114.0
91.6
115.6
121.5
Cancers
Females Males
Bangladesh
Bhutan
DPR Korea
India
Indonesia
Maldives
Myanmar
Nepal
Sri Lanka
Thailand
Timor-Leste
Country
105.0
124.8
106.4
75.0
120.9
261.5
119.8
116.4
84.3
105.9
107.5
Total
22.1
18.7
23.1
21.0
29.0
8.2
23.4
21.0
36.7
64.4
19.3
Females
25.6
26.1
22.6
26.9
29.9
3.7
25.6
24.5
39.8
46.4
21.8
Males
23.8
22.3
23.1
23.8
29.5
5.8
24.4
22.6
38.2
56.3
20.5
Total
Diabetes mellitus
371.0
372.1
245.1
268.7
278.2
214.1
317.8
285.7
220.0
229.7
258.3
Females
424.2
444.7
318.3
366.1
373.9
215.2
398.0
379.6
364.5
304.2
336.6
Males
397.2
409.8
278.6
316.5
323.6
214.1
355.0
329.0
285.7
265.3
296.1
Total
Cardiovascular diseases
73.7
73.0
48.8
128.5
53.6
66.5
63.0
55.8
62.3
30.7
50.0
Females
91.7
93.3
77.2
181.2
103.1
60.2
91.6
87.1
107.1
119.2
77.8
Males
82.5
83.5
59.9
153.6
75.8
63.1
76.0
70.1
82.3
68.6
63.2
Total
Annex 2: Age-standardized death rates due to noncommunicable diseases (NCDs) per 100 000
population in Member countries of SEAR, 2008
86
27.2
8.0
30.5
22.9
36.2
46.0
32.5
23.5
29.1
30.7
29.6
Breast
(females)
29.8
20.4
6.6
27.0
12.6
13.3
26.4
32.4
11.8
24.5
11.4
Cervix uteri
(females)
3.5
4.0
7.2
1.2
3.5
0.0
6.3
1.1
1.0
19.9
2.5
4.1
8.1
15.8
3.2
10.3
0.0
16.5
1.7
2.3
40.6
7.6
4.0
4.4
16.0
3.5
15.6
2.0
12.0
4.8
5.8
13.4
11.2
4.5
7.9
15.0
4.3
19.1
7.8
12.3
5.3
7.5
13.2
17.6
Cancer site
Liver
Colorectum
Females Males
Females
Males
Source: GLOBOCAN 2008. International Agency for Research on Cancer and World Health Organization
Bangladesh
Bhutan
DPR Korea
India
Indonesia
Maldives
Myanmar
Nepal
Sri Lanka
Thailand
Timor-Leste
Country
8.7
10.8
25.8
2.5
10.9
0.0
13.9
18.2
2.7
12.1
7.2
30.4
8.7
34.0
10.9
29.8
20.3
22.9
20.7
12.0
26.8
28.6
Lung
Females
Males
1.9
1.7
2.3
3.7
10.6
3.0
5.8
2.2
5.8
6.5
7.9
Prostate
(males)
87
2011
2011
Risk factor
Attributable fraction
(%)
5.4
0.8
1.7
0.7
2.4
9.4
4.9
6.8
2.2
2.9
5.1
6.8
2.3
0.5
2.2
0.5
3.9
1.4
4.1
0.5
0.4
1.8
0.8
0.2
Attributable deaths
(number in thousands)
964
815
301
583
751
405
213
497
366
1 438
756
1 044
343
449 583
781 670
1 037 188
354 481
72 879
331 809
72 526
668
114
336
137
982
000
828
121
252
110
365
598
207
630
70
57
270
121 294
37 998
88
162
0.7
24
1200
230
0.3
50
29
20
68
1.1
1 784
6 817
2009
31
31
22
31
27
28
27
37
24
22
45
30
27
2009
6
7
14
7
9
6
8
6
12
11
5
8
11
2009
2.0
0.0
1.3
1.9
1.5
2.5
1.4
2.5
0.9
1.0
1.2
1.8
1.5
1.6
2.5
0.5
1.6
1.3
1.4
0.8
2.1
0.8
0.9
3.3
1.5
1.2
19891999 19992009
Population
Total
Aged
Aged
Annual growth rate (%)
(millions) under 15 (%) over 60 (%)
Bangladesh
Bhutan
DPR Korea
India
Indonesia
Maldives
Myanmar
Nepal
Sri Lanka
Thailand
Timor-Leste
SEAR
Global
Country
20
16
58
26
31
26
25
9
17
29
21
26
43
1990
24
25
60
28
42
28
28
13
16
31
24
29
47
2000
28
36
63
30
53
39
33
18
15
34
28
33
50
2009
24
24
34
25
28
24
28
21
30
33
17
26
29
2009
Median
age (years)
89
2011
2011
2.8
6.7
4.6
2
8.7
2.1
5.1
3.7
3.4
8.8
3.9
2000
3.3
5.5
4.2
2.3
13.7
2.3
6
4.1
4.1
13.9
3.8
2008
7.6
12.6
3.9
4.5
11.1
1.2
7.7
6.9
9.9
12.7
4.7
2000
7.4
13
4.4
6.2
13.8
0.7
11.3
7.9
14.2
11.9
5.6
2008
General government
expenditure on health as
percent of total
government expenditure
Bangladesh
Bhutan
DPR Korea
India
Indonesia
Maldives
Myanmar
Nepal
Sri Lanka
Thailand
Timor-Leste
SEAR
Country
95.1
96.5
free services free services
92.2
74.4
72.9
70.3
73.8
72
99.2
95.7
91.2
72.4
83.3
86.7
76.9
68.1
43.4
37.2
89.4
75.1
2000
Out-of-pocket
expenditure as percent
of private
expenditure on health
22
165
---69
47
242
12
43
101
165
67
64
2000
44
263
---122
91
769
27
66
187
328
112
116
2008
9
131
---19
17
113
2
11
49
92
48
21
2000
14
217
---40
49
470
2
25
82
244
93
46
2008
Annex 6: Health expenditure in Member countries of SEAR, 2000 and 2008 comparison
90
43 315
52
74 597
660 801
65 722
552
23 709
5 384
10 279
18 918
79
903 408
9 171 877
Number
3.0
0.2
32.9
6.0
2.9
16.0
4.6
2.1
4.9
3.0
1.0
5.4
14.0
Density*
39 992
545
93 414
1 430 555
465 662
1 539
41 424
11 825
40 678
96 704
1 795
2 224 133
19 379 771
Number
2.7
3.2
41.2
13.0
20.4
44.5
8.0
4.6
19.3
15.2
21.9
13.3
29.7
Density*
Bangladesh
Bhutan
DPR Korea
India
Indonesia
Maldives
Myanmar
Nepal
Sri Lanka
Thailand
Timor-Leste
SEAR
Global
Country
Physicians 20002010
6 091
80
2 685
6 493
2 013
172
2 411
2 151
22
Number
0.4
0.4
1.2
0.3
0.4
0.1
1.1
0.4
0.3
Density*
Number
Density*
48 692
195
50 715
478
3 247
16 206
10
119 543
1 369 772
3.3
0.9
0.5
13.8
0.6
6.3
0.1
0.9
4.0
91
2011
2011
1.
The data presented on the website are for the year 2008 and are
updates on estimates of deaths by cause, age and sex using the
same general methods as previous revisions carried out by WHO
for 2002 and 2004. Mortality estimates are based on analysis of
latest available national information on levels of mortality and
cause distributions as at the end of 2010 together with latest
available information from WHO programmes, International
Agency for Research on Cancer (IARC) and Joint United Nations
Programme on HIV/AIDS (UNAIDS) for specific causes of public
health importance and using the 2008 revision of the population
estimates for WHO Member States prepared by the UN
Population Division. Further details of the methods, sources of
data and the reference year are provided in Annex xx at the end of
this document and on the website http://apps.who.int/ghodata/
?vid=2490.
2.
Methods for risk factor data are presented in the Global status
report on noncommunicable diseases 2010. Briefly, these data are
based on country reported results from national surveys as well as
published and unpublished literature. These data have come from
surveys/studies that fulfilled certain criteria such as: a random
sample of the general population, with clearly indicated survey
methods (including sample size) and risk factor definitions.
Adjustments were made for the following factors so that the same
indicator could be reported for a standard year (in this case 2008)
in all countries: standard risk factor definition, standard set of age
groups for reporting, and representativeness of the population.
Using regression modeling techniques, crude adjusted rates for
each indicator were produced. To further enable comparison
92
continued...
focused largely on quantitative indicators, the qualitative aspects
were not adequately covered. For example, while the survey
focuses on the availability of guidelines, equipments and services
in the countries with a yes or no response, it does not elicit crucial
aspects related to coverage or quality of services. Third, since this
was a self-administered questionnaire, it was not possible to
explain or clarify the questions or use probes. Thus, it is possible
that the respondents may not have understood clearly some
questions or differentiated distinctly between policies, strategies,
programmes or plans. Therefore responses related to some of the
questions may not have been accurate. Finally, data on the role of
the private sector, which manages a major share of NCDs, could
not be obtained in the survey.
93
2011
94
2011
Noncommunicable
Diseases in the
South-East Asia Region
2011
Situation and Response
WHO
SEARO