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“ สถานการณ์และระบาดวิทยา โรคไม่ติดต่อในประเทศไทย ”. แพทย์หญิงฉายศรี สุพรศิลป์ชัย นายแพทย์ทรงคุณวุฒิ กรมควบคุมโรค วันที่ 9 ตุลาคม พ.ศ.2555 ณ โรงแรมริชมอนด์ จังหวัดนนทบุรี. วัตถุประสงค์. - PowerPoint PPT Presentation
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9 ..2555
(Public Health Services)Public health services are very broad and include services in the area of health protection, communicable disease surveillance, disaster preparedness and response, disease prevention services delivered to the community and individual and health promotion, also at community and individual level
The 10 Essential Public Health Operations (EPHOs) 2012 (1)Surveillance of population health and well-being Monitoring and response to health hazards and emergencies Health protection, including environmental, occupational, food safety and others Health promotion, including action to address social determinants and health inequity Disease prevention, Risk Management including early detection of illness
The 10 Essential Public Health Operations (EPHOs) 2012 .(2) Assuring governance for health and well-being Assuring a sufficient and competent public health workforce Assuring sustainable organizational structures and financing Advocacy, communication and social mobilization for health Advancing public health research to inform policy and practice
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Figure 1: Global monitoring framework for NCDs.
4 categories of indicator setCategory 1 indicators that are considered to be high-impact in nature and that can be used for one-head line statistic reportingCategory 2- indicators that complete the picture given by thosenin category 1Contextual indicators- indicators that do not directly relate to chronic disease but provide a broad view of the health environmentIndicators for development this is a temporary category for two indicators that require further researched developmentRef: Key indicators of progress for chronic disease and associated; Data report June 2011; AIHW
Criteria for KIP Set Be relevantBe applicable across population groupsBe technical sound Be feasibleBe timelyBe markable
(Noncommunicable diseases) (Unhealthful lifestyles and environment) : ..
What is chronic diseases ? ..are mostly characterised by complex causality, multiple risk factors, long latency periods, a prolong course of illness and functional impairment or disability (AIHW 2002).
The chronic diseases are the focus of the KIP set are those which are considered in the some way preventable, largely through behaviors, or those taht react favourly in terms of management and medical treatment Zif they are detected and treated in their early stages.
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63% of the worlds annual deaths are due to NCDs, approximately 25% of which are premature (below 60 years) and could be preventedSource : The Global status report on noncoommunicable diseases 2010, WHO 2011
: Ala Alwan, et al. Chronic Diseases: Chronic Diseases and Development: Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countries . The 2007 Lancet Chronic Diseases Series see http://www. The lancet.com/series/ chronic-diseases.
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4 4
; Infetious diseases
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10 leading cause of death by gender, 2009, Thailand
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1 100,000 ..2541-2550 : :
Chart2
85.648.712.8
68.758.618.4
52.363.920.9
56.268.420.5
52.673.321.3
63.778.920.4
63.381.319.7
59.1281.417.8
54.583.116.6
55.284.915.9
CVD
Cancer
RTI
Sheet2
20-3435-4445-5455-6465-7475+
254211.711.714.519.820.316.4
25438.510.210.414.522.718.7
25447.58.814.1192421.8
25455.18.214.619.425.624.2
254647.613.718.126.228
25474.58.115.219.526.524.3
Sheet2
2542
2543
2544
2545
2546
2547
Sheet1
StrokeHTIHDDM25402541254225432544254525462547254825492550
25407515849148.7Stroke7578.292.7105.81115.33138.34151.5169.94174.88188.33206.34
254178.2169.659.9175.7HT158169.6216.6259.02287.5340.99389.83477.35544.08659.57782.38
254292.7216.681.9218.9IHD4959.981.998.03111.13140.88165.65185.72198.68232.68262.32
2543105.81259.0298.03257.59DM148.7175.7218.9257.59277.71340.95380.75444.16490.53586.82654.44
2544115.33287.5111.13277.71
2545138.34340.99140.88340.95
2546151.5389.83165.65380.75
2547169.94477.35185.72444.16
2548174.88544.08198.68490.53
2549188.33659.57232.68586.82
2550206.34782.38262.32654.44
Sheet1
Stroke
HT
IHD
DM
Sheet4
2539254025412542254325442545254625472548
CVD108.498.685.668.752.356.252.663.763.359.12
Injury75.861.541.763.566.464.468.471.770.764.5
RTI27.221.212.818.420.920.521.320.419.717.8
Cancer50.543.448.758.663.968.473.378.981.381.4
Sheet4
CVD
Injury
RTI
Cancer
Sheet5
StrokeHTIHDDM
2545138.34340.99140.88340.95
2546151.5389.83165.65380.75
2547169.94477.35185.72444.16
2548174.88544.08198.68490.53
2549188.33659.57232.68586.82
Sheet5
Stroke
HT
IHD
DM
Sheet7
2541254225432544254525462547254825492550
CVD85.668.752.356.252.663.763.359.1254.555.2
Cancer48.758.663.968.473.378.981.381.483.184.9
RTI12.818.420.920.521.320.419.717.816.615.9
Sheet7
CVD
Cancer
RTI
Sheet6
2541254225432544254525462547254825492550
HT3.34.95.56.35.15.443.943.83.6
IHD3.67.910.112.414.419.117.718.6919.420.8
Stroke710.813.418.221.529.130.825.2720.620.6
DM7.911.412.213.211.810.612.311.851212.2
Sheet6
HT
IHD
Stroke
DM
Sheet3
2539254025412542254325442545254625472548
HT5.33.43.34.95.56.35.15.443.94
IHD4.83.23.67.910.112.414.419.117.718.69
Stroke10.910.1710.813.418.221.529.130.825.27
DM9.17.57.911.412.213.211.810.612.311.85
Sheet3
HT
IHD
Stroke
DM
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Trend of Crude Death rate (per 100,000) in Thailand from Stroke and Key activities in 1995-2007Screening for Hypertensive Diseases & Diabetes MellitusNon-pharmacologic CareHypertension AwarenessQuality Standard HT & DM ScreeningStroke Awareness & Comprehensive CVD Risk ScreeningIncrease Communication Thru Salt NetSource: BNCD (.2006) and edited in 2012 Start CBI for Comprehensive risk reductionStart National Exercise Campaign
Chart1
10.9
10.1
7
10.8
13.4
18.2
21.5
29.1
30.8
25.3
20.6
20.6
20.8
21
27.5
Death Rate
Sheet1
YearDeath Rate
199610.9
199710.1
19987
199910.8
200013.4
200118.2
200221.5
200329.1
200430.8
200525.3
200620.6
200720.6
200820.8
200921
201027.5
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5 ..2548-2553 :
Chart1
81.411.93.928.225.3
83.1123.828.420.6
84.912.23.629.320.6
87.612.23.929.820.8
88.311.13.62921
91.210.83.928.927.5
..
Sheet1
254825492550255125522553
81.483.184.987.688.391.2
11.91212.212.211.110.8
3.93.83.63.93.63.9
28.228.429.329.82928.9
25.320.620.620.82127.5
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DALYs DALYs 1 1,032,313 18% 1 459,618 11% 2 623,339 11% 2 278,108 6% 3 234,737 4% 3 269,107 6% 4 205,785 4% 4 145,236 3% 5 169,624 3% 5 133,424 3% 6 159,948 3% 6 123,008 3% 7 157,487 3% 7 121,780 3% 8 149,188 3% 8 120,769 3% 9 141,012 2% 9 112,759 3% 10 138,438 2% 10 102,400 2% .. 2542
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10 leading cause of death by gender, 2009, Thailand
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/: : : ..2552 2553 5 ..2548-2553
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: (.2549) * TBRFSS2548 ** TNHEXAM2546
Risk Factors **MiIllionsOverweight and Obesity~ 16.1 Low fruits and vegetable Diet~ 38 Physical Inactivity~ 19 Hypertensive Diseases~ 7.4 Diabetes~ 3.4
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Burden of Major Thai Chronic NCDs in 2005Source: BNCD (.2006) esttimated from * TBRFSS2548 *
Diseases*MillionsStroke and ISHD~ 0.9 Chronic Renal Failure~ 1.8 Cancer~ 0.2 COPD and Asthma~ 1.6 Depression~ 0.6
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26 2555www.nesdb.go.th* : 10
()
%
+
HIV/AIDS
60,480
13,397
73,877
35%
49,582
4,875
54,456
26%
17,727
2,716
20,442
10%
15,367
4,386
19,753
9%
9,499
2,150
11,650
6%
10,757
1,521
12,278
6%
5,562
3,480
9,042
4%
4,575
704
5,279
3%
1,472
21
1,493
1%
0
0
0
0%
0
0
0
0%
8
10
18
12
175,028
33,259
208,287
100%
84%
16%
100%
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..2534-2552: 1, 2, 3
Chart1
5.4112221.4
2.34.66.96.9
2534
2539
2547
2552
Sheet1
2534253925472552
5.4112221.4
2.34.66.96.9
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15 NHES III(2546-2547)NHES IV(2551-2552) 6.9% 6.9% 22.0% 21.4% 15.5% 19.4%43.4%68.8%28.6%49.7%12.9%27.3%28.5%12.2% 8.6%20.9% 6.2%14.8%
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Figure 2 Effective coverage of hypertension servicesSource: NHES (2004, 2009)
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Figure 1 Effective coverage of diabetic servicesSource: NHES (2004, 2009)
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Integration
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Cross cutting areaLife course relatedHuge problems but Limited resources
WHO
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19.9.50 /:/ -/ & : :
- - & &
, , ,
260252:
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280151
60 30 4/ / -/ / -/ .260252
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28.12.50
- - - / - /
28.12.50
Health ReformReform Government SystemDecentralizationCivil society PolicyThailandProvincial and local governmentPolicyNCDUniversal Coverage InsuranceThaiHealth Foundation FundMOPHNational NCD Program Move to Department of Diseases Control in 2003
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/
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(......) 061051Ref.: A Tool for Strengthening Chronic Disease Prevention and Management Through Dialogue, Planning and Assessment:Introduction to the Tool. 2008 Canadian Public Health Association.http://www. cpha.ca/en/portals/CD.aspx (5 of 5) [5/10/2551 12:46:09]
Consulting/ Collaboration and cooperation/ Monitoring and support/Regional evaluationDevelopment of social and campaign processServices System Quality DevelopmentDDC..With OtherDepts,Central and Regional SystemSocial mobilization and campaignFor awareness and risk reductionDevelopment needed Mechanism for prevention and controlHlth Provincial OfficeCEO and Provincial Managerial OrganizationAreaPeople: risk and diseases awareness, risk protection, self management and accessing service needed 20
Law Development and EnforcementSurveillance and Information Development
Development & Research
HMR Development
Policy and Plan DevelopmentSocialOrganizationHealth care netSupport for quality of prevention and control(focused on risk reduction and qulity improvement process)Regulation and Law enforcement for protection from risk BNCDODCPCU/CHC 2547
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/ .
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Reference: JAMA October 16, 2002 Vol 288, No.15; AMA
(..) BP235-6-8-14-4-5-9-3-4-7
280151
Health care System: Family health, Health Learning, Health services, Social ServicesHigh RiskEarly Symptoms
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. 15/12 /51
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* : Eliner Wilson, Gregory Taylor, Stephen Phillips, et al., Creating a Canadian Stroke system, CMAJ ; June26, 2001; 164 (13) p.1853. .; 2549
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Policy (policy/ target/KPI (ministry/ national monitoring)) other supporting system (Health guide, CPG)Finance (Universal coverage insurance, social insurance, local budget, etc) Level of service units/ age specificSettings, local specific population and area target Consequence Results in PHC: Financial support forStroke risk screening service risk reduction serviceStroke Fast Track
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Hypertension & Diabetes Mellitus ScreeningNon-pharmacologic CareHypertension AwarenessQuality Standard HT & DM ScreeningStroke Awareness & Comprehensive CVD ScreenIncrease Communication Thru Salt Net Trend of Crude Death rate (per 100,000) in Thailand from Stroke and Key activities in 1995-2007Source: BNCD (.2006) and edited in 2009 Start CBI for Comprehensive risk reductionStart National Exercise Campaign
Chart1
10.9
10.9
10.1
7
10.8
13.4
18.2
21.5
29.1
30.8
25.27
20.6
20.6
Stroke
Sheet1
19951996199719981999200020012002200320042005200620072008
Stroke10.910.910.1710.813.418.221.529.130.825.2720.620.6
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+ ( ) (Road Map + R&D + KM) ( + + ) () + ( Result based program ( ???) ) ( ) () ....... ( )........ competency ........ Web site E learning
280151
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.
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. 2551 .260252
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Indicators and targets for the global monitoring framework for NCDs (2nd WHO Discussion paper)** All indicators should be disaggregated by gender, age, socioeconomic position, and other relevant stratifiers
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* . 30 2552
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: (Stroke) (PVD) (MI)(Sudden Death) (HF)(Inflammation)
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Sufficient Causation Model
*** ..2548 (%) () 8.31; 3,703,297. 3.69; 1,597,326 0.88; 396,408 10.7; 478,785 1.08; 483,865 0.48; 213,777 0.40; 179,551 1.31; 585,788 4.10; 1,824,351*Ref.: Making Health System Work: INTEGRATED HEALTH SERVICES WHAT AND WHY ?. Technical Brief No.1, 2008.*:,k9i
***According to reviewing effective and efficiency policy and strategic approach for NCD prevention and control. We found that Primary care service group is the important strategic unit and organization that connect proactive prevention and control services and communities to reducing risk and diseases which could be seen in many success countries such as Japan Finland Canada etc.
*Adapted from Arch Intern Med, with addition data from StamlerReference: JAMA October 16, 2002 Vol 288, No.15; AMA*
***Quality standard for hypertension and diabetes screening:Verbal and medical screening for targeted population aged more than 40 yearsInform results of risk statusBrief intervention for practical guide to reduce their own risk factors corresponding for their own risk status.. *: /
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