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

? ()

....... ....... ....... .........

? ()

....... .......

? ()

..................................

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%

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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.. *: /