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Non-Communicable Diseases and Emergencies: A Call for Renewed Action

Berlin Humanitarian Conference, 2012

Alessandro Demaio

on 16 October 2012

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Transcript of Non-Communicable Diseases and Emergencies: A Call for Renewed Action

Non-Communicable Diseases and Emergencies: A Call for Renewed Action Dr Alessandro Demaio, Copenhagen School of Global Health, Denmark

Dr Rebecca Horn, ChronAid International, Washington DC, USA

Dr Jennifer Jamieson, MSF & The Alfred Hospital, Melbourne, Australia

Professor Maximilian de Courten, Professor for Global Health,
Copenhagen School of Global Health, Denmark

Dr Slim Slama
Geneva University Hospitals, Switzerland

Professor Ib Christian Bygbjerg, Professor of International Health
Copenhagen School of Global Health, Denmark

Siri Tellier, Coordinator, Course on Health in Emergencies
Copenhagen School of Global Health, Denmark Non-Communicable Diseases and Emergencies: A Call for Renewed Action Despite some progress, with regards to the health effects and mitigation strategies for NCDs and emergencies there continue to be significant gaps:

- scientific evidence
- technical guidelines
- teaching A comprehensive literature review of excess morbidity and mortality from NCDs & on current practice of NCD management in emergencies Increased monitoring and reporting of NCD morbidity and mortality patterns during and following emergencies Development of technical guidelines on the clinical management of NCDs in emergencies Greater integration and coordination of health service provision during and following emergencies - CD and NCD Integration of NCDs into the practical and academic training of humanitarian workers and emergency-response coordinators Further incorporation of NCDs into existing emergency-related policies, standards, and resources Persons with NCDs are more vulnerable in emergencies Emergencies exacerbate NCDs leading to acute complications Long-term Implications of NCDs resulting from emergencies THE CURRENT UNDERSTANDING OF NON-COMMUNICABLE DISEASES IN EMERGENCIES The compounding morbidity and mortality burden created by NCDs during and following emergencies continue to be under-recognised, under-researched and under-resourced.

Healthcare workers, communities and governments must further acknowledge, understand, study and address the structural determinants of NCDs within emergencies. NCDs should no longer have a token inclusion in emergency responses, but rather a meaningful and integrated one that addresses a serious care gap in this vulnerable population.. and on a scale that reflects the magnitude of this public health challenge Many individuals with NCDs are dependent on long-term medications, durable medical equipment and consistent healthcare services; often disrupted or destroyed during emergencies The compounding impact of NCDs, emergencies and poverty In the aftermath of the 2011 United Nations High Level Meeting on Non-Communicable Diseases (NCDs), there is now an unprecedented opportunity for a renewed call to action on the management of NCDs during and following emergencies There is no denying a global increase in the burden of NCDs including heart disease, diabetes, cancers and chronic lung diseases. Simultaneously, our global landscape is regularly affected by emergencies and in the context of climate change and corrosive political instability in many world regions, it is unlikely that we will see a future reduction in disasters or their resulting health impacts Continues to be limited research, and as a result, evidence

Thus a lack of integration of NCDs in operational emergency guidelines, policies and capacity building Conclusions A Way Forward Background Many NCDs require close and sustained interaction with health systems and providers

Due to interruptions in access to care and medications during and following an emergency, acute exacerbations of previously stable chronic disease may occur The need for adequate monitoring and treatment associated with NCDs is normally life-long

A lack of appropriate care for even a short period can result in greater levels of chronicity and suffering LMIC countries are simultaneously and disproportionately burdened by both NCDs and emergencies; countries with health infrastructure least able to cope

Emergency situations render those with NCDs increasingly susceptible to overcrowding, inadequate sanitation, poor shelter, insufficient food supply and disruptions to healthcare services

NCDs are a poverty-cycle catalyst, exacerbated during an emergency One.. Two... Three... Four... Five... Six... Preparedness


Following As well as risk assessments and preparedness before emergencies which include NCDs Addressing the special needs of people with chronic diseases should be part of emergency preparedness (especially for disaster prone countries) at:
micro: patient and community empowerment,
meso: health infrastructures
and macro level: national disaster preparedness policies Humanitarian Emergency Preparedness: Documentation of key chronic disease burdens and pre-existing health systems ‘responses is currently one of the key aspects needing further action Health Information systems, chronic diseases & emergencies High rates of exacerbation of chronic disease and NCDs

Up to 68% of medications dispensed in clinics for chronic conditions (Day 4 - Day 31)

Reliance on retail pharmacy supplies to meet this demand as medical relief pharmacy supplies did not consistently reflect the actual demands of evacuees

Katrina survivors had 1 or more chronic conditions in the year before the hurricane; of these, 20.6% cut back or terminated their treatment because of the disaster HC Katrina 2005 Documented rise in HBA1C & BP as a result of a lack/disruption of chronic disease management

Particularly in elderly

Potential for acute and long-term complications & morbidity

Preventable with planning Kobe EQ 1995 Renal Disaster Relief Task Force (RDRTF) intervened in the aftermath of the earthquake of 8 October 2005 in Kashmir, Pakistan

77 victims with Acute Renal Failure, of whom 66 survived, were treated by dialysis in the broad Islamabad area

Entire intervention lasted for 23 days

In total, one scouting team and two full rescue teams were dispatched, and 15 volunteers (eight nurses, five doctors, two dialysis technicians) from four countries Pakistan EQ 2005 Death toll of some 240K

21K trauma pts in SL but also large CD

Heavily NCD burdened nations (India, SL)

Diabetic complications, HTN, mental health, asthma

Not to mention MH ramifications Boxing Day Asian Tsunami 2004 BMJ Open 2012;2:e000830 doi:10.1136/bmjopen-2012-000830 Jhung, M. A., N. Shehab, et al. (2007). "Chronic disease and disasters medication demands of Hurricane Katrina evacuees." American Journal of Preventive Medicine 33(3): 207-210

Kessler, R. C. (2007). "Hurricane Katrina's impact on the care of survivors with chronic medical conditions." Journal of general internal medicine 22(9): 1225-1230. Vanholder, R. (2006). "Intervention of the renal disaster relief task force (RDRTF) in the Kashmir earthquake." Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 21(1): 40. The diseases are responsible for 35 million deaths each year with 80% of this mortality occurring in low- and middle-income countries (LMIC). Underway... Underway, but slow... Working on this also...
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