NCDs account for 70% of diseases, 38m deaths globally

Iran a role model for curbing non-communicable diseases

August 30, 2016

TEHRAN — Non-communicable diseases (NCDs) account for 38 million deaths per annum worldwide, the World Health Organization (WHO) said in its January 2015 report. This has become worrying for many countries and urged international health agencies and bodies to take immediate measures to tackle this growing problem.

In that respect the Tehran Times has conducted an interview with Farshad Farzadfar, the director for Non-Communicable Diseases Research Center, Endocrinology and Metabolism research Institute, Tehran University of Medical Sciences.

Below is the text of the interview:

Q: Would you please tell me a little about NCDs, their prevalence in the world and in Iran?

A: NCDs are emerging as a health problem and they are responsible for major part of the burden of the disease across the countries in the world. 70 percent of the diseases are attributed to the NCDs globally.

Regarding Iran the number is pretty much higher; 76 percent of the burden of the diseases comes from NCDs. 

In 2011, the heads of states gathered in New York and decided to combat NCDs. Following the gathering WHO came up with a program that covers four specific categories of NCDs comprising ischemic heart diseases, diabetes, Asthma and Chronic Obstructive Pulmonary Disease (COPD), and cancer and four risk factors which are common across these categories including unhealthy diet, physical inactivity, smoking, and alcohol consumption.

WHO decided to combat these risk factors by taking nine specific measures such as reducing 25 percent of the premature death caused by NCDs until 2025 for age group 30-70 what we call 25 by 25, reducing smoking, increasing physical activity, reducing trans-fat, and providing the essential medication for those suffering from hypertension and diabetes.It is not possible for the market to survive without the help of academia and no academia would be able achieve their goals without the help of market. But there is no correlation between these two in Iran and this makes us to distance from achieving the resistance economy objectives.

In line with WHO’s activities to combat NCDs) in 2015 we established a committee in Iran called National Non-Communicable Disease Committee at the Ministry of Health headed by the Health Minister, Hassan Qazizadeh Hashemi. There are also six subcommittees affiliated with this committee responsible for controlling cancer, cardiovascular diseases, metabolic disorders, air pollution and inter-sectoral collaboration, traffic injuries, and a subcommittee for monitoring and evaluating whole action plan for the NCDs in Iran which I’m responsible for.

The national plan was endorsed by President Hassan Rouhani, Parliament Speaker Ali Larijani, Director-General of WHO Margaret Chan Fung Fu-Chun and WHO Regional Director for the Eastern Mediterranean Ala Alwan and it was very appreciated by other countries because the action plan is not just limited to one ministry and sector but to other sectors as well. 

Right now the committee is going to prepare the provincial action plan by asking the universities of medical sciences to prepare their provincial plan to combat NCDs.

Q: What is this center’s objective and goals?

A: The NCDs research center was established four years ago in 2012. We try to provide evidence about the level of the incidence and prevalence of the diseases specifically NCDs to help policy makers decide efficiently and to save resources for the health sector because we have very limited resources. To do so we developed various projects.

There is a study we call National and Sub-National Burden of Diseases (NASBOD) deciding the incidence and prevalence of different diseases and now we have data on 290 diseases for both genders for 19 age groups in 31 provinces from 1990 to 2015.

There are also several clinical trials. One which is being led in collaboration with Oxford University is poly-pill, where we put anti-hypertension agents, aspirin, and anti-hyperlipidemia agents together and give it to a person once a day and it can control the NCDs specifically cardiovascular diseases by bringing the prevalence of the disease from 20 percent to 15 percent. We have 27,000 individuals in the control arm and 27,000 in the intervention arm. We compare the final results in these two groups after 5 years to see how they differ in the level of ischemic heart diseases.

Telematics is another project we are working on. It is a very small device which is able to transmit data from a car to our servers and the data that is coming is about the velocity and shocks caused by careless driving and then we analyze these data to come up with a driving score having control and intervention arms (to reinforce the results).

What we are hoping to achieve is to reduce premature mortality by 25 percent until 2025. If we implement action plan correctly it is projected that we can reduce that to more than 40 percent.

Q: What international bodies this center is collaborating with?

A: The telematics project is in collaboration with Tufts University and John Hopkins University. We’ve also conducted another project called Global Nutrition and Epidemiologic Transition Initiative (GNET) in collaboration with Harvard University. The project NASBOD is in close collaboration with Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle. We are also conducting a project in Uppsala in Sweden regarding cancer and how the incidence of cancer is different between the Iranian who have migrated to Sweden and Iranian who are living here to remove the effects of genes and see how the environment can decrease or increase the level of the cancer.

We are also working with University of Sydney, Brandeis University and co-conducting two projects with Imperial College London one revolving around risk factors at the global level and the other is about Asthma and COPD using a device on the elderlies aging over 60 asking them to report if they experience any discomfort while breathing when they go out as the device that can measure level of pollution.

Additionally we cooperate with different international agencies such as WHO in Geneva, in Cairo, in Iran, UNICEF in Tajikistan, UNHCR in Iran, and UNAIDS in Iran. Moreover we are holding talks to start collaboration with World Bank.

Q: A high-ranking delegation of health officials paid a visit to the center, including WHO Assistant Director-General for NCDs Dr. Oleg Chestnov. What were the outcomes of this visit?

A: The WHO delegation’s trip to Iran was to check on the National action plan I mentioned before to see how we did this and that was kind of validation of the reports. They were really impressed by what we did. We had a really productive discussion regarding different parts of the action plan.

Regarding Iran’s performance in providing accurate results WHO decided to put Iran in the list of 10 countries as a role model for all other countries after this meeting. They will also send someone from Geneva to help us to make this survey as an example for other countries and also to make sure that all these plans are actually being implemented in the country and are not just on the paper.When it comes to human resources there are two problems. One is training and educating them and the other is motivation. I do believe that the level of the motivation is pretty much low compared to what we are expecting. The financial problems are nothing compared to magnitude of the problems with the human resources.

Q: How does the center interact with Ministry of Health? What are the obstacles you are facing?

A: Regarding this center’s collaboration with Ministry of health we are pretty much smooth. We don’t have that much problem still there are problems regarding getting approval for a proposal or getting the finance but it is usual in Iran.

When it comes to human resources there are two problems. One is training and educating them and the other is motivation. I do believe that the level of the motivation among the people in the medical universities who are working on the NCDs is crucial and is pretty much low compared to what we are expecting.

At the provincial level when we are dealing with universities of medical sciences there are serious concerns. I was looking at the lists of the professors that are working in each university and I found that some university professors that had no papers at all. What kind of professor they are who are teaching but have no scientific productions at all?

I think the main task of Ministry of Health is to increase the capacity and knowledge of the personnel for combatting NCDs. I do believe that the financial problems are nothing compared to magnitude of the problems with the human resources.

Q: Where does the finance come from for the center’s projects?

A: There are several sources. The major source is the Ministry of Health. The other parts come from other organizations that are concerned with the public health problem. Some of them are international agencies like WHO, UNICEF who give us very small grants. The other parts come from Setade Ejraiye Farmane Imam (literally meaning the Executive Headquarters of Imam Khomeini's Directive).

For some specific projects like clinical trials we get the money from pharmaceutical companies. Also we have several funding sources from outside of the country such as MRC, Wellcome Trust and National Institute of Health (NIH) that gave us a grant but we still are not able to transfer this money to Iran because of the sanctions.

Our lawyers in universities of Oxford and Harvard are working on this to see if it is possible to find a way to convince banks to transfer the money but so far we had no success.

We don’t have any experience working with private sector except for some pharmaceutical companies and I actually think that the private sector is not motivated enough to invest on research. But I’m telling for certain that it is not possible for the market to survive without the help of academia and no academia would be able achieve their goals without the help of market. But there is no correlation between these two in Iran and this makes us to distance from achieving the resistance economy objectives.

Q: What is the utmost goal of this center?

A: What we are hoping to achieve is to reduce premature mortality by 25 percent until 2025. If we implement action plan correctly it is projected that we can reduce that to more than 40 percent but it totally depends on how we are capable to implement this action plan because usually in our culture we are good at designing and demonstrating what we need and setting clear strategies but there is a low level of motivation when it comes to implementation. There are some cultural and social reasons for that and this is another gap we have and when it comes to the implementation of the rules.

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