PREVENSAUN NO KONTROLO BA TABACO IHA TIMOR LESTE

Apresentação em tema: "PREVENSAUN NO KONTROLO BA TABACO IHA TIMOR LESTE"— Transcrição da apresentação:

1 PREVENSAUN NO KONTROLO BA TABACO IHA TIMOR LESTE
Dr.Herculano Seixas dos Santos Chefe Departemento de Controlo de Doencas Nao Contagiosas e Mentais

2 Objetivos Atu Komprende baze legal no prevalensia Global no Nasional ba Tabaku Atu komprende Efeitus husi Tabaku ba Saude Atu Koñese Bareiras no Dezafius atu kontrolu Tabaku iha Timor Leste Atu Kompriende Estrategia kombate Tabaku iha Timor Leste

3 Baze Legal Decreto Lei No 9 / 2006: Avisos de Saúde e Controlo Fiscal do Tabaco Manufacturados Timor Leste asina ona Plataforma Konvensaun ba Kontrolu Tabaku iha loron 25 Maio (FCTC) no ratifika ona iha loron 22 Dezembru 2004 Lejislasaun Tabaco Komprensivo Draf ona no sei submete ba konsellu ministro iha tempo badak . Rejime publisidade ba Tabaku no alkohol 2011 Planu estrategiku ba kontrolu Moras la Hada’et

4 DNSP DSCD D. CDNC U.Idosos, Moras Cronica no Disabilidade U.Saude Matan U. Saude Mental U.Saude Oral U. Prevensaun Injuria, Controlo Tabaco no Alcohol DPHO NCDC 13 DISTRITOS

5 INTRODUSAUN Globalmente Epidemia tabacco hamate ema besik miliaun 6 kada tinan Mortalidade > /tinan husi ema fumador pasivu. Bainhira ita la foti asaun ruma, epidemia bele hamate ema liu husi miliaun 8 kada tinan iha 2030. >80% husi menus halo prevensaun ba mortalidade mak ema ne’ebe moris iha nasaun sira nebe rendementu kiik inklui mos Timor leste Industria tabaku iha maneira oi-oin hodi dada konsumedor foun sira hodi nune’e bele mantein no hasa’e fan tabaku no hetan lukru.

6 Non-Communicable Diseases (NCDs): 36 million deaths (63% of global mortality)
10 M 20 M 30 M 40 M; 50 M 60 M 28% 16% 47% 9% Globally, 58 million people died in 2005. 35 million of these deaths were a result of chronic diseases. This means that 60% of all deaths in 2005 were due to chronic diseases. 2008 estimates Communicable, maternal, perinatal and nutritional conditions NCDs < 60 NCDs > 60 Injuries

7 Low and middle income countries are the most affected
Low-income Countries Lower- Middle-income Countries Upper- Middle-income Countries High-income Countries Communicable, conditions NCDs < 60 NCDs > 60 Injuries

8 The problem has a serious impact!
NCDs Have major adverse effects on the quality of life of affected individuals; Cause premature deaths: 44% of NCD deaths occur at age <70 years Create large adverse economic effects on families, communities and societies in general. It is a misunderstanding that chronic diseases would mainly affect high income countries The reality is that four out of five chronic disease deaths are in low and middle income countries Looking at the graph you can see that only for the lowest income countries, communicable diseases are a bigger problem than chronic diseases. And even there almost 40% of people die from chronic diseases For all the other countries, chronic diseases is the main cause of death.

9 Prevention is possible
Largest part of main NCDs can be prevented if risk factors are eliminated 20% 20% 20% 60% 40% 80% 80% 80% The largest part of the main chronic diseases can be prevented! 80% of type 2 diabetes for example, can be prevented. (source WHO Chronic disease report from 2005) Heart disease Stroke Type 2 diabetes Cancer preventable not preventable

10 Substansia hirak ne’ebé maka perigu

11 Social determinants of health
Causal links NCDs Raised BP Overweight/obesity Raised blood glucose Raised lipids Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol Globalization Urbanization Population ageing Social determinants of health Metabolic Risk Behavioral risk factors

12 Mekanismu oinsa tabaku aumenta risku ?
Radical livre—kauza oxidasaun ba plasma LDL Aumenta LDL Adesaun ba monosytos ba arteria/veias aumenta ateroesklerosis

13 Risk Factors Common to Major NCD Conditions
Cardiovascular diseases Diabetes Cancer Respiratory Conditions Tobacco use √ Alcohol Low fruit & vegetable High dietary salt Physical Inactivity Obesity Raised blood pressure Raised blood glucose Abnormal blood lipids

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15 Expozisaun ba fuma passivu iha uma maka entre labarik foin sa’e sira ho idade 13-15

16 Prevalencia konsumo Tabaco no fator risku seluk iha Timor-Leste
Timor Leste seidauk iha Informasaun seluk kona ba Tobaco iha tinan ida ne’e

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18 * La inklui mate fetal intrauterina
Mortalidade no Morbilidade tanba MLH iha ospital Timor Leste (Jan-Dez 2012) Fonte: Relatóriu Anual Estatistika Saúde Kategoria Moras Admisaun/Baixa Mate Númeru % Moras La hada’et 17193 49.9 272 22.2 Moras Kardiovaskular inklui Stroke 1307 3.8 147 12.0 Diabetes Melitus 115 0.3 16 1.3 Moras Respiratória Krónika 531 1.5 29 2.4 Moras Hepátika no Renál 608 1.8 73 6.0 Moras Nutrisionál 563 1.6 21 1.7 Moras Mental no neurolójiku 183 0.5 0.0 Kanek 1416 4.1 39 3.2 Kauza moras la-definidu ka La-espesífiku 12504 36.3 626 51.2 TOTAL 34420 100.0 1223* * La inklui mate fetal intrauterina

19 The UN High-level Meeting Konaba Moras Lahadaet NCDs (New York, 19-20 September 2011)
Badala rua isu saude diskuti husi Estadus Unidus Asembleia Geral (UN GA) Atende husi Ulun Boot nasaun 113 Chefe Nasaun ka representativu Hamosu: Declarasaun Politika As many of you are aware, last year in September, there was a high-level meeting of the UN General Assembly to discuss NCDs. It was only the second time in history that UN GA discussed a health issue, the first time being a decade earlier to discuss HIV/AIDS. The UN HLM on NCDs was a landmark event attended by heads of states and other high level delegates from113 Member States The outcome of the UNHLM was the Political declaration which lists many follow-up actions for MS, WHO and partners 19

20 Moras La Hadaet iha Timor-Leste
Moras oin rua mak mosu– Moras Hadaet komesa tun neneik no Moras La Hadaet komesa sae neneik 30% husi pasient moras baixa iha hospital no mate tamba moras sira Lahadaet Numeru arkivu Hospital hatudu katak moras lahadaet aumenta no pasiente nia tinan menus ba bebeik. Afeita ba profuktividade ekonomia durante periodu moris. Pasiente nebe refere ba nasun seluk hatudu gastu makas iha orsamentu Saude.

21 Prevensaun & controla Moras Lahadaet (NCD): Framework Simples
Hahalok sira nebe bele muda: Tobacco La halo actividade Physico Dieta nebe la saudavel (masin, bokur & midar, afuan/modo) Patho-physiological Fator Risku Tensaun As Kolesterol As Diabetes Bokur liu Atakasaun moras Fuan Stroke Diabetes Cancers Moras Kroniku Respiratoria Strategia ba Populasaun: Envairomentu Regulamentu/Lei Edukasaun Strategia ba Risk-As: Screening no tratamentu ba ema risku Kustu efektivu tx ba kasu mora la hadaet akut + Surveillance Matadalan & halao evaluasaun ba intervensaun Prevensaun Primaria (Hamenus incidensia kasu-kasu foun)

22 Concentración media por pitillo
Komponentes husi Sigaru suar Componente Concentración media por pitillo Alquitrán 1-40 mg Nicotina 1-2.5 mg Fenol mg Catecol mg Pireno mg Benzo (a) pireno 20-40 mg 2.4 Dimetilfenol 49 mg m- y p-Cresol 20 mg p-Etilfenol 18 mg Sigmasterol 53 mg Fitosteroles (toal) 130 mg Seluk tan

23 Relasaun Tabaco ho Saúde
Sigaru suar nia kontenidu iha sustancia >4000 substancias quimicas :Nicotina, no > 60 Cansirigenos (Provoca Kankru) Substancia hanesan monóxido de carbono, alquitrán, arsénico no plomo toxiku ba ita nia isin . Nicotina hanesan Droga Psikoativa ne’ebe provoka Toleransia no Dependensia (Ketagihan) Hanesan substancia Hidrosoluble ne’ebe absorbe direitamente husi ita nia ibun no vias respiratorias, ran, Aten, Bazo no kakutak Sigaru nia suar iha Monoxido de Carbono provoca disfunsaun endotelial Generalizada no provoca ateroesclerosis (Sulan uat) Efeitus Cigarus aumenta Estimulos Nervoso simpatiku, Libera Adrenalina halo oat sai klot no Aumenta Tensaun Arterial

24 Efeitus husi Tabacco ba Saúde
Fuma no Hasae Risku ba Saude Moras coronaria (fuan) dala 2 to’o dala 4 Stroke dala 2 to’o dala 4, Mane dezenvolve kankru aten bo’ok to’o dala 23 Desenvolvementu kankru ba Feto to’o dala 13 Hamosu moras respirasaun Kroniku(hanesan Bronquitis Kronika, Enfisema, Asma) dala 12 to’o dala 13.

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26 Moras Kankru Kanker iha ibun “Cancer of the oral cavity (mouth)”
Kanker iha Aten Book (Lung cancer) Kankru iha ran (Acute myeloid leukemia) Kanker Mamik (Bladder cancer) Kanker iha Servikal (Cancer of the cervix) Kanker iha Esofagus (Cancer of the esophagus) Kanker iha Rins (Kidney cancer) Kanker iha Laringe “Cancer of the larynx (voice box)” Kanker iha Pharinx “Cancer of the pharynx (throat)” Kanker iha Pankreas (Pancreatic cancer) Kaker iha kabun (Stomach cancer)

27 Types of Cancers Cancer is known by many different names. Carcinomas (cells that cover internal and external body surfaces) Leukemia (Blood Cells) Lung Lymphomas (Lymph nodes &tissues) Breast Colon Bladder Sarcomas Cells in supportive tissues – bones & muscles Prostate (Men)

28 Efeitu Seluk husi Tabaku
La iha fertilidade (Laiha oan) Partus antes (preterm delivery), Moris mate (stillbirth), Bebe moris ho todan menus (low birth weight), no Sinais mate derepente ba bebe depois partus “sudden infant death syndrome (SIDS)”. Malformasaun konjenita

29 Moras vaskular no moras seluk
Fuma provoka gangrena Fuma taka arteria no kauza ataka kardiaku no estrok. Avizu: fuma kauza moras hirak ba ibun Fuma kauza matan delek Kankru Avizu: Fuma kauza 92% husi kankru oral hirak.

30 Risku maka’as ba ataka kurasaun
BA DALA RUA BELE MATE

31 Feto sira Fuma bele aumenta liútan oportunidade ba abortu

32 Maski horon fuma uitoan ida mos perigu Laíha nível seguru ba expozisaun ba Fumu Pasivu
Fumu Passivu maka kauza boot ida ba moras fuan, estrok, moras respirasaun, kankru pulmaun, no selu-seluk tan. Maski so expozisaun 30 minutu de’it ba fuma passivu, produz reasaun fiziku hirak ne’ebé hanesan ne’ebé sei mosu husi fuma ba longu prazu, no aumenta risku ba moras fuan ba ema sira ne’ebé la fuma. Aumentu ida iha risku ba kankru pulmaun ba ema sira ne’ebé la fuma ne’ebé hetan expozisaun ba fumu passivu iha 20% iha feto no 30% iha mane sira. Ema sira ne’ebé la fuma ne’ebé hetan expozisaun ba Fumu Passivu iha serbisu fatin iha aumentu husi 16 to’o 19% iha risku husi dezenvolve kankru. Rizku husi hetan kankru pulmaun aumenta depende ba nível expozisaun.

33 Lakuna Manufacturasmanan profit husikonsumuprodutos halo stragabasaúde
Media moshalaopublisidadebaproductosne’ebe halo stragabasaúde Governogeneralizareseitahusifaanprodutosne’ebehalo stragasaude Konsumedoresgostauzaproductosne’ebe halo stragasaúde Tradisaun/ Situasaun Sociocultural iha Timor Lestefodalanbaemaatukontinuakonsumo Tabaco Behaviour modification approaches require changes in social policies, which pose several difficulties. Government generates revenue from industrial production and sale of health damaging products such as alcohol, tobacco, and processed food; media benefits from advertisements of these products; producers of these products profit from their consumption; and consumers enjoy using them. Therefore, any attempt to restrict the production, distribution, and advertisement of these products is foiled by these companies by lobbying. Their argument is that government should educate people for not consuming these products, and let market be regulated by the consumers rather by the government. In reality, government budgets for education never matches with budgets which companies employ for advertisements. However, innovative approaches of public health advocacy keeping in mind the local socio-economic and cultural context can overcome these barriers.

34 Dezafios ba Saúde Pública
Merkado livre/Globalizasaun Moris Moderna ( Stilos Moris la saúdavel ) Sosiokultura ( Tradisaun moris rai nian ) Asesu Tabaco ne’ebe libre tebes ba populasaun ho idade hotu-hotu. There are three key public health challenges that the governments have to face to effectively to cope with rising burden of NCDs: Firstly, Macro-economic policies in agriculture, industry, energy and housing can affect living conditions leading to chronic diseases which need long-term and often expensive care. Secondly, globalization and trade liberalization process will influence the development policies of nations, some of which will affect health. Thirdly, inequity is likely to increase as the care of NCDs is long-term and expensive. The poor are less likely to get early screening even when effective preventive treatments are available. They are more likely to seek care at late stage only when symptoms occur mainly from organ involvement or organ failure. The poorer population who need more care would not be able to access it due to high costs, thereby continuing the inequity. Fourthly, as a result of modern living, chronic diseases will kill and disable both the rich and the poor. Obesity a consequence of physical inactivity results from mechanization which can pervade all sections of the society. Addictions to nicotine, alcohol and other drugs are common lifestyles among both poor and rich.

35 Estratejia Nasional ba Kontrolu no Prevensaun ba Moras la Hada’et 2014-D:\PLANU ESTRATEGIKU NCDC TRADUZIDU\PLANU ESTRATEJIKU NCDC PREPARA BA TRADUSAUN_Revisaun\Planu Estratejiku NCDC Final\Final NCD Strategy cum Action Plan Copy.pdf 2018

36 Vision “Ema Timor oan hotu bele Goja moris saudavel no moris produktivu no livre husi moras, disabilidade no mate sedu relasiona ho Moras La Hadaet (NCDs).”

37 Estrategia Nacional ba kontrolu Tabaku
Advokasia no Lideransa ba resposta husi multi-setoral Promosaun Saude no Prevensaun Primaria Haforsa sistema saude Surveilencia, Monitorizasaun, Evaluasaun no Pesquija

38 Estrategia ba no prevensaun no kontrolu Tabaku
Introdusaun komprensivu ba lejizlasaun ne'ebé relasiona ho tabaku hodi tau iha kompromisu tuir Konvensaun Enkuadramentu kona-ba Kontrola Tabaku (FCTC) no obriga ninia implementasaun. Hasa’e impostu kona-ba produtu tabaku inklui taxa importasaun. Deklara fatin públiku hotu hotu livre tabaku Halo obrigatoriedade avizu saúde ho imajen iha produtu tabaku Implementa bandu ka proibisaun komprensivu ba iha publisidade tabaku iha mídia no liu husi Orgaun legal, patrosíniu no promosaun. Bandu fa’an tabaku ba no husi otas sei ki’ik.

39 Estabelese Servisu Hapara Tabaku iha fasilidade saúde sira.
Harii sistema vijilánsia tabaku nian hodi monitoriza ninia uzu inklui entre adolesente sira. Estabelese Servisu Hapara Tabaku iha fasilidade saúde sira. Hala’o kampaña mídia hodi responde hasoru influensia husi industria tabaku no dezenkoraja uza tabaku.Backup of PROPOSTA DE LEI DO TABACO, Versao Ultimada docx Proposta RCT pptx

40 Advokasia Política saudável Edukasaun Saúde
An understanding of the decision-making process among policy makers, politicians and bureaucrats is required for success of health promotion. Political action to change the public policy is of major importance. Therefore, advocacy and lobbying strategies have to be utilized which are backed fully by evidence in favour of change. Without the policy support creating supportive or enabling environment it will be difficult to change behaviours by health education alone. Conversely, taking a somewhat ‘tough’ policy decision is immensely difficult unless there are sufficient public (ballot box) pressures for it which can only be built up by an effective health education campaign also called ‘agenda setting’. The relation between health education and healthy public policy is synergistic. Muda hahalok Hili Hahalok saudável hanesan ‘ fasil’ atu hili

41 Asaun Multisetoral no Interministerial
Advokasia / Akonsellamentu Mudanca hahalok ema lubun ida Harii sistema vijilánsia tabaku nian hodi monitoriza ninia uzu inklui entre adolesente sira. Estabelese Servisu Hapara Tabaku iha fasilidade saúde sira. Politica no Regulamentu Limitasaun ba Manufaktura Hasa’e Taxa Limitasaun husi publisidade Regulamento ba faan sigaru Avizu saúde iha label sigaru Fatin publiku livre husi sigaru Bandu fa’an tabaku ba no husi otas sei ki’ik. Komprimentu: kompriende no halo mundansa livre husi fuma

42 Kolaborasaun Interministerial no multisektoral hodi kontrola Tabaku iha Timor Leste
Instituisaun Privadu Sociendade Sivil NGO Igreja Ministerio Saude Ministerio Edukasaun Ministerio Justisa Ministerio Agrikultura MTCI SEJD Sec.Estado Com. Social Sec Est.Seguransa Media etc

43 Haforsa Sistema Saúde Haforsa kapasidade rekursu humano iha nivel hotu sistema saude Fo kontinuasaun servisu liu husi sistema referal inklui tratamentu tersiaria Establese servisu tratamentu tersiaria iha Hospital Nasional ba moras Fuan, moras rins, stroke no kankru. Desenvolve solusaun inovativa atu kobre kustu inklui realokasaun husi taxa ba atividade promosaun saude Estabelese Akonselamentu hapara tabaku (Tobacco Sesasion services)

44 Survelencia, Monitoriza, Evaluasaun & Pesquiza
Halao Survey ba Fator Risku NCDs kada tinan 5 Identifika area sira iha Estudu Demografia Saude (DHS) atu involve dadus Peskiza ba Tabaco. Haforsa Sistema Informasaun Saude hodi fo suporta ba foti desijaun Atu haforsa peskisa relasiona ho Fator risku ba Moras la hadaet (NCDs)

45 13 targets set for 2025

46 Kankru Ibun

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49 PREVENE ESTILO DE VIDA LA SAUDAVEL

50 PROMOVE ESTILO DE VIDA SAUDAVEL

51 OBRIGADO WAIN www.palaciodascinzas.com seixasnico@yahoo.co.id