Non-communicable diseases (NCDs, Chronic Diseases)
Non-communicable diseases, also known as Chronic Diseases - a group of conditions which include cancers, cardiovascular diseases, chronic respiratory diseases and type II diabetes are a global crisis and require a global response. They are diseases of long duration, and, by large, of slow progression. By definition they are non-transmissible and non-infectious, but are a growing threat to the health and prosperity of individuals living in all regions of the world. The World Health Organization (WHO) estimates that 63 percent of the 57 million deaths each year are linked to NCDs. With the death rates greater in low-income and middle-income countries than in high-income countries, these potentially preventable diseases have the same impact on both men and women equally. This essay will give a brief description of the key risk factors for the leading NCDs, the misconceptions regarding the NCDs and how such misconceptions have influenced the limited response to the NCDs in particular the low and middle-income countries. Along with identifying the five priority interventions aimed at preventing the NCDs as listed by Beaglehole et al5 and a program aimed at averting NCDs for a low/middle-income country.
The causes of the main NCDs are well established and well recognised. Many risk factors have been identified and can be categorised into two groups - modifiable risk factors and non-modifiable risk factors. The modifiable risk factors include: tobacco use including exposure to second-hand smoke; unhealthy diet and excessive energy intake; physical inactivity and alcohol consumption. These three risk factors lead to obesity, raised glucose levels, raised blood pressure and abnormal lipid levels. The non-modifiable risk factors include: hereditary and age.
Underlying these main risk factors are socioeconomic elements: unemployment, inequality, poverty, unfair trade, global imbalances and social instability. The relationship between the non-modifiable risk factors and the modifiable risk factors is the main reason why NCDs exist and it explains why some cancers, cardiovascular diseases, chronic respiratory diseases and type II diabetes account for so many deaths in regions of the world.
The misconceptions around NCDs is one of the core features why global responses for them have been slow to emerge. For over 20 years now, the appreciation of the rising global burden of NCDs have been evolving. Despite efforts made by health managers and physicians in the management and prevention of NCDs, through effective measures of pharmaceutical treatments and behavioural interventions. Neither measures are equitably distributed or being used widely. Additionally, a broadening gap exists amongst the reality of the NCD burden worldwide and the response of national governments, international agencies and civil societies.
The serious consequences of NCDs and their risk factors are currently not being recognised by the international health community and as a result are not being supported financially by the development and health agencies. NCDs are frequently being characterised as problems of the prosperous and aging populations who have attained them through over indulging in the risk factors for disease (physical inactivity, tobacco use and unhealthy diets). It is these misconceptions which have influenced the limited response to NCDs, particularly regarding the low and middle-income countries. The fact is NCDs are a larger problem in low and middle-income countries, in particular those who do not have the resources and knowledge to pursue a healthy lifestyle. Recent evidence presented in the Lancet suggests that deaths from lung cancer and heart disease occurs earlier in life of those living in low and middle-income countries where effective treatments are not widely used, available and prevention is not the main concern. Misconceptions about NCDs have grave consequences for the welfare and health of people in low and middle-income countries. The price of illness on a national level is high and with the cost of chronic diseases also high many families are directly lead to poverty with the majority of families having to make out of pocket payments for the needed treatment.
Another misconception which has influenced the limited response to NCDs, predominantly in low and middle-income countries is that nothing can be done to prevent such conditions as they are the result of 'unhealthy behaviours that people choose to have'. However, the reality couldn't be further from the truth. Ones behaviour is shaped by numerous influences which encompass economic and environmental stresses. Economical and environmental stresses along with the upsurge of urbanising populations within low and middle-income countries can result in the lack of physical activity and poor diet choices.
The burden of NCDs is growing in low and middle-income countries, disproportionally affecting those individuals who are poor and as a result increasing inequalities. Individuals who reside in low and middle-income countries live in settings where legislations, regulations and policies to tack on NCDs either do not exist or are inadequate. Beaglehole et al listed five priority interventions aimed at preventing NCDs. The five priority interventions; tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies were chosen for their cost effectiveness, health effectiveness, political and financial feasibility and low cost of implementation.
Tobacco control:
Tobacco control would prevent 5. million deaths over 10 years in 23 low and middle-income countries with the burden of NCDs. Having total tobacco control would have instant economic and health benefits as it would not only reduce the exposure of tobacco smoke (both directly and secondary) it would also diminish the burden of cardiovascular disease within 1 year and as a result, health expenditures.
Salt reduction:
Reducing ones salt intake would lead to lower blood pressure- one of the main risk factors for heart disease and stroke. A reduction of salt in one's diet would prevent up to 8. million deaths across 10 years. Not only would a reduction in salt diminish the risk of NCDs, in the long run, it would have a greater effect as it would diminish the age-associated blood pressure rise in low and middle-income countries.
Promotion of healthy diets and physical activity:
Promoting healthy diets and physical activity can lead to extensive health gains, including prevention of cardiovascular disease, obesity and some cancers. The promotion of healthy diets and physical activity would pay for themselves as they would eventually reduce the cost of health-care in the future.
Reduction of harmful alcohol consumption &Access to essential drugs and technologies:
Policies that affect the availability, price and promotion of alcohol minimise alcohol-related harms. Along with worldwide access to affordable and good-quality drugs for NCDs is an important issue for all countries in particular low and middle-income countries. An incorporated approach is needed for reduction and access to reduce inequalities.
Prevention is needed to reduce the burden of NCDs, and to protect future generations by providing an environment that encourages and supports people to maintain a healthy lifestyle and to continue to make the healthier choices. Preventative interventions ranging from; market intervention, policy changes and regulation are of highest priority especially once a new NCDs develops as the hindrance on health systems is ample. A program aimed at preventing NCDs for a low-middle-income country, based on cost-effectiveness, broadest population reach and has potential for simple implementation is the one directed at the tobacco control, salt reduction and low-cost generic drug interventions. These three interventions, if broadly implemented, would prevent 23 million deaths over 10 years in 23 low and middle-income countries which have the burden of NCDs. The program can be applied in a step-wise manner. Firstly, all low/middle-income countries should implement total tobacco control, and provide services which are simple for the cessation for all smokers. The second step involves programmes to promote physical activity and healthy diets which contain a reduced salt level and alcohol intake. Lastly, the third step entails a full range of cost-effective health-systems and multisectoral interventions. This programme, not only has the potential to advance NCD treatment and prevention quickly but will ensure an integrated response to all priority diseases.
There is no shortage of knowledge, therefore tackling problems such as NCDs in low/middle-income countries should not be of an issue for many. Dietary changes, for example: reduced consumption of salt in diets and an increase in vegetables and fruits; increased physical activity; cessation of smoking and the reduction of harmful alcohol consumption (possibly by an increase in tobacco and alcohol taxes, and through communication campaigns, information and education on the misconceptions); and altering medical training to adhere to the changing nature of diseases are all possibilities to which one can try to avert/minimise the effects of NCDs. To make the above achievable, it would be helpful to have a wide range of resources (i.e. stakeholders/investors) which could contribute towards the goals by either through donations or through the media so other organisations and countries are aware of what is going on around the world. New technologies to treat, diagnose and prevent NCDs can be developed. The marketing of healthy products and making the current foods healthier products would also go far. Given that the resources for health in low and middle-income countries are inadequate, priorities along with everything else must also be set. For many that will mean taking into consideration the real picture of the current burden of NCDs and acting on them fast. The reality is one needs to realise that the current projected numbers of deaths which are occurring aren't going to diminish or get any better if nothing is done.
References
- Abegunde et al. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 2007; 370: 1929-38.
- Beaglehole R, Bonita R, Alleyne G, et al for The Lancet NCD Action Group. UN High-Level Meeting on Non-Communicable Diseases: addressing four questions. Lancet 2011 DOI:10. 016/S0140- 6736(11)60879-9.
- Beaglehole R, Bonita R, Horton et al for The Lancet NCD Action Group and the NCD Alliance. Priority actions for the non-communicable disease crisis. Lancet 2011 ; 377: 1438-1447.
- Strong K, P Mathers C, Leeder S et al. Preventing chronic diseases: how many lives can we save? Lancet 2005; 366: 1578 -1582.
- WHO. Preventing chronic diseases: a vital investment. Geneva: WHO; 2005 http://www.who.int/chp/chronic_disease_report/full_report.pdf
