PH-12

Global Non-Communicable Diseases (NCDs) _______________________________________________

Introduction

In Module IV we studied communicable diseases, the different types and their causes and distribution globally. In this Module, we will explore non-communicable diseases (NCDs). These are diseases of long duration and generally slow progression. NCDs are classified into four main types: cardiovascular diseases (like heart attacks and stroke), cancer, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes. As we will learn in this module, these diseases are now diseases of the world, affecting everyone from the rich of New York or Los Angeles to the poor of rural Sudan, India or Zimbabwe. Actually, according to WHO, NCDs, are by far the leading cause of death in the world. It is estimated that more than 36 million people die annually from NCDs (63% of about 57 million global deaths), including more than 14 million people who die too young between the ages of 30 and 70. As with CDs, low- and middle-income countries are worst hit - bearing 86% of the burden of these premature deaths, resulting in millions of people trapped in poverty and estimated cumulative economic losses of US$7 trillion by 2030.

NCDs have many risk factors. Four modifiable risk behaviors are key: tobacco use, harmful use of alcohol, physical inactivity and unhealthy diet. These risk behaviors are prevalent worldwide and increasingly common in LMICs. Tobacco use alone kills more than 6 million people each year, accounting for one in six deaths from NCDs. Biological risk factors, such as raised blood pressure and overweight and obesity, arise in part from the four major risk behaviors and also contribute to the global NCD epidemic. These four diseases share the common risk factors of tobacco use, unhealthy diets, physical inactivity, and harmful use of alcohol, as well as high blood pressure and cholesterol.

At the end of this Module you should be able to articulate the following:

Critical Skills

1. Explain what the main types of NCDs are.

2. Describe the risk factors, trend and distribution of NCDs globally.

3. Acknowledge the disease burden associated with NCDSs.

4. Describe interventions implemented to address NCDs.

5. Be familiar with at least two development organizations/NGOs working to address NCDs.

WHY WORRY ABOUT NCDs?

Burden of NCDs

Global health is facing a dramatic change. For the first time in human history, more people live in urban than rural areas. This shift is accompanied by a big change in lifestyle – generally speaking from an active, farm based rural lifestyle to a more sedentary lifestyle. Because of this and other factors such as globalization and trade liberalization, more people are overweight than underweight around the world. Lack of physical activity and unhealthy lifestyle provide fertile breeding ground for some of the NCDs. Today, NCDs such as heart disease and stroke, cancer, diabetes, and chronic lung disease are the world’s leading forms of preventable illness, disability and mortality - killing more people globally than infectious diseases.

Five of the top six specific causes of death worldwide were NCDs. NCDs were responsible for 54 percent of disability-adjusted life years (DALYs) globally in 2010. By comparison, the next highest contributor — communicable, maternal, neonatal and nutritional disorders — was responsible for 35 percent of DALYs. The contribution of NCDs to disease burden has grown since 1990, when communicable diseases were the leading cause of DALYs. At the time, communicable diseases accounted for 47 percent of total DALYs while NCDs accounted for 43 percent. NCD epidemics are a global challenge. While they are often misconstrued as a problem of high-income countries, they place an equal — or even greater — burden on low and middle-income countries (LMICs). LMICs account for approximately 86 percent of all NCD deaths, and 90 percent of NCD deaths before the age of 60. These countries have a lower capacity to respond and tend to face a double burden of increasing NCD prevalence on top of high rates of infectious diseases — mainly HIV, tuberculosis (TB) and malaria. Future projections suggest an even greater NCD burden. The World Health Organization (WHO) estimates that by 2020 NCD-attributable deaths will have increased by 15 percent globally, with an increase of over 20 percent anticipated in the WHO regions of Africa, South-East Asia and the Eastern Mediterranean. By 2030, NCDs are expected to be the major cause of death in all regions, including Africa, and to kill 52 million people per year, nearly five times more than communicable diseases. Also by 2030, the proportion of DALYs attributed to NCDs in LMICs is projected to reach 45 percent, up from 33 percent in 2002.

NCDs impose several interrelated social and economic costs. Lost productivity due to illness, disability or death from NCDs can impede macroeconomic growth and shift public budgets from other important health and development objectives. Likewise, NCDs place an enormous and growing burden on health systems. Households face social and economic costs. NCDs — and poor health generally — can exacerbate poverty and insecurity, with the burden of care often falling on women and girls. These costs, together, affect progress on each of the Millennium Development Goals (MDGs).

The global burden and threat of NCDs constitutes a major public health challenge that undermines social and economic development throughout the world, and inter alia has the effect of increasing inequalities between countries and within populations.

Country-specific macroeconomic costs: China, India and the Russian Federation will forego on average US$23–53 billion in national income between 2005 and 2015 due to mortality from heart disease, stroke and diabetes. A 2011 World Bank study found that chronic conditions have depressed Egypt’s labor supply nearly one fifth below its potential. As a result, GDP is estimated to be 12 percent below its potential. In Namibia, a study of over 7000 workers from 2009–10 concluded that the greatest cause of absenteeism from the workplace was high blood glucose and diabetes. Health-sector costs in the country had already been rapidly escalating due to HIV.

What is being done?

In an effort to curb the burden of tobacco use, WHO in its WHO MPOWER package identified six actions that have now been proven to decrease smoking and save lives. These actions attempt to change conditions of daily life to promote physical activity and limit the production, advertising and consumption of tobacco, alcohol and unhealthy foods. Examples include taxes on tobacco and alcohol products, restrictions on ‘junk food’ advertising to children, the provision of smoke-free areas and limits on trans-fats.

They include:

Monitoring tobacco use and prevention policies; Protecting people from tobacco smoke; Offering help to quit tobacco use; Warning about the dangers of tobacco; Enforcing bans on tobacco advertising, promotion, and sponsorship; and Raising taxes on tobacco.