Noncommunicable Diseases
Noncommunicable
diseases (NCDs) are the leading cause of death worldwide in low, middle, and
high income countries (http://www.economist.com/node/21556393).
NCDs include cardiovascular disease, diabetes, cancer, and mental disorders. As
a result of social detriments of health and globalization, present and future
rates of NCDs are on the rise which poses concerns for global health,
healthcare workers, and challenges for health care systems—particularly
surrounding costs and financing. To combat the growing concern on NCDs, WHO (http://www.who.int/mediacentre/factsheets/fs355/en/)
has
begun Global Action Plan (http://www.who.int/gho/ncd/en/index.html)
which offers nine specific target goals to prevent, reduce, and address response
to NCDs—these targets focus on controllable elements such as diet, limiting
alcohol and tobacco use, and increasing physical activity as well as additional
elements such as coverage of health care services, and reducing premature
mortality.
With the current shift in awareness
towards NCDs, The NCD Alliance (http://ncdalliance.org/) states: “The
omission of NCD indicators in the MDGs has been a barrier to securing donor
funding for NCDs”. Additionally, GBCHealth (http://www.gbchealth.org/)
a coalition whose stated mission is: “to leverage the power and resources of
the business community for positive impact on global health challenges”, is
working with partner organizations to address the stated target of a 25 percent
reduction in premature mortality from non-communicable diseases by 2025. The
partner organization, Medtronic Philanthropy (http://www.gbchealth.org/news-article/778-medtronic_philanthropy_seeks_global_partners_to_combat_non-communicable_diseases/),
is seeking a five year initiative increasing access to care for chronic disease,
with a focus in cardiovascular disease and diabetes. Other organizations rising
to challenge, are ones such as NCD Free, (http://ncdfree.org/)
a self-stated global social movement against NCDs, comprised of a core group of
young professionals, backed by supporting and partner organizations from around
the globe. Through global events, advocacy films, on the ground community work,
and more, NCD Free is bringing non-communicable disease education and advocacy
into the spotlight.
In Zambia, for example,
MkondoLungu, Deputy Speaker of the National Assembly, urged both corporate and
private sectors to join the government’s efforts to fight cardiovascular
disease, “the highest silent killer in Zambia.” (http://allafrica.com/stories/201311140463.html)
According to WHO (http://www.who.int/en/),
33% of total mortality rates in Kenya in 2007 were due to NCDs. In response to
their problem, Kenya created a National Strategic Plan on NCDs, (http://www.times-publications.com/non-communicable.htm) in which “the Ministry of Health has already achieved
much, including: setting up legislative and legal frameworks; developing policy
guidelines; and developing clinical and training guidelines.” During a Non-Communicable
Disease Synergies Network (http://www.ghdonline.org/ncd-synergies-kigali2013/) conference held last July, Kenya was among the
countries pointed out for effectively addressing this global epidemic. Niger
has also created a National Strategic Plan to prevent and control NCDs by “strengthening
the control of NCDs; strengthening governance and leadership in the prevention
and control of NCDs; developing mechanisms for financing NCDs control, and
promoting research on NCDs.”
Despite the current efforts in building awareness and working
to combat the prevalence of NCDs, social determinants of health remain a huge
factor impacting the prevalence of NCDs. Both NCD risk factors and mortality
from NCDs are higher in low and middle income countries—within countries people
are affected by NCDs disproportionately along the social gradient. In addition,
low and middle income countries are unlikely to have the economic ability to
meet the double health, economic, and social burdens of CDs and NCDs (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2960063-X/fulltext).
Low-income people are disproportionately exposed to NCD risk
factors of excessive tobacco and alcohol consumption, lack of access to
nutritious foods, insufficient physical activity, all of which lead to raised
blood pressure, overweight/obesity, hyperglycemia, and hyperlipidemia. In addition
to these risk factors, people in low-income countries face added risks,
“including use of biomass fuels and coal for cooking and heating, which are
risk factors for chronic obstructive pulmonary disease and lung cancer; fetal
and early childhood under-nutrition,” these are also linked to cardiovascular
and metabolic diseases in the adult years of life along with “infections that
can lead to rheumatic heart disease, cardiomyopathy, heart failure, and cancers
of the cervix, liver, stomach, and other sites.” (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961851-0/fulltext).
As the epidemiological shift from communicable
diseases (CDs) to NCDs occurs, the global health community will have to augment
their focus on prevention and care to include long-term treatment in order to
adequately address the double-burden of CDs and NCDs. As we know, upstream
factors such as public policies are dominant forces that influence health
outcomes. Forming public policies that ensure access to healthy home
environments, work environments, community environments, foods, and
high-quality healthcare are essential to decreasing the prevalence and impacts
of CDs and NCDs. Throughout history we have seen that once countries become
more developed they go through a period known as the epidemiologic transition.
This transition can be described as the changing patterns of population age
distributions, mortality, fertility, life expectancy, and causes of death (http://ajl.sagepub.com/content/3/1_suppl/19S.full.pdf+html).
This is saying that with the advancement of medicine people are now living
longer than ever before—with longevity comes the problem of having to treat
chronic diseases.
Countries such as the
US and Canada completed this transition in the 1950’s and countries such as
Brazil, Columbia and Costa Rica have been going through this transition since
the 1980’s and 1990’s (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961343-4/fulltext)
One of the issues this transition brings with it is the increasing cost that
caring for these diseases will bring on our economy . A 2011 study published by
The Harvard University Public Health Department estimated the total economic
cost of NCDs from the year 2011-2030 could reach a staggering $47 trillion (http://www.weforum.org/EconomicsOfNCD).
This will affect everyone and not only the low-middle income countries (see
table1). One thing I would like to point out is that these figures are
estimates and not definite; we can do many things to address these issues, some
of which are already in place, such as building awareness, collaborative global
efforts, and providing education on steps individuals can make to improve their
health such as the importance of nutrition.
Country
income group
|
Diabetes
|
Cardiovascular
diseases
|
Chronic
Respiratory diseases
|
Cancer
|
Mental
Illness*
|
Total
|
High
|
0.9
|
8.5
|
1.6
|
5.4
|
9.0
|
25.5
|
Upper-middle
|
0.6
|
4.8
|
2.2
|
2.3
|
5.1
|
14.9
|
Lower-middle
|
0.2
|
2.0
|
0.9
|
0.5
|
1.9
|
5.5
|
Low
|
0.0
|
0.3
|
0.1
|
0.1
|
0.3
|
0.9
|
LMIC
|
0.8
|
7.1
|
3.2
|
2.9
|
7.3
|
21.3
|
World
|
1.7
|
15.6
|
4.8
|
8.3
|
16.3
|
46.7
|
Table
1.
The
anticipated economic burden of NCDs, 2011-2030 (trillions of US$ 2010)1
Connections between the cause of chronic
diseases and nutrition are well-supported http://www.mcspotlight.org/media/reports/who_rep.html.
What have become known as the ‘Big-4’ (http://www.ncdchild.org/NCDs/Specific-NCDs)
of the non-communicable disease list - Cardiovascular Diseases, Cancers,
Diabetes, and Chronic Lung Diseases-have all been linked
(http://ajcn.nutrition.org/content/84/2/289.long)
to the increasingly poor food system. As a result of this, the Big-4 are now
coined nutrition-related non-communicable diseases (NR-NCDs). “The magnitude of
the impact of diet on disease risk and the potential for prevention have been
highlighted by recent studies” (http://www.cpc.unc.edu/projects/nutrans/research/bellagio/papers/PHNPekkaFinland.pdf). As
the drive for, and evolution into, the globalization of our world is becoming
more and more realized, it has become all too obvious that changes in diet and
nutrition are major factors in the global disease transition from communicable
to non-communicable.
The NR-NCDs were at one time
referred to as diseases of the affluent; however, over the last couple decades
this has ceased to be true. NR-NCDs are no longer considered diseases of the
affluent in higher-income countries, and are increasingly growing in lower- and
middle-income countries. Along with the spread of development and globalization
populations are enticed and in some cases forced from their traditional food
cultivation, preparation, and cuisine to a “diet that is high in saturated fat,
sugar and refined foods and low in fiber” (http://www.cpc.unc.edu/projects/nutrans/publications/PHNPopkinOverview.pdf).
This diet is also known as the Western diet (http://ajcn.nutrition.org/content/).
A diet that is tied to the land of dreams fulfilled and all things thought to
be achievable, but with the price tag of cardiovascular diseases, cancers,
diabetes, and chronic lung diseases.
In conclusion, there are many elements in play that are
aiding in the rise and prevalence of NCDs such as social detriments of health,
nutrition, epidemiologic transition, a lack of access to health care services,
and cost. Currently, NCDs kill more than 36 million people a year with a
concentration of 80% of NCDs in low and middle income countries (http://www.who.int/mediacentre/factsheets/fs355/en/). Additionally,
these rates are expected to increase in the next 10-20 years. While there are
links to the causes of NCDs the causes of the causes are preventable and
avoidable. The efforts that are in place focus greatly on the causes but unless
the entirety of the issue is addresses which includes acknowledging the causes
of the causes and making changes to these global health will continue to be
greatly influenced by NCDs.
-Team
Get It:
Leslie Simonetti, Alexandra Stabenow, Jenny Molesworth, Sarah Stanford, Evan
Mitchell, Brittany Shoemaker
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