Meeting the Challenge of Non-Communicable Diseases Lecture 14

Non-communicable diseases Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide; they account for 60 percent of all deaths globally People living in developing countries are more likely to develop and die prematurely from chronic disease – Have limited access to comprehensive health services for NCDs – Live in countries that do not have effective policies for NCDs (tobacco, alcohol, air pollution, etc.) In addition to their devastating impact on health, NCDs have a major socio-economic impact on individuals, families, communities, and countries There is an urgent need to raise the profile of NCDs on the international development agenda The burden of chronic disease will account for over 75 percent of deaths by 2030

Health Statistics and Informatics Ten leading causes of burden of disease, world, 2004 and 2030

Many of the risk factors associated with NCDs are related to modifiable behaviors

Cardiovascular Diseases The leading cause of death worldwide, accounting for 17 million deaths in 2005 – Of these, 7.2 million were due to heart attacks and 5.7 million due to stroke Include coronary heart disease (heart attacks), cerebrovascular disease, raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease, and heart failure If current trends continue, WHO estimates that 23.6 million people will dies from cardiovascular disease by 2030

Chronic Respiratory Diseases (CRDs) Include asthma, respiratory allergies, chronic obstructive pulmonary disease (COPD), occupational lung diseases, sleep apnea syndrome and pulmonary hypertension Collectively, CRDs account for 4 million deaths per year; COPD is the fourth leading cause of death worldwide Many CRDs are preventable, although they often fail to receive adequate attention from the health care system

Cancers A leading cause of death group worldwide, accounting for 7.4 million deaths in 2004 The global cancer burden has doubled in the past 30 years; by 2020, the cancer burden of 2000 is expected to double again More that 70 percent of cancers occur in low- and middle-income countries The leading type of cancer is lung cancer, accounting for 1.3 million deaths per year In less developed countries, the leading type of cancer for men is lung cancer, followed by liver cancer; the leading type for women is breast cancer followed by cervical cancer

Diabetes Worldwide, over 220 people had diabetes in 2004 Nearly 80 percent of diabetes deaths occur in low- and middle-income countries WHO estimates that diabetes deaths will double between 2005 and 2030 Causes kidney failure, diabetic retinopathy, and diabetic neuropathy; increases the risk of heart disease and stroke 43 million pre-school children worldwide are obese or overweight

60 per cent of the world’s total deaths are due to non- communicable diseases, many of which are preventable

90 per cent of people dying prematurely from NCDs live in developing countries

NCDs are among the top ten causes of causes of death in every income group

Without action, Africa will witness the largest increase in deaths from NCDs in 2015 (compared to 2004). South East Asia and the Western Pacific will have the highest absolute number of deaths.

Factors that contribute to the rise of NCDs Rapid urbanization has led to changes in diet, physical activity, and environmental exposure Decreases in the price of animal based products, sweeteners, and oils over the past two decades have contributed to dietary changes Increasing availability of tobacco products as a result of expanding markets and lack of protective trade policies Lack of knowledge about chronic disease and poor understanding of contributing risk factors Shifting patterns of behavior due to globalization and increased media exposure/marketing

Economic impact of NCDs NCDs reduce the economic productivity of individuals and cause many families to fall into poverty – The long-term nature of treatment and care for chronic disease results in significant household expenditures over prolonged periods of time and inability of the household to accumulate savings – Indian households that include a family member with a chronic disease are 40 percent more likely to fall into poverty The expense of treatment often deters individuals from seeking treatment – In Nigeria, over 60 percent of cancer patients failed to complete their chemotherapy treatments because of the prohibitive cost of the drugs NCDs also have a severe impact on the economies of countries – Over the next decade, China is estimated to lose over $550 billion in national income due to cardiovascular disease – In Central Asia, chronic diseases may reduce workers’ labor effort by 7 to 30 percent

Common myths that surround NCDs – that people knowingly choose to engage in unhealthy behaviors (smoking, drinking, diet), or that chronic diseases related to aging are inevitable – may be detrimental to collective action Policies that aim to regulate individual behavior (taxes on soft drinks, cigarettes) may be seen as impinging on individual agency Weak health information systems prevent adequate surveillance of chronic disease in many developing countries; without data, it is difficult to argue for the prioritization of NCDs based on the burden of disease Although international advocacy for NCDs is growing, greater efforts are needed on the local level to raise the profile of NCDs on national agendas Another myth around NCDs is that low- and middle-income countries should give priority to infectious diseases. However, this approach does not align with the burden of disease in these countries. Why have NCDs been neglected?