NCDs, also known as chronic diseases, are not passed from person to person. They are of long duration and generally progress slowly. The four main types of NCDs are cardiovascular diseases (myocardial infarction, stroke), cancers, chronic respiratory diseases (chronic obstructive pulmonary disease, asthma) and diabetes. Let’s bring this back home. For example, in my extended family alone, we have cases of hypertension and diabetes and I am sure that the same goes for a lot of families globally. I am quite certain that in most homes there are family members suffering from at least one of these NCDs, thus, the need to increase awareness about this topic. It should be noted that NCDs disproportionately affect people in low- and middle-income countries where more than three quarters of global NCD deaths (31 million deaths) occur. So the next question is, who should we be focusing on if we are attempting to emphasize the importance of NCDs? Who is at risk? The answer is quite simple…everyone is at risk of NCDs.
No one is left out and no one is immune. People of all age groups, regions and countries are affected by NCDs. These conditions are often associated with older age groups but evidence shows that 15 million of all deaths attributed to NCDs, occur between the ages of 30 and 69 years. Of these “premature” deaths, over 80% are estimated to occur in low- and middle-income countries. Children, adults and the elderly are all vulnerable to the risk factors associated with NCDs, whether from unhealthy diets, physical inactivity, exposure to tobacco smoke or the harmful use of alcohol.
These diseases are driven by forces that include rapid, unplanned urbanization, the globalization of unhealthy lifestyles and population ageing. Unhealthy diets and a lack of physical activity may present as raised blood pressure, increased blood glucose levels, elevated blood lipids and obesity. These are called metabolic risk factors that can lead to cardiovascular disease, the leading NCD in terms of premature deaths.
Just as we are taught in school with other diseases about modifiable and non-modifiable risk factors, the same applies here. We need to know how instrumental we are to our own health. How we can either wield the sword that strikes us or the shield that protects us.
Modifiable behavioural risk factors
Modifiable behaviours, such as tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol, all increase the risk of NCDs.T obacco accounts for 7.2 million deaths every year (including the effects of exposure to second-hand smoke). This figure is projected to increase markedly over the coming years. (1) Almost 4.1 million annual deaths have been attributed to excess salt/sodium intake. (1) More than half of the 3.3 million annual deaths attributable to alcohol use are from NCDs, including cancer. (2) Another 1.6 million deaths annually can be attributed to insufficient physical activity.
Metabolic risk factors
Metabolic risk factors contribute to four key metabolic changes that increase the risk of NCDs:
- raised blood pressure
- hyperglycemia (high blood glucose levels)
- hyperlipidemia (high levels of fat in the blood)
In terms of attributable deaths, the leading metabolic risk factor globally, is elevated blood pressure to which 19% of global deaths are attributed). (1) This is followed by obesity and raised blood glucose. So if it is important to us as individuals, what is the impact of NCDs on our societies? And why should various partners in health be dedicated to this cause? What are the socioeconomic impacts of NCDs? NCDs threaten progress towards the 2030 Agenda for Sustainable Development, which includes a target to reduce premature deaths from NCDs by one-third by 2030.Poverty is closely linked with NCDs. The rapid rise in NCDs is predicted to impede poverty reduction initiatives in low-income countries, particularly by increasing household costs associated with health care. Vulnerable and socially disadvantaged people get sicker and die sooner than people of higher social positions, especially because they are at greater risk of being exposed to harmful products, such as tobacco, or unhealthy dietary practices, and have limited access to health services. In low-resource settings, health-care costs for NCDs quickly drain household resources. The exorbitant costs of NCDs, including often lengthy and expensive treatment and loss of breadwinners, force millions of people into poverty annually and stifle development. Thus, if this is the reality we live in, how can we then be instrumental in the preservation of our lives?
Prevention and control of NCDs
An important way to control NCDs is to focus on reducing the risk factors associated with these diseases. Low-cost solutions exist for governments and other stakeholders to reduce the common modifiable risk factors. Monitoring progress and trends of NCDs and their risk is important for guiding policy and priorities. To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed requiring all sectors, including health, finance, transport, education, agriculture, planning and others, to collaborate to reduce the risks associated with NCDs, and promote interventions to prevent and control them. Investing in better management of NCDs is critical. Management of NCDs includes detecting, screening and treating these diseases, and providing access to palliative care for people in need. High impact essential NCD interventions can be delivered through a primary health care approach to strengthen early detection and timely treatment. Evidence shows such interventions are excellent economic investments because, if provided early to patients, they can reduce the need for more expensive treatment. Countries with inadequate health insurance coverage are unlikely to provide universal access to essential NCD interventions. NCD management interventions are essential for achieving the global target of a 25% relative reduction in the risk of premature mortality from NCDs by 2025, and the SDG target of a one-third reduction in premature deaths from NCDs by 2030. WHO RESPONSE WHO’s leadership and coordination role. The 2030 Agenda for Sustainable Development recognizes NCDs as a major challenge for sustainable development. As part of the Agenda, Heads of State and Government committed to develop ambitious national responses, by 2030, to reduce by one-third premature mortality from NCDs through prevention and treatment (SDG target 3.4). This target comes from the High-level Meetings of the UN General Assembly on NCDs in 2011 and 2014, which reaffirmed WHO’s leadership and coordination role in promoting and monitoring global action against NCDs. The UN General Assembly will convene a third High-level Meeting on NCDs in 2018 to review progress and forge consensus on the road ahead covering the period 2018-2030.To support countries in their national efforts, WHO developed a Global action plan for the prevention and control of NCDs 2013-2020, which includes nine global targets that have the greatest impact on global NCD mortality. These targets address prevention and management of NCDs.
Urgent government action is needed to meet global targets to reduce the burden of non-communicable diseases (NCDs), and prevent the annual toll of 16 million people dying prematurely – before the age of 70 – from heart and lung diseases, stroke, cancer and diabetes, according to a new WHO report. Just as the adage says, a word to the wise is enough. Thus, I can conclude that my words are more than enough. I do hope that these few words of mine have been able to shed more light on non-communicable diseases. Let us join hands together with our partners in health and work towards reducing the mortality associated with NCDs. This, we can do by increasing awareness on this topic not just in our homes and our families but also in our communities through our noble profession. This way, we can proudly say that we are “friends of the human race” (AMICUS HUMANIS GENERIS).Remember, change always starts with the man in the mirror. Let’s make a change we can be proud of.