Diseases and Conditions

The underlying Mechanisms of preventable Conditions and Diseases

Noncommunicable diseases (NCDs), also known as chronic diseases or lifestyle-related diseases (LRDs), are not passed from person to person. They are of long duration and generally slow progression. The four main types of noncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes.

NCDs already disproportionately affect low- and middle-income countries where nearly 80% of NCD deaths – 29 million – occur. They are the leading causes of death in all regions except Africa, but current projections indicate that by 2020 the largest increases in NCD deaths will occur in Africa. In African nations deaths from, NCDs are projected to exceed the combined deaths of communicable and nutritional diseases and maternal and perinatal deaths as the most common causes of death by 2030.

MISCONCEPTIONS ABOUT CHRONIC DISEASES AND THE REALITY

Several errors have led to not worry about lifestyle diseases. The idea that they are a distant threat and are less important and serious than some infectious diseases can be dispelled by a body of evidence. Several misconceptions and half-truths are the most common in the report with the stories of people affected by chronic disease.

Fact: Chronic diseases are the leading cause of death

Fact: Risk factors are widespread: 1 billion people are overweight

WHO IS AT RISK OF SUCH DISEASES?

All age groups and all regions are affected by NCDs. NCDs are often associated with older age groups, but evidence shows that more than 9 million of all deaths attributed to noncommunicable diseases (NCDs) occur before the age of 60. Of these “premature” deaths, 90% occurred in low- and middle-income countries. Children, adults and the elderly are all vulnerable to the risk factors that contribute to noncommunicable diseases, whether from unhealthy diets, physical inactivity, exposure to tobacco smoke or the effects of the harmful use of alcohol.

These diseases are driven by forces that include ageing, rapid unplanned urbanization, and the globalization of unhealthy lifestyles. For example, globalization of unhealthy lifestyles like unhealthy diets may show up in individuals as raised blood pressure, increased blood glucose, elevated blood lipids, overweight and obesity. These are called ‘intermediate risk factors’ which can lead to cardiovascular disease, a NCD.

PATHOPHYSIOLOGY

These behaviours lead to four key metabolic/physiological changes that increase the risk of NCDs:
– raised blood pressure
– overweight/obesity
– hyperglycemia (high blood glucose levels)
– hyperlipidemia (high levels of fat in the blood).

In terms of attributable deaths, the leading NCD risk factor globally is elevated blood pressure (to which 16.5% of global deaths are attributed) (1) followed by tobacco use (9%), raised blood glucose (6%), physical inactivity (6%) and overweight and obesity (5%). Low- and middle-income countries are witnessing the fastest rise in overweight young children.

SOCIO-ECONOMIC IMPACT

NCDs threaten progress towards the UN Millennium Development Goals. Poverty is closely linked with NCDs. The rapid rise in NCDs is predicted to impede poverty reduction initiatives in low-income countries, particularly by forcing up 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 food, and have limited access to health services.

In low-resource settings, health-care costs for cardiovascular diseases, cancers, diabetes or chronic lung diseases can quickly drain household resources, driving families into poverty. The exorbitant costs of NCDs, including often lengthy and expensive treatment and loss of breadwinners, are forcing millions of people into poverty annually, stifling development.

In many countries, harmful drinking and unhealthy diet and lifestyles occur both in higher and lower income groups. However, high-income groups can access services and products that protect them from the greatest risks while lower-income groups can often not afford such products and services.

POTENTIAL FOR PREVENTION

To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed that requires all sectors, including health, finance, foreign affairs, education, agriculture, planning and others, to work together to reduce the risks associated with NCDs, as well as promote the interventions to prevent and control them.

An important way to reduce NCDs is to focus on lessening the risk factors associated with these diseases. Low-cost solutions exist to reduce the common modifiable risk factors (mainly tobacco use, unhealthy diet and physical inactivity, and the harmful use of alcohol) and map the epidemic of NCDs and their risk factors (1).

Other ways to reduce NCDs are high impact essential NCD interventions that can be delivered through a primary health-care approach to strengthen early detection and timely treatment. Evidence shows that such interventions are excellent economic investments because, if applied to patients early, can reduce the need for more expensive treatment. These measures can be implemented in various resource levels. The greatest impact can be achieved by creating healthy public policies that promote NCD prevention and control and reorienting health systems to address the needs of people with such diseases.

Lower-income countries generally have lower capacity for the prevention and control of noncommunicable diseases.

High-income countries are nearly four times more likely to have NCD services covered by health insurance than low-income countries. Countries with inadequate health insurance coverage are unlikely to provide universal access to essential NCD interventions.

REFERENCES AND CONTINUED READING

  • Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012; 380(9859):2224-2260.
  • World Health Organization (WHO). Global status report on noncommunicable disease 2010. Available at http://www.who.int/nmh/publications/ncd_report_full_en.pdf.
  • Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine 2006; 3: e442.
  • Kvaavik E, Batty GD, Ursin G et al. Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey. Arch Intern Med 2010; 170: 711–718.
  • Rosengren A, Hawken S, Öunpuu S, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 953-962.
  • Boffetta P, Couto E, Wichmann J et al. Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst 2010;s 102(8): 529–537
  • Parkin DM, Boyd L, Walker LC. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer 105: S77-S81.
  • Danaei G, Vander Hoorn S, Lopez AD et al. Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet 2005; 366: 1784–1793.