Non communicable diseases (NCDs), also known as chronic diseases, are not passed from person to person. They are of long duration and generally slow progression. The 4 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 three quarters of NCD deaths – 28 million – occur.
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 16 million of all deaths attributed to noncommunicable diseases (NCDs) occur before the age of 70. Of these "premature" deaths, 82% 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, and obesity. These are called 'intermediate risk factors' which can lead to cardiovascular disease, a NCD.
Risk factors
Modifiable behavioural risk factors
Tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol increase the risk of NCDs.
- Tobacco accounts for around 6 million deaths every year (including from the effects of exposure to second-hand smoke), and is projected to increase to 8 million by 2030.
- About 3.2 million deaths annually can be attributed to insufficient physical activity. (1)
- More than half of the 3.3 million annual deaths from harmful drinking are from NCDs 1.
- In 2010, 1.7 million annual deaths from cardiovascular causes have been attributed to excess salt/sodium intake.(2)
Metabolic/physiological risk factors
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) and 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 18% of global deaths are attributed) (1) followed by overweight and obesity and raised blood glucose. Low- and middle-income countries are witnessing the fastest rise in overweight young children.
What are the socioeconomic impacts of NCDs?
NCDs threaten progress towards the UN Millennium Development Goals and post-2015 development agenda. 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 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.
Prevention and control of NCDs
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.
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 4 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.
WHO response
Under the leadership of the WHO more than 190 countries agreed in 2011 on global mechanisms to reduce the avoidable NCD burden including a Global action plan for the prevention and control of NCDs 2013-2020. This plan aims to reduce the number of premature deaths from NCDs by 25% by 2025 through nine voluntary global targets. The nine targets focus in part by addressing factors such as tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity that increase people's risk of developing these diseases.
The plan offers a menu of “best buy” or cost-effective, high-impact interventions for meeting the nine voluntary global targets such as banning all forms of tobacco and alcohol advertising, replacing trans fats with polyunsaturated fats, promoting and protecting breastfeeding, and preventing cervical cancer through screening.
In 2015, countries will begin to set national targets and measure progress on the 2010 baselines reported in the Global status report on noncommunicable diseases 2014. The UN General Assembly will convene a third high-level meeting on NCDs in 2018 to take stock of national progress in attaining the voluntary global targets by 2025.
Footnotes
References
(1) 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.
(2) Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, Lim S et al.; Global Burden of Diseases Nutrition and Chronic Diseases Expert Group. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014;371(7):624−34. doi:10.1056/NEJMoa1304127.
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