Non Communicable Diseases Essay Paper

Every year more than 36 million people die, due to non communicable diseases (NCDs) out of this, 80% deaths-29 million reported only in low and middle income countries (WHO, 2013a).Global burden of NCDs was 43% in year 1999 which is estimated to increase up to 60% and supposed to be responsible for 70% of global deaths by the year 2020 (WHO, 2013b). Diabetes is one of the NCD which is negatively affecting the quality of life and increasing per capita health expenditure. In diabetes, body does not have capacity to produce insulin hormone which is required for a cell to utilize glucose and use it as energy. Globally, about 382 million people are currently suffering from diabetes in age group of 40-59 years, which is estimated to increase by 55 % in year 2035 i.e. 592 million (IDF Diabetes Atlas, 2013) and 80% of cases reported in low-middle income countries. In year 2013, 5.1 million deaths are only attributed to diabetes. i. e. one person losing his life every 6 second by diabetes (IDF Diabetes atlas, 2013). Few decades back diabetes was called ‘disease of wealthy’ but now the scenario is changing, it is not any more a disease of affluent. Purpose of this study is to explore illness perception of diabetes & to know about health seeking practices in urban slums. Non Communicable Diseases Essay Paper
A study by Hussain, Rahim, Khan, Ali & Vaaler in Bangladesh describes that due to urbanization and migration, there is an increase in number of slum dwelling in the vicinity of cities. These people are exposed to many risk factors which can be responsible for NCDs like diabetes (2005). Diabetes mellitus is caused by the effect of obesity, intake of high calorie food and less physical activity. (Auchincloss, 2009).Adler & Newman stated that low socio economic conditions are associated with sedentary life style & less fiber consumption which can lead to diabetes. Slum dweller often have limited opportunity of education so it limits their knowledge about risk (2001).Besides this, stress is also an important factor which can serve as a risk factor, although it affects all classes but lower socio economic people have more stressful life. Some of the factors can indirectly increase the stress like crowding and noise exposure, low control at work, and social isolation which in turn affects health (Adler & Newman, 2001).
Schulz et. al has shown model of health determinant in which he has shown correlation of above mentioned factors is ultimately responsible for causing diabetes.

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Hjelm & Atwine stated in their study about illness perception of diabetes that, general weakness, fall down, collapse, vaginal itching, dizziness, dry tongue, severe thirst, high blood pressure, joints pains, dysfunctional sex were described by participants as a reason of health seeking. They also found people stating the influence of natural and supernatural forces causing DM (2011). Participant are also asked to tell from where they sought health care and they mentioned to sought care from, professional sector doctors or nurses in the hospital, private for profit clinic, pharmacy, self-care measures. In case health care sector fails to relieve their symptoms, they were also seeking care of folk healer like Chinese medicine or herbal medicine. Few participants also visited traditional healer & spiritual healers (Hjelm & Atwine, 2011). Researchers attribute complications and high mortality to poor medical management and harmful self care practices, including use of ethno-medicine (Kolling, Winkley & Deden, 2010).Non Communicable Diseases Essay Paper

It is found that low income consumers are more likely fail to stick to dietary guidelines. Bhojani, in his study talked about constraints faced by urban poor in accessing health care which are financial hardship, compromised care, dependency of woman on other family members for buying medicine, family structure, inter-generational conflict, provider’s attitude, patients consciousness about their economic condition & difficult access to health care system (2013).

Non-communicable diseases (NCDs, e.g., cardiovascular disease, diabetes, cancers, chronic respiratory diseases, neurological diseases) have been the commonest cause of death and disability globally for at least the last three decades [1]. Even in sub-Saharan Africa, NCDs contribute a third of the disability-adjusted life year burden. However, research resources allocated to NCDs in low- and middle-income countries (LMICs) are trivial [2].

We analyse the interplay between applied health research in NCDs in high-income (HICs) and LMICs and demonstrate that there are opportunities for mutual advantages. We argue that different NCDs are at varying stages in a cycle of research, policy development, and action. The research and actions that are needed depend on the stages of this cycle.

The Interplay between Research in HICs and LMICs

There is abundant information on the prevention and control of major NCDs from HICs, but little attention has been given to how research in LMICs can benefit HICs. Box 1 illustrates some of the forces arising in HICs, which are now having global impacts on NCDs. Research methods developed in HICs to study these forces are equally applicable to LMICs. In this section we explore this interplay.Non Communicable Diseases Essay Paper

There are global benefits from repeating studies of “established” risk factors in LMICs. The first indication that there is no “safe” level of blood cholesterol came from research in China showing increased rates of coronary heart disease (CHD) even at low levels of blood cholesterol [3]. This finding spurred trials of statins among people with average cholesterol levels, leading to their widespread use regardless of blood cholesterol level for high risk individuals in HICs and LMICs [4].

In 2011 a WHO study revealed that noncommunicable diseases were the leading cause of death worldwide. In 2008, 36.1 million people died from conditions such as heart disease, stroke, chronic lung disease, cancer and diabetes. Nearly 80% of these deaths occurred in low-income and middle-income countries.Infectious disease control was at the top of the agenda during the sixty-third session of the World Health Assembly, which took place in May 2010 in Geneva. With much attention given to progress towards achieving the health-related Millennium Development Goals, polio eradication, the implementation of the International Health Regulations, the regulation of counterfeit drugs, and influenza preparedness, there was little time to discuss one of the largest killers: non-communicable or chronic diseases.
Together, chronic diseases are responsible for about 60 per cent of deaths worldwide. The big four–diabetes, cardiovascular disease, cancer, and chronic respiratory diseases–are caused by three common risk factors: tobacco use, unhealthy diet, and lack of exercise.
Contrary to popular perception, the poor are the worst affected. The All India Institute of Medical Sciences reported that 11 per cent of men and almost 10 per cent of women -living in urban slums in India had diabetes. Similarly, researchers from the Pan American Health Organization found that 47 per cent of women and 44 per cent of men in Peru had hypertension, with the poorest households in the study experiencing the highest burden of the chronic disease. Numerous studies demonstrate the strong link between poverty and chronic diseases.
What money is available to tackle this problem? It is estimated that less than 3 per cent of total donor funding goes to addressing non-communicable diseases, and a Lancet study found that, in 2005, chronic disease funding from the four largest donors in health was estimated at $3 per death annually, compared to $1,030 for HIV/AIDS.Non Communicable Diseases Essay Paper
Research by the Center for Global Development has shown that major donors such as the United States Government, the World Bank, and the United Kingdom Department for International Development have been reluctant to provide grants and loans to tackle non-communicable disease. Why is there such miniscule funding on the table? Perhaps because chronic diseases are not seen as directly linked to poverty or development, but are superficially attributed to affluence and Westernization. Perhaps because these conditions do not evoke the same feelings of empathy and social justice as do the traditional diseases associated with poverty. Perhaps because we put the onus of responsibility on the individual rather than on society, on personal choice rather than socio-economic circumstance.
Since donors are not interested, financing and institution-building will need to come from national governments. Yet it is difficult for national governments to invest in preventing chronic disease. In low-income, aid-dependent countries, governments must orient health strategies towards the Millennium Development Goals (which exclude chronic disease) to receive external funding, which can constitute 50 per cent or more of the health budget. Even self-reliant countries such as Brazil and India sing the same tune. Although both countries are overwhelmed by cardiovascular disease, mental health problems, unintentional injuries, and cancer, there is a tremendous mismatch between government spending priorities and priority needs for the people of these nations.
This is where regional forums in health become central, and can complement global discussion and activities. Recently, the Caribbean Community Secretariat pushed for a UN General Assembly resolution on non-communicable diseases and possibly a UN General Assembly Special Session. This suggests that issues of non-communicable disease might have more salience at the regional level, particularly in the Middle East and the Caribbean, which are being ravaged by these diseases, than at the global level where investment in infectious disease prevention and treatment still dominate.
The recent decision by the UN General Assembly to hold a High-Level Summit involving Heads of State on non-communicable diseases in September 2011 is a major step forward.* The next year presents a huge opportunity to provide compelling evidence to key officials in governments and development agencies that non-communicable diseases are a development concern — a case which helped raise the profile of HIV/AIDS — and to persuade the public that non-communicable diseases are as deserving of financing and attention as infectious diseases.

Nearly three-quarters of all noncommunicable disease (NCD) deaths worldwide take place in low- and middle-income countries, according to the World Health Organization (WHO). These 28 million deaths—from cancers, diabetes, and cardiovascular and respiratory diseases—are related to poverty and lack of detection and treatment. In these countries, inadequate healthcare systems can lead to higher rates of premature deaths as well.

Non-communicable diseases (NCDs) constitute a major global health challenge, hampering nations’ economic growth and sustainable development. The four major groups of NCDs – cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes – account for over 80% of all NCD related deaths and share the same four major risk factors: tobacco use, harmful use of alcohol, unhealthy diets, and physical inactivity. Recently, mental health and environmental determinants were also added to the NCD agenda.Non-communicable diseases represent a major public health problem. Those diseases, mainly cardiovascular diseases, diabetes, cancers and chronic respiratory diseases contribute to the majority of causes of death and constitute a major burden for socio-economic development especially in developing countries like Iraq. Non-communicable diseases are chronic in nature and may not cure, however, existing evidence indicates that these disease are largely preventable by means of effective intervention that tackle their shared contributory risk factors and the underlying social determinants. In addition, early detection and proper management of such diseases can reduce morbidity and premature death and may improve the quality of life. The global response through the last decade was represented by endorsement of the Global Strategy for Prevention and Control of Non-communicable Diseases in addition to a number of mandates as the WHO Framework Convention on Tobacco Control (2003) and the Global Strategy on Diet, Physical Activity and Health (2004). In 2008 the Strategic Action Plan for the Global Strategy for Prevention and Control of NoncommunicableDiseases was endorsed. Finally, the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases was adopted in 2011. Current Situation In Iraq Iraq, like many developing countries is undergoing a transitional epidemiological period with increasing burden of Non communicable diseases and their contributory risk factors. The Ministry of Health statistics indicate that the four major chronic non-communicable diseases cardiovascular diseases, diabetes,cancers and chronic respiratory diseases contribute to around 50% of total mortality. Around 30% of these deaths occur before the age of 60.Non Communicable Diseases Essay Paper

This new collection issue brings together a wide and diverse author group, to focus on key issues and suggest scalable solutions to accelerate the implementation of the high level commitments made in the three UN general assembly meetings. As this collection expands over time, it looks to cover the major issues in prevention and control of NCDs, and to provide a holistic perspective on the current challenges and scope of future action to tackle NCDs and improve health worldwide.

In Kenya, the main risk factors for NCDs are tobacco use, physical inactivity, unhealthy diets, and harmful use of alcohol due to effects of globalization on marketing and trade. Being diagnosed with an NCD often means years of poor health and disability, making NCDs a factor in 30.2 percent of all disability-adjusted life years in Kenya.

In addition, NCDs accounted for 31 percent of deaths in the country in 2015, with 51 percent being considered premature (people under the age of 70 years old). More than half of in-patient admissions and 40 percent of hospital deaths in Kenya are due to NCDs as well, severely compromising health care budgets.

Environmental risk factors are recognised as an important cause of disease burden, but the impact on non-communicable diseases (NCDs) is now being established.123 Household and outdoor air pollution, alongside unhealthy diets, lifestyles, and work environments, were recently included in the global strategy to prevent NCDs Non Communicable Diseases Essay Paper

Chronic non-communicable diseases (NCD) account for almost 60% of global mortality, and 80% of deaths from NCD occur in low- and middle-income countries. One quarter of these deaths–almost 9 million in 2005–are in men and women aged <60 years. Taken together, NCD represent globally the single largest cause of mortality in people of working age, and their incidences in younger adults are substantially higher in the poor countries of the world than in the rich. The major causes of NCD-attributable mortality are cardiovascular disease (30% of total global mortality), cancers (13%), chronic respiratory disease (7%) and diabetes (2%). These conditions share a small number of behavioural risk factors, which include a diet high in saturated fat and low in fresh fruit and vegetables, physical inactivity, tobacco smoking, and alcohol excess. In low- and middle-income countries such risk factors tend to be concentrated in urban areas and their prevalences are increasing as a result of rapid urbanization and the increasing globalisation of the food, tobacco and alcohol industries. Because NCD have a major impact on men and women of working age and their elderly dependents, they result in lost income, lost opportunities for investment, and overall lower levels of economic development. Reductions in the incidences of many NCD and their complications are, however, already possible. Up to 80% of all cases of cardiovascular disease or type-2 diabetes and 40% of all cases of cancer, for example, are probably preventable based on current knowledge. In addition, highly cost-effective measures exist for the prevention of some of the complications of established cardiovascular disease and diabetes. Achieving these gains will require a broad range of integrated, population-based interventions as well as measures focused on the individuals at high risk. At present, the international-assistance community provides scant resources for the control of NCD in poor countries, partly, at least, because NCD continue to be wrongly perceived as predominantly diseases of the better off. As urbanization continues apace and populations age, investment in the prevention and control of NCD in low-and middle-income countries can no longer be ignored.

Noncommunicable diseases and their risk factors

Prevention of noncommunicable diseases

Reducing the major risk factors for noncommunicable diseases (NCDs) – tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol – is the focus of WHO’s work to prevent deaths from NCDs.

NCDs – primarily heart and lung diseases, cancers and diabetes – are the world’s largest killers, with an estimated 38 million deaths annually. Of these deaths, 16 million are premature (under 70 years of age). If we reduce the global impact of risk factors, we can go a long way to reducing the number of deaths worldwide.

Prevention of NCDs is a growing issue: the burden of NCDs falls mainly on developing countries, where 82% of premature deaths from these diseases occur. Tackling the risk factors will therefore not only save lives; it will also provide a huge boost for the economic development of countries.

The department is split into four teams:

Tobacco Free Initiative

Conscious of the global tobacco epidemic’s massive toll of death, sickness and misery, and mindful of the need to raise the profile of its tobacco control work, WHO in July 1998 established the Tobacco Free Initiative (TFI). TFI focuses international attention, resources and action on the global tobacco epidemic.Non Communicable Diseases Essay Paper

The tobacco control team works in three core areas: tobacco control economics, national capacity building, and surveillance and information systems for tobacco control.

The tobacco control economics team aim to demonstrate that tobacco control policies, in particular tobacco taxation, make good economic sense. They work with countries to strengthen their tobacco tax systems, carry out research, develop tools and manuals to support research and policy development, and survey tobacco taxation in countries.

The national capacity building team provide assistance to countries to enhance their ability to resist the epidemic of tobacco and to reduce the demand for tobacco, in line with the WHO Framework Convention on Tobacco Control (WHO FCTC).

The comprehensive information systems team seeks to improve the availability of surveillance data on tobacco use, exposure and related health outcomes.

In addition to its core area of work, PND is involved in two cross-cutting projects: the Bloomberg Initiative to Reduce Tobacco Use, and the Bill & Melinda Gates Foundation Tobacco Control in Africa project. WHO partners with both projects to focus on reducing the burden of tobacco control in the most at-risk countries worldwide.

Health Promotion

The Health Promotion team promotes action across sectors for health and health equity, the reduction of health risks and the promotion of healthy lifestyles. Oral Health and School Health are two key work programmes of the team. The former aims to integrate oral health into NCD prevention and control, and the latter to intensify action for achieving NCD related health and education outcomes at the population level, in collaboration with key stakeholders within and beyond WHO.

Surveillance and Population-based Prevention

Surveillance and population-based prevention are fundamental to the mission to prevent deaths from NCDs. Population-based prevention focuses on broad policy, program and environmental interventions targeted at the general population more than just the high-risk individuals.

The major areas of focus are very cost-effective policy options contained within the WHO Global Strategy on Diet, Physical Activity & Health and the Global NCD action Plan 2013 – 2020. These include physical activity promotion, salt reduction, WHO recommendations on marketing of foods and non-alcoholic beverages to children, and fiscal policies for diet amongst others.

Surveillance focuses on coordinating and providing direction and support to strengthen NCD surveillance worldwide, with particular emphasis on low and middle-income countries, and provides global information resources on risk factor burden, trends and distributions.Non Communicable Diseases Essay Paper

The team also provides technical and administrative support to the Commission on Ending Childhood Obesity. The Commission has been tasked by the WHO Director-General with producing a report specifying which approaches and combinations of interventions are likely to be most effective in tackling childhood and adolescent obesity in different contexts around the world.

mHealth

mHealth uses mobile-based technologies to promote healthy behavioural changes in populations. The joint initiative, between the World Health Organisation and the International Telecommunications Union (ITU), provides toolkits and technical advice to countries to roll-out mHealth based NCD prevention programmes. The initiative is steered by two WHO clusters (HIS and NMH) and with a secretariat split between PND and ITU.

The mHealth initiative is aiming to harness mobile phone use as a channel for improving other healthy habits relating to the prevention and reduction of NCDs. The joint initiative helps governments take advantage of this new access channel provided by mobile phones, whilst avoiding the endless cycle of small-scale, low-impact mHealth projects. This is achieved through the creation of global toolkits for each NCD area, containing technical content, design, set-up and management for each programme. Each country then adapts this global version to suit national requirements and context. The initiative currently works in 8 9 countries : Costa Rica (mTobaccoCessation), Senegal (mDiabetes), Zambia (mCervicalCancer), Norway (mCOPD), the UK (mHypertension), the Philippines (mTobaccoCessation), Tunisia (mTobaccoCessation) and India (mTobaccoCessation & mDiabetes) and Egypt (mDiabetes).

Noncommunicable – or chronic – diseases are diseases of long duration and generally slow progression. The four main types of noncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancer, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes.

Noncommunicable diseases, or NCDs, are by far the leading cause of death in the world, representing 63% of all annual deaths. Noncommunicable diseases (NCDs) kill more than 36 million people each year. Some 80% of all NCD deaths occur in low- and middle-income countries.

Mortality trends and profiles in the Region of the Americas have undergone substantial changes in recent decades (). In Latin America and the Caribbean (LAC), demographic changes coupled with evolving lifestyle, environmental, behavioral, and economic factors have led to noncommunicable diseases (NCDs) replacing or, in some settings, co-existing with the burden of communicable diseases (CDs) (). This epidemiological transition helps explain the particularly heterogeneous mortality trends in LAC countries (), where the double burden of CDs and NCDs is common and takes a tremendous toll on the health system (). However, improvements in primary health care () and disease control and surveillance have reduced the risk of death from vaccine-preventable diseases () and complications during pregnancy and childbirth ().Non Communicable Diseases Essay Paper

In the Americas overall, the past decade has been characterized by an increase in deaths resulting from external causes such as road traffic injuries and suicides, which have contributed to changes in the Region’s mortality profile (). These changes have not occurred uniformly across different subregions, countries, populations, age groups, and genders (). For example, declines in mortality rates among indigenous populations in LAC countries have generally lagged compared to those in other groups ().

The analysis of mortality trends is crucial for developing effective health, social security, and other types of policies (). This chapter describes the trend and magnitude of mortality in the Americas between 2002 and 2013, by main causes of death, time period, and age group, and the heterogeneous patterns of mortality across subregions of the Americas in different stages of the epidemiological transition.

The LAC region has been recognized as having the highest socioeconomic disparities in the Americas, a status that has inevitably translated into high mortality due to NCDs, including cardiovascular diseases, diabetes, and cancer (). Reversing mortality trends due to NCDs in these subregions may be the Region’s biggest challenge as well as its greatest opportunity to meet the Sustainable Development Goals (SDGs) ().

Aging, globalization, urbanization, and the rise in obesity and physical inactivity in the Region have made cardiovascular diseases the leading cause of death and disability in the Americas (), accounting for almost one-third of all Regional mortality, with the risk generally higher in men compared to women.

The Region of the Americas also suffers from a high burden of diabetes mellitus, which is known to increase the risk of cardiovascular diseases two- to fourfold, and is among the top five causes of death in the LAC region, according to the 2010 Global Burden of Disease Study (GBD) (). Based on current trends, mortality from diabetes in the LAC region is projected to be 1.6 times higher than the SDG target (). In addition, cancer contributes to one-third of the NCD burden in the Region, according to the World Health Organization (WHO), with demographic, social, economic, and environmental factors, as well as changes in reproductive patterns, as the main drivers of the patterns of cancer mortality ().

Over the last decade, the Americas has experienced a decline in mortality from CDs resulting from improvements in access to water and sanitation services, micronutrient supplementation, primary care, and vaccination, among other areas (). Between 2007 and 2009, 12.5% of all deaths in the Region were attributed to CDs, with the highest mortality rates observed in Guatemala and Peru (). Despite favorable trends in CD mortality overall, challenges such as antibiotic resistance and emerging and reemerging infectious diseases will require continued and constant surveillance (). A better understanding of the link between climate change and infectious diseases will also be crucial given the predicted climatic effects on vector-borne and zoonotic diseases ().

Maternal mortality reduction remains an unfinished agenda in the Americas. No country in the Region achieved Millennium Development Goal 5 (MDG 5) (“Reduce maternal mortality”). In fact, from 1999 to 2013, an increase in maternal mortality was reported in the Americas (). This increase may be at least partially attributable to the enhanced identification of direct and indirect maternal deaths; the addition of a pregnancy checkbox in U.S. death certificates in 2003 (); the inclusion of late maternal deaths in the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10); active surveillance of maternal deaths in Brazil and Mexico since 2002 (); and an increasing prevalence of chronic conditions and risk factors such as obesity, hypertension, diabetes mellitus, and heart disease among pregnant women, along with the obstetric transition ().

The lowest rate of decline in maternal mortality during the 1990–2015 period was observed in the Caribbean, which reported a 1.8% reduction (). Maternal mortality reporting in the Region continues to be challenged by misclassification and under-reporting ().

Despite an overall decline in complications during pregnancy and childbirth across the Region (), direct obstetric causes still accounted for 75.0% of Regional maternal deaths in 2007 (). Improvements in fighting CDs and perinatal complications in children over the last few decades have led to marked reductions in deaths in neonates and children under 5 years old, which enabled the LAC region to meet MDG 4 (“Reduce child mortality”) (). Nevertheless, striking disparities remain within LAC countries. For example, despite major improvements in preventing maternal, newborn, and child mortality, Mexico’s neonatal mortality rate is still twice as high as the United States’ (8.2 compared to 3.6 deaths per 1,000 live births) ().

Youth and adolescents, representing about 26% of the total population of the Region, comprise the largest cohort in the Americas (). This population is also the most affected by external causes of mortality, which accounted for 64.7% of deaths in the 10–24 year age group and 11.1% of all deaths in the Region between 2007 and 2009 (). The largest contributors to external causes of death include road traffic injuries, which are among the leading causes of death in the 5–14 and 15–44 year age groups (), followed by accidental injuries, assaults, and suicides. Global estimates predict that by 2020 road traffic injuries will rank third in the causes of disability-adjusted life years (DALYs) lost (). External causes of death thus remain a major concern given the increasing proportional mortality they represent in the Region of the Americas.

The differences in mortality due to external causes by sex are striking, disproportionately affecting men more compared to women (). For example, deaths from assaults account for up to 30.0% of total deaths from external causes among males but only 10–12% of total deaths among females, and the risk of death from road traffic injuries was 3–4 times higher in men than in women in 2007 ().Non Communicable Diseases Essay Paper

To assess mortality in the Americas, an ecological study was conducted using data from () the Pan American Health Organization (PAHO) mortality database for 2002–2013 and () estimated maternal and infant mortality indicators obtained from interagency groups. This chapter describes the magnitude, distribution, and trends of mortality data across the Americas and its subregions over three time periods (2002–2005, 2006–2009, and 2010–2013). The countries are grouped according to PAHO’s Regional Core Health Data Initiative (RCHDI), with Mexico and Brazil listed separately as subregions due to their population size. Age-adjusted mortality rates were calculated for comparison across subregions, using the WHO world population age structure constructed for the period 2000–2025 as the standard population. Relative risk (RR) of mortality was calculated by sex and each of the 3-year time periods, along with the percentage of change in mortality between the time periods, using the latest interval as the reference variable.

In developing countries, the noncommunicable disease (NCD) and risk factor burdens are shifting toward the poor. Treating chronic diseases can be expensive. In developing countries where generally much health care costs are borne by patients themselves, for those who live in poverty or recently escaped severe poverty, when faced with large, lifelong out-of-pocket expenses, impoverishment persists or can reoccur. These patterns have implications for national economic growth and poverty-reduction efforts. NCDs can change spending patterns dramatically and result in significantly reducing non?medical-related spending on food and education. In India, about 40% of household expenditures for treating NCDs are financed by households with distress patterns (borrowing and sales of assets). NCD short- and long-term disability can lead to a decrease in working-age population participation in the labor force and reduce productivity and, in turn, reduce per capita gross domestic product growth. To fully capitalize on the demographic dividend (i.e., aging of the population resulting in less dependent children, not yet more dependent elderly, and greater national productivity), healthy aging is necessary, which, in turn, requires effectively tackling NCDs. Last, from an equity standpoint, the economic effect of NCDs, evident at the household level and at the country level, will disproportionately affect the poor and vulnerable populations in the developing world.

This study, commissioned by the Supreme Council of Health in the State of Qatar, focuses on the main noncommunicable diseases (NCDs) globally and regionally, in order to gauge their potential impact on Qatar. The research shows that the Gulf Cooperation Council is projected to be affected dramatically by NCDs in the coming years. The top five NCDs that will affect Qatar in terms of economic burden and disability-adjusted life years are cardiovascular diseases, mental health and behavioral disorders, cancer, respiratory diseases, and diabetes. Whilst these diseases have diverse effects on patients, their causes can be traced to “… common lifestyle-related, or behavioral, risk factors such as tobacco use, a diet heavy in fat, and physical inactivity”. The total direct and indirect costs to the Gulf Cooperation Council calculated for the above five NCDs were $36.2 billion in 2013, which equates to 150% of the officially recorded annual health care expenditure. If this trajectory is maintained, spending per head of population in Qatar will reach $2,778 by 2022. These figures demonstrate not only the potential financial impact of the main NCDs, but also give an idea of how the current health system is working to address them.

Noncommunicable diseases (NCDs) are the quiet killers, attracting less attention than infectious diseases and, due to their steady, relentless nature, accepted by many as matters of fate. This is ironic, since behavior can influence the risk factors for these diseases. In 2008, according to WHO, 63 percent of global deaths were attributable to NCDs, mainly due to cardiovascular disease, diabetes, cancer and chronic respiratory disease.Non Communicable Diseases Essay Paper

Once thought to be the afflictions of developed nations, NCDs are projected to increase everywhere, but more so in low- and middle-income regions. Nearly 80 percent of NCD deaths occur in low-and middle-income countries and NCDs are the most frequent causes of death in most countries, except in Africa, where infectious diseases end lives before NCDs take hold.

Morbidity and mortality data from WHO reveal that the disproportionate impact on lower resource settings is growing. Over 80 percent of cardiovascular and diabetes deaths, and almost 90 percent of deaths from chronic obstructive pulmonary disease, occur in low- and middle-income countries. More than two-thirds of all cancer deaths occur in low- and middle-income countries. By 2030, NCDs are expected to account for three-quarters of the disease burden in middle-income countries, up from two-thirds today.

So where does grant making for capacity building and training fit in? A large percentage of NCDs are preventable through the reduction of four main behavioral risk factors: tobacco use, physical inactivity, alcohol abuse and unhealthy diet. Others are treatable with drugs to reduce blood pressure and cholesterol. But changing behavior, improving diet, eliminating substance abuse and enhancing access to expensive drugs are challenging in settings where choices are limited by economics.

In 2008, Fogarty chose to address NCDs as one of its five strategic goals and funds a number of programs designed to build NCD research capacity in developing countries. Fogarty recently launched an initiative called Chronic, Noncommunicable Diseases and Disorders Across the Lifespan (NCD-Lifespan), combining and building on previous programs devoted to increasing expertise in NCDs, operations research, genetics and population studies in low-resource settings. In addition, for more than a decade Fogarty has supported research regarding tobacco consumption and ailments triggered by occupational and environmental issues that include asthma, lung disease and some cancers.

Another program – Fogarty International Research Collaboration Awards – supports studies on a wide variety of topics, among them breast cancer in Egypt and Chile, kidney disease in Nicaragua and cardiovascular risk factors in the Philippines. Finally, a component of the Medical Education Partnership Initiative is strengthening training in cardiovascular research in Uganda and Zimbabwe, and HIV-related cancers in Malawi.Non Communicable Diseases Essay Paper

Although the UN meeting on NCDs will not include mental health, Fogarty has a long-established program that supports studies of brain disorders in the developing world.

The rapidly growing burden of NCDs in low- and middle-income countries is accelerated by the negative effects of globalization, rapid unplanned urbanization and increasingly sedentary lives.

People in developing countries are increasingly eating foods with higher levels of carbohydrates and sugars and are targeted by marketing for tobacco, alcohol and junk food.

The costs to health-care systems from NCDs are high and projected to increase. Significant costs to individuals, families, businesses, governments and health systems add up to major economic impacts. Heart disease, stroke and diabetes cause billions of dollars in losses of national income each year in the world’s most populous nations. Economic analysis suggests that each 10 percent rise in NCDs is associated with 0.5 percent lower rates of annual economic growth.

NCDs are quiet killers with an explosive impact. But as the articles focusing on Chronic Diseases demonstrate, both awareness of the epidemic and efforts to curtail it are growing.

In this context, environmental risks to health are defined as all the external physical, chemical, biological, and work related factors that affect a person’s health, excluding factors in natural environments that cannot reasonably be modified. Environmental risks to health include pollution, radiation, noise, land use patterns, work environment, and climate change.

Every year in the Americas, noncommunicable diseases (NCDs) are responsible for nearly four of every five deaths (79%). This figure is only expected to increase in the next decades as a consequence of population growth and aging, urbanization, and exposure to risk factors. Cardiovascular diseases (38%), cancer (25%), respiratory diseases (9%), and diabetes (6%) are the four leading causes of NCD deaths ().

As people age, they face longer exposure to potential risk factors such as tobacco use, harmful use of alcohol, insufficient physical activity, and unhealthy eating patterns and diets. As a result, multiple chronic conditions emerge in the elderly. An overview of the population trends and projections in the Americas by age group from 1970 to 2030 shows a doubling of the overall population by 2030, with the greatest increases in groups aged 60–79 years (a 4.2-fold increase) and 80+ years (a remarkable 7.3-fold increase).

Demographic and epidemiologic shifts contributed to the rising NCD burden in the Americas. Moreover, NCDs are no longer considered exclusively a result of the natural life course, since NCDs are preventable and the cause of many premature deaths. Of all NCD deaths, 35% occurred prematurely in people from 30 to 70 years of age, of which cardiovascular diseases and cancer combined to account for 65% of total premature deaths ().

Four main NCDs and their common risk factors

The four leading NCDs (cardiovascular diseases, cancer, respiratory diseases, and diabetes) share four risk factors: tobacco use, harmful use of alcohol, unhealthy diet, and physical inactivity. These in turn lead to other key metabolic/physiological changes such as raised blood pressure, overweight/obesity, raised blood glucose, and higher cholesterol levels (). The status of the key modifiable and biological risk factors that contribute to NCDs in the Region is presented in the following. Non Communicable Diseases Essay Paper

Harmful use of alcohol

The harmful use of alcohol contributes to over 200 health conditions, the majority of which are NCDs, including cancers, cardiovascular diseases, and liver cirrhosis. For most diseases and injuries caused by alcohol, there is a dose-response relationship: the higher the consumption, the larger the risk for a negative consequence ().

In the Americas, alcohol is a significant public health problem. It is the WHO Region with the second highest levels of alcohol per capita consumption (APC) and heavy episodic drinking (HED) in the world. Average APC among those aged 15 years and older in the Americas is 8.4 L, compared to 6.2 L globally. APC among all drinkers is 18.0 L for males and 8.0 L for females, indicating that those who drink do so at high levels ().

At the same time, certain patterns of consumption are particularly significant in determining many of the harmful effects of alcohol: the volume of alcohol consumed in a single occasion is linked to acute consequences such as alcohol poisoning, violence, and injuries. The prevalence of HED (60 g of pure alcohol at least once a month) is estimated to be 13.7% in the Americas and 22% among drinkers (1 in 5 drinkers); each occasion is associated with a high risk for an acute consequence, and the higher the frequency of these occasions, the higher the risk of chronic disease including cancers, liver cirrhosis, and alcohol use disorders (AUD). The prevalence of HED among the general adult population is especially high in Paraguay and Dominica

NCDs or non-communicable diseases are those conditions that are usually not passed on from one affected person to others, but are caused as a direct result of lifestyle and environmental factors.

These include a host of different conditions including chronic lung diseases, diabetes, cancer and cardiovascular diseases. A disturbing trend in the last decade has been the consistent rise in NCDs on a global level. Particularly in regions that are more affluent, the number of people affected by chronic NCDs has been on a steep rise, forcing experts to alter long-harbored opinions about this class of diseases and trying to find ways to stem this tide.Non Communicable Diseases Essay Paper

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While wealth distribution might still have a role to play, the statistics show that currently, almost three-quarters of global NCD deaths arise from low or middle income countries, where the instances of NCDs are fast on the rise.

NCDs and the Mounting Problems

NCDs are long-term and chronic conditions that rob affected people of many productive years of their life, eventually resulting in debilitation and death in most cases. They are incurable conditions, and the only treatment available focuses on controlling the conditions and their symptoms.

Cases of NCDs are Spreading

Much has been made recently of the fact that NCDs are on the rise in 2^ndand 3^rd world countries. Various lifestyle and environmental factors all contribute heavily to the onset of NCDs and some of them are a direct product of the sluggishness on a global level, to promote measures that ensure a cleaner, healthier environment. We just can’t absorb the seriousness of the situation even though the signs are everywhere.

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What causes NCDs?

Lack of physical activity, causing health problems related to cardiovascular systems and metabolism, along with the development of certain kinds of cancer

Poor, unbalanced diets which fail to supply the proper nourishment and nutrients, with problems regarding salt, sugar and fat consumption contributing towards the development of NCDs

Abuse of tobacco and alcohol which leaves people vulnerable to a host of diseases including lung disease, metabolic disorders and cancer

Environmental factors resulting from unsustainable practices and emissions that influence bodily function and aid in the development if NCDs

What is the impact of our global population’s failing health?

The increase in chronic NCD cases is a global problem on many levels, and we can only expect it to escalate. With more and more people getting affected, our global productivity is also getting hit.

In spite of competent medical care, people affected by NCDs suffer the loss of valuable healthy years of their lives. The threat to life and the adverse effects it has on happiness on morale can also be particularly devastating.

The implications on the healthcare industry are also significant, with more and more healthcare costs emerging with increase in the NCD epidemic. In those countries where the environmental factors are at their worst and the options of treatment available are limited, the risk of death is by far the most significant.

Noncommunicable diseases (NCD) are not passed from person to person. They are typically of a long duration and progress slowly. The most common NCDs include cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes. NCDs share several common, modifiable risk factors – tobacco use, harmful alcohol use, physical inactivity, and unhealthy diet. Mitigating the effects of these common risk factors is critical to combatting NCDs worldwide.Non Communicable Diseases Essay Paper

Quick Facts About NCDs

NCDs are the leading cause of death worldwide. The World Health Organization (WHO) estimates that NCDs account for 60% (more than 35 million) deaths annually.
Roughly 80% of NCD related deaths occur in low- and middle-income countries, where fragile health systems often struggle to meet the population’s most basic health needs.
WHO estimates that 48% of NCD deaths in low- and middle-income countries occur before 70 years of age, compared with 26% in high-income countries.
In 2012, all United Nations member countries committed to achieving a 25% reduction in premature mortality from NCDs by 2025 (the 25 x 25 target).

NCDs Are a Family Matter

The chronic nature of NCDs means patients are sick, suffer longer and require more medical care. Consequently, family members often have to care for loved ones who are unable to work due to illness or disability, resulting in additional lost productivity and wages. In 2011, the World Economic Forum estimated that the combined global economic impact of cardiovascular disease, chronic respiratory disease, cancer, diabetes, and mental health will be more than $47 trillion dollars over the next 20 years.Non Communicable Diseases Essay Paper

PSI’s growing work in NCDs leverages over four decades of expertise in social marketing, as well as organizational strengths in social franchising, behavior change communications and service delivery.

PSI’s focal NCD health areas are cervical cancer, cardiovascular disease, diabetes in pregnancy and Type 2 diabetes. We recognize that the NCD spectrum is large and complex; therefore, we encourage our network members to develop NCD interventions aligned with country and region-specific priorities, disease burden, and the local context. Our technical teams work to share lessons learned, case studies and research findings across our network, and outward to the broader community of NCD stakeholders.

Effective prevention and control of NCDs will require sustained engagement across multiple sectors. Globally, our network members engage with policy makers, government leaders, academic institutions and other civil society organizations to increase awareness and shift policy and funding support for NCD control and prevention. PSI is a member of the NCD Roundtable as well as the Task Force on NCDs and Women.Non Communicable Diseases Essay Paper

These risks are driven by policies in sectors outside the health sector, such as energy, industry, agriculture, transport, and land planning. More cooperation is needed if the health sector is to effectively tackle NCDs and reduce health costs resulting from policies in other sectors. Here, we summarise the evidence for the links between environmental risks and NCDs, review existing solutions and interventions, and outline opportunities for reducing environmental risks as part of an intersectoral NCD agenda.

The burden of non-communicable disease (NCD) is a major global concern and is projected to increase by 15% over the next 10 years. NCD is the leading cause of mortality in Oman and other countries of the Gulf Cooperation Council (GCC). Some of the most successful interventions to address NCD include legislations like banning smoking in public places. A desk review of available policies and legislations related to the behavioural risk factors of NCD from the GCC and from Oman was conducted with a focus on policies and legislations related to food, physical activity and tobacco. The review identified numerous documents; most were policies and resolutions related to tobacco control. Although only a few documents were laws, a majority were issued by non-health sectors. This policy review is the first effort in the GCC to consolidate information on the regulatory framework for the three key risk behaviours in the region, tobacco use, unhealthy diet and physical inactivity. Further work is needed to strengthen the regulatory framework, at both the national and regional levels, to strengthen tobacco control as well as to improve dietary patterns and physical activity levels. Given that a bulk of laws, regulations and policies are beyond the scope of the health sector, significant advocacy efforts are required to generate a multisectoral response.

Symposium on Implementation Science Harnesses Efforts to Curb NCD Prevalence

In an effort to address these daunting statistics, the Kenyan Ministry of Health has unveiled various interventions aimed at reducing the prevalence of NCDs in the country. These interventions could help ease the burden that NCDs have placed on the socio-economic development of Kenya’s 43 million people—not only those who suffer from NCDs, but those who care for them.

To assist in this effort, RTI International worked with Kenya’s Ministry of Health and NCD Alliance Kenya to launch the 2016 Symposium on Noncommunicable Diseases in Nairobi, Kenya. Other organizations involved included the Kenya Medical Research Institute, Global Diagnostic Imaging, Healthcare IT & Radiation Therapy, and the University of Nairobi.

The symposium, which was held in September 2016, was the culmination of a year-long effort to create a forum for leaders to share ongoing research, identify research needs, and formulate a coordinated road map to guide future implementation research. The event brought together local, regional, and international health researchers in hopes of sparking the exchange of ideas focused on the quest for actionable policies to ease the burdens created by NCDs.

Symposium on Implementation Science Harnesses Efforts to Curb NCD Prevalence

Who is at risk of such diseases?

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 85% are estimated to occur in low- and middle-income countries. Children, adults and the elderly are all vulnerable to the risk factors contributing to NCDs, whether from unhealthy diets, physical inactivity, exposure to tobacco smoke or the harmful use of alcohol.Non Communicable Diseases Essay Paper

These diseases are driven by forces that include rapid unplanned urbanization, globalization of unhealthy lifestyles and population ageing. Unhealthy diets and a lack of physical activity may show up in people as raised blood pressure, increased blood glucose, 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.

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.

Tobacco accounts for over 7.2 million deaths every year (including from the effects of exposure to second-hand smoke), and is projected to increase markedly over the coming years. (1)
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)
1.6 million deaths annually can be attributed to insufficient physical activity. (1)

Metabolic risk factors

Metabolic risk factors contribute to four key metabolic 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 19% of global deaths are attributed), (1) followed by overweight and obesity and raised blood glucose.

What are the socioeconomic impacts of NCDs?

NCDs threaten progress towards the 2030 Agenda for Sustainable Development, which includes a target of reducing 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.Non Communicable Diseases Essay Paper

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.

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.Non Communicable Diseases Essay Paper

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.

Iraq has developed a national strategy and plan of action for the prevention and control of noncommunicable diseases in line with global and regional strategies. Major attention has been given to support the national programme for cancer control and development of the cancer registry. Programmes for early detection of cancer, as well as palliative care, have also been enhanced.

The number of cancer cases is rising, mainly due to the ageing population, widespread tobacco consumption and exposure to environmental hazards. The majority of cancer cases in Iraq are only detected at an advanced stages and thus are incurable, even if the best therapies are offered. Chemotherapeutic drug supplies are inadequate and of interrupted supply. Radio therapeutic facilities are outdated.

The WHO noncommunicable disease programme has paid special attention to promote the activities of the WHO Framework Convention on Tobacco Control in Iraq, particularly the tobacco-free campaign, as part of the Global Youth Tobacco Survey and Global Health Professional Tobacco Survey.

The WHO noncommunicable disease programme in Iraq provides technical support for the control of noncommunicable disease by:Non Communicable Diseases Essay Paper

adopting a multisectoral approach for the promotion of healthy lifestyles
strengthening the surveillance system for risk factors and the capacities of focal points for noncommunicable disease at governorate level, as well as involving nongovernmental organizations and civil society
developing a comprehensive cancer control programme, including cancer literacy for people, early detection, ensuring availability of chemotherapeutic drugs and modernization of radio therapeutic facilities
developing a comprehensive programme for disability and the care of people with physical disabilities, including the creation of workshops for prosthesis
mobilize the necessary programme to train primary health care/GPS and health workers to provide basic maternal health care at the first level of health care, paying special attention to services for post-traumatic stress disorder
establish a community-based mental health care model to be supported by primary health care centres and local level health workers and community female volunteers
providing local training to primary health care dentists and school teachers, in addition to providing fellowships outside of the country in recognised centres to upgrade capacities.

Over the next 5 to 6 years, technical support will be provided by WHO to integrate noncommunicable diseases into the national development plan and noncommunicable diseases within primary health care strengthened. Areas for strengthening will include articulation of clear roles and responsibilities within the referral system, cancer control, development of rehabilitation and care for people with physical disabilities, road traffic crashes prevention, greater incorporation of primary eye care into primary health care and promotion of healthy lifestyles. Non Communicable Diseases Essay Paper

Replicating health promotion trials for CHD in LMICs is sensible as rates are rising, health literacy is low, and there are strong views about these interventions [5],[6]. A recent large trial of health promotion in rural India demonstrated no effects on risk factor profiles or health knowledge [7]. These findings are disappointing, but may avoid wasteful investment in this particular approach in both HICs and LMICs.

The causes of many NCDs are unknown and therefore ways to prevent them remain elusive. Combined studies in LMICs and HICs may be more powerful, as there is often greater variation in exposure levels and marked differences in underlying confounders of risk factor–NCD associations. For example, breastfeeding appears to lead to lower blood pressure and body mass index in children in HICs, but no associations are found in LMICs, making it unlikely that the association in HICs is causal [8].

The upstream determinants of known causes of NCDs may differ between LMICs and HICs. High blood pressure, dyslipidaemia, and smoking are important proximal causes of cardiovascular disease globally, but their upstream causes reflect potentially modifiable social, fiscal, and legal environments that influence our behaviours and vary between HICs and LMICs [9]. Upstream determinants include economic [10], educational [11], occupational [12], agricultural [13], and trade [14] policies, all of which are adversely affecting risk factors globally.

Some exposures—for example, pesticides—do not occur widely or at high levels in HICs, making identification of potential health hazards difficult. Exposures that are orders of magnitudes higher occur in LMICs and enable harms to be identified, encouraging control of pesticides globally.Forces that are near-ubiquitous in HICs (see Box 1) make it impossible to detect adverse effects through studies conducted in HICs [15],[16]. For example, asthma prevalence increases as countries become more economically productive and cleaner. The hygiene hypothesis suggests that lower childhood infection rates may “programme” the immune system, leading to asthma and allergy. The “hygiene hypothesis” cannot be tested only in HICs and requires global studies [17].

Strong associations have been reported between HIV/AIDS and cardiometabolic disorders [18]–[20], smoking and tuberculosis [21],[22], and diabetes and tuberculosis [23]. Cancers with an infectious aetiology are more common in LMICs and include gastric cancer (Helicobacter pylori), hepatocellular cancer (hepatatis B and C), and cervical cancer (human papilloma virus) [24]–[26]. Furthermore, the high burden of infectious diseases and associated chronic inflammation may exacerbate risks for some NCDs. The underlying mechanisms of these associations, new therapeutic targets, and opportunities to integrate communicable and NCDs in health sector reforms may be found by doing studies in LMICs [27].

Identifying the underlying forces that influence government and private sector decision-making on agriculture, trade, and the built environment requires research. Understanding how the tobacco industry, for example, operates in HICs helped shape the World Health Organization (WHO) Framework Convention on Tobacco Control [28], and led to effective counter-measures that are now being applied in LMICs. Similar research is needed in these other areas, particularly the food sector [29],[30]. Reliance on fiscal and legal interventions based on simple models examining the direct effects on consumption and other behaviours are becoming insufficient as there is growing understanding of the macroeconomic “ripple” effects of interventions across economic sectors and between countries [31].Non Communicable Diseases Essay Paper

New approaches to treatment of NCDs in LMICs are needed. The HIV/AIDS movement arising in HICs showed the importance of working with all stakeholders. The largest constituency affected by NCDs—elderly people—has been ignored in NCD discourses and alliances [32]. Elderly people constitute a major pressure group for achieving better, integrated, holistic services that respond to all their health needs.

Primary health care, supported by family and self-care, will form the backbone of cost-effective ways of treating and caring for NCDs and will require research to develop optimal care models [33]. Research on task shifting to non-medically qualified practitioners, low-cost near patient diagnostics, and self and family management are needed [34], and are also of relevance to HICs [35]. In addition, there is a great need to evaluate prevention interventions in different contexts in LMICs, given the current paucity of evidence. The results should be useful for informing prevention programmes with ethnic minorities in HICs.

The Political Need for Research

The inexorable rise of NCDs in LMICs has been left unchecked for two decades with major economic consequences and avoidable loss of lives. The current situation is unduly influenced by economic and commercial interests that negate the importance of NCDs [36]. Global and local research, particularly if it can be conducted in parallel in HICs and LMICs, can provide powerful arguments for the need to act globally, as envisaged in the 2011 United Nations high-level meeting on NCD prevention and control [37].

Situations: Research and Action

Research agendas for LMICs have been published recently [38]–[41] proposing what needs to be done. We are concerned that “action” only may seem to be preferable to “research” in LMICs to deal with the rising NCD burden. Research and action are not opposite extremes of a continuum but responses that arise depending on specific situations, which are summarized in Box 2.

We lack data on the burden of disease even for common conditions such as asthma and epilepsy. Adding NCD modules to existing health and demographic surveillance systems that provide burden of disease estimates for maternal and child health is underway and will provide additional sources of robust data [60].

Understanding the “upstream” causes of NCDs can make use of natural experiments such as the introduction of urban mass transport systems on physical activity [61]; social and economic change on risk factors [62]; and rural development strategies (e.g., new roads, employment schemes) on obesity and diabetes. The Prospective Urban Rural Epidemiology [63] study runs in 600 communities in 17 countries to examine the impact of urbanisation on health.

Occupational exposures make a substantial contribution to NCD in industrialised countries, but their relevance in LMICs has not been assessed [64]. This is of particular concern given that many hazardous industries are situated in LMICs [65].For example, in India’s asbestos industry, health risks are discounted: “That lung cancer deaths have been caused by asbestos fibre has not been proved in India,” argues John Nicodemus, executive director of the Asbestos Cement Products Manufacturers’ Association, a New Delhi–based industry organization [66].Non Communicable Diseases Essay Paper

Management of NCDs through mHealth technology, task shifting from doctors to other health workers, and self-management all require robust evaluation. They may also be highly relevant to cost-constrained health services in HICs.

”Salt restriction lowers blood pressure but is difficult for individuals to do as much dietary salt is hidden in processed foods. In the UK, bread manufacturers have voluntarily reduced the salt content of bread slowly, which should result in reductions in population levels of blood pressure [67].

first, the population burden of many NCDs is not even known. Recent global burden of disease studies have produced modeled estimates derived from existing, but patchy, data of common risk factors trends to fill the information gap [42]–[45]. Existing surveillance and monitoring systems require expanding to include the major NCDs and risk factors to improve estimates of burden and monitor trends in LMICs, as has been done for asthma [46].

Second, while the population burden of some diseases is known, the causes aren’t. Rapid socioeconomic growth in many LMICs, alongside the severe economic crisis affecting HICs, and growing migration and urbanisation are generating “natural experiments” that will allow investigation of the upstream determinants of common risk factors for NCDs. For example, a recent study examining the association of unemployment in an economic recession and the increasing number of suicides implicated a lack of social protection systems in the United States (compared with other European countries) as a causal factor [47].Non Communicable Diseases Essay Paper

Third, when causes are known there still needs to be more research into methods of prevention. Tobacco control topped the UN high-level meeting’s priority list for action [37]. The total global population covered by comprehensive smoke-free laws increased from 3.1% in 2007 to 5.4% in 2008, providing protection for an additional 154 million persons [48]. While this is a big relative improvement in a short period of time, it is clear that current strategies are failing the remaining 95% of the global population, and tobacco use is still increasing globally.

Fourth, research is needed to improve patient treatment and care. In parallel with prevention, improved patient management is essential [49]. Health services research, well developed in HICs, is needed to identify cost-effective treatments, and implementation research is then required to get research findings into practice and improve quality of health care [50]. The potential for improving NCD health care through health services research is huge: for example, eHealth; non-invasive imaging to aid diagnosis; and integrated patient health records. Many of these developments, pioneered in LMICs and evaluated collaboratively using robust methods, will likely yield global benefits through reverse innovation [51].

Finally, a situation where what is needed is known, but not how to implement it. There are some NCDs for which it can be argued that sufficient knowledge is available to act now. For example, five priority interventions—tobacco control, salt reduction, improved diets and physical activity, reduction of hazardous alcohol intake, and access to essential drugs and technologies—were recently defined as requiring “leadership, prevention, treatment, international cooperation, monitoring and accountability” [52]. Experiences from both HICs and LMICs will be relevant in finding the best ways forward.Non Communicable Diseases Essay Paper

Economics of NCDs and Funding Research For NCDs

The economic consequences of NCDs are large and have been well documented. Estimates of the lost output attributable to NCDs amount to trillions of dollars a year [53]; the costs of simple effective interventions are measured in millions of dollars [54]. Research investments are now required urgently to fill the implementation gap between what works and achieving health gain in practice. The UN high-level meeting on NCDs formally acknowledged that resources devoted to combating NCDs are not commensurate with the magnitude of the problem [37]; the meeting noted that domestic, bilateral, regional, and multilateral channels of funding will be required.

Most health research funding is spent in HICs, but the greatest need, both in scientific and public health terms, is in the rest of the world [55]. Previous calls to action on NCDs over the last decade have had some impact on funding [54], which may generate further enthusiasm for funding research in LMICs.

While most LMICs do have a budget for NCD-related work [56], there is no room to innovate and evaluate strategies for NCDs. Much of the research and development relevant to implementation is country-specific and requires national funding. The WHO has recommended that the extra resources needed could come from increasing efficiency of revenue collection; improving access to social health insurance; increased tobacco and alcohol taxes; and including NCDs as a priority for official development assistance [57]. A further need is to develop capacity to conduct applied NCD health research. This is limited in most LMICs. Training and partnerships with experienced NCD researchers and institutions should be a high priority for development programmes.Non Communicable Diseases Essay Paper

The time has now come for all health-related research and development funders—global, regional, and national— to acknowledge the existence of NCDs and rise to the challenges they present. For example, the United Kingdom’s Department for International Development has identified the importance of NCDs in contributing to poverty and has initiated a mental health programme in several LMICs. Hopefully other programmes will follow [58]. A first step would be for global and bilateral agencies, major national health research councils, and charities to publish their spending by disease categories to track their contribution in meeting the World Health Assembly’s recent NCD targets of a 25% reduction in NCD mortality by 2025 [59].

There are unique opportunities for answering critical research questions about NCDs in LMICs (see Box 3). The list reflects our experiences and disciplinary perspectives from public health, epidemiology, primary care, and health policy. Where to begin will depend on the scientific capacity to deliver, national priorities, and the funds available. The important point is to make a start somewhere. The 2011 UN high-level meeting provided a strong context for research and action. A major shift in attitudes from knowing what needs to be done towards using research to prioritise, evaluate, monitor and, incrementally, improve health outcomes is urgently needed. Action and research are required: they are intimately entwined and the balance between them will depend on the situation and the health problem. Non Communicable Diseases Essay Paper