Tackling the Non Communicable Disease (NCD) Epidemic Sustainably in Developing countries
Non-communicable diseases (NCD) are diseases that are not caused by infectious agents (non-transmissible) and can last for a long time. They progress slowly and most times inflict years of disability on its victim and their family. They are a group of conditions that include cardiovascular disease, chronic respiratory diseases, cancers, diabetes, and mental illness.
NCDs are recognized as the leading cause of death worldwide and worse still it is a major threat to economic and social development. According to the Global burden of disease data, NCDs cause 28 times more deaths than human immunodeficiency virus, but receive 17 times less funding. There has been an increase in death rate from communicable diseases to NCDs in most developing countries. 75% of NCD deaths globally occur in developing countries and it is increasing faster in younger people with worse outcome than in developed nations. Despite this fact the fight against NCD has not been as impressive as in communicable disease or maternal and neonatal burden, among others.
NCDs and the SDGs
Sustainable Development Goal (SDG) 3, target 4 states: “By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”. The inclusion of NCD reduction, in the SDGs (an updated version of the Millennium Development Goals: MDGs), provides a unique opportunity to advance the NCD agenda and explore symbiotic linkages with other SDGs. To achieve the ultimate goal of sustainable development there needs to be progress in economic growth, social equity and environmental protection. Preventing and controlling NCDs is integral to this progress.
How can the NCD menace be addressed to ensure continuity, scalability and achieving desirable outcome among the appropriate population, in developing nations?
Healthcare Systems
Unfortunately, existing healthcare systems in most developing countries are not equipped to manage these conditions. As stated in my previous article: The Need for Sustainability in the Nigerian Healthcare Sector “the Nigerian healthcare sector, is plagued with inadequate facilities, outdated technologies, insufficient medical supplies, poor attitude and quality of healthcare personnel, shortage of healthcare workers, poor infrastructure, sharp differences in the accessibility and availability of medical facilities across the country resulting from policy disconnection, inadequate capital spending and low remuneration of public healthcare workers, among others”. It is important to address these multiple challenges, while integrating the provision of prevention and management systems for NCDs and most especially the provision of appropriate treatments, screening and early diagnostics services.
Health care delivery that incorporates the innovative use of human and technology resources in the health space is recommended. Mhealth (the practice of medicine and public health supported by mobile devices) is capable of providing improved and easily accessible NCD/healthcare services especially in rural communities and low income households. Mhealth has been highlighted as a key strategy in combating NCDs in developing countries, owing to increased utilization and availability of mobile phones, in developing countries. Already, mhealth has made significant impact in the fight against HIV/AIDS, malaria among other health condition. Although the burden of NCDs is growing at a faster level, mhealth practices can provide improved and easily accessible healthcare services for NCDs to a larger population size with minimum healthcare workers and at lesser cost.
In addition addressing key risk behaviors such as early tobacco and alcohol use, physical inactivity, and unhealthy diet, among young people today can significantly shift the expected progression of NCDs in Africa. This can be achieved by integrating related topics that control tobacco, alcohol, salt, blood pressure, obesity, and glucose into the school’s curriculum and improving awareness and education via digital media.
Workplace
The workplace is the single greatest source of stress and continuous stress can result in cardiovascular disease, sexual health complications and frailer immune systems among others. Also stress may encourage disordered eating, smoking, and alcohol intake. Employees spend significant amount of their time at work, this blend of time and opportunity makes the workplace an important location to address NCDs.
While most developed countries continue to adopt workplace health programs, a wide gap still exist in this practice in developing countries especially in small organizations. Several workplace health programs can cover a wide range of approaches and diseases. The following measures has been be employed and has shown positive impact in the workplace in addressing NCDs: provision of legislation such as smoke-free regulation, workplace health and safety training and support, improve work–life balance and healthy workplace award schemes that addresses tobacco, healthy eating and physical activity . In addition workplace should be addressed for safety in the prevention of cardiovascular and chronic respiratory diseases. Healthier and safer workplaces can prevent about 1 million NCD deaths each year, including from chronic obstructive pulmonary disease (COPD), pneumoconiosis, mesothelioma, lung and larynx cancers and leukaemia.
Environment
Environmental factors contribute significantly more to NCDs than their effect on health is recognized. 23% of global deaths are connected to the environment; 8.2 million out of the 12.6 million deaths annually caused by the environment are due to NCDs. Most cancers are instigated by environmental exposures in genetically predisposed individuals: about 25% of lung cancer deaths are linked to ambient air pollution, and 17% to household smoke from burning fossil fuels. New research shows significant links between cardiovascular diseases and diabetes and exposure to environmental chemicals present in air, food, and water. NCDs can be prevented by improved environmental management to reduce exposure to modifiable risks. The most urgent issues comprise climate change, mismanagement of water resources, sanitation issues, and water, air and food pollution, healthy housing among other.
NCD prevention spans across individual responsibility to societal responsibility in reducing air pollution from transport, energy generation and industrial emissions, utilization of clean energy, sustainable agricultural practices among others. Examples and case studies of such collective measures include, the decreased air pollution recorded during the 2008 Beijing Olympics through measures such as traffic control, shutting down highly polluting factories and adding small coal-fired boilers to natural gas which led to the decrease in cardiovascular mortality also the ban on coal sales in Dublin in 1990 triggered a decline of 15.5% in respiratory and 10.3% in cardiovascular deaths, and 5.7% of total non-injury deaths. Furthermore Lung cancer incidence in farmers in Xuanwei, China, decreased by more than 40% when they switched from using smoky coal in unvented fire pits to stoves with chimneys in their homes.
The prevalence of NCDs can be reduced to the minimum when there is a holistic approach towards prevention both individually and as entities. NCD prevention can prevent over 75% of deaths in Africa annually.
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