AsianScientist (Apr. 28, 2011) – Non-communicable diseases are the leading causes of death worldwide and are on the rise, the first WHO Global status report on noncommunicable diseases (NCDs) launched yesterday confirms. In 2008, 36.1 million people died from conditions such as heart disease, stroke, chronic lung disease, cancer and diabetes. Nearly 80 percent of these deaths occurred in low- and middle-income countries.
Cardiovascular diseases account for most NCD deaths, or 17 million people annually, followed by cancer (7.6 million), respiratory disease (4.2 million), and diabetes (1.3 million). These four groups of diseases account for around 80 percent of all NCD deaths, and share four common risk factors:
- Tobacco use.
- Physical inactivity.
- Harmful use of alcohol.
- Poor diets.
Low- And Middle-Income Countries Hit Hardest
The rapidly growing burden of NCDs in developing countries is driven by a few factors.
Firstly, the negative effects of globalization such as rapid and unplanned urbanization have led to lifestyles characterized by reduced physical activity and unhealthy lifestyle choices. This is further aggravated due to irresponsible marketing by tobacco and junk food companies looking to expand their businesses in these developing markets. Vulnerable populations within society such as children, adolescents and women are seen as easy targets for these companies.
Secondly, people from developing nations tend to consume energy dense foods. This practice was necessary for the labor-intensive occupations they once held. But with the rapid economic growth in some of these countries, peasants who would otherwise have settled for a life of farming now have more career options open to them. These people move into cities in droves and take up occupations such as driving taxis and clerical jobs which are not as physically demanding. This is when their staple of energy dense foods becomes a problem.
Overwhelmed with the speed of growth, many governments are already struggling to deal with more pressing issues such as the need for infrastructure. As such, interventions such as anti-smoking laws, promoting physical activity and healthy eating get relegated on their list of priorities.
Thirdly, the aging populations across Asia due to increased life expectancies and reduced birth rates mean that people are living long enough to develop NCDs.
Economic Impact Of NCDs On Poor Countries
- Loss of income.
When a family member is afflicted with a NCD such as cancer, the economic impact on the family can be devastating. NCDs often result in many days off work, which translates to a reduction in income. This reduction can be particularly drastic if the breadwinner falls ill. Casualties of this extra-tight budget are often children, whose educational opportunities might be cut off. Without an education, these children are unable to escape poverty.
- Financial hardship from paying for healthcare.
In most developing countries, governments are unable to subsidize healthcare so the out-of-pocket expenditure for a family with a sick member can be significant. Diseases such as diabetes and cardiovascular disease require multiple daily medications that place a huge financial burden on struggling families. According to the WHO report, an estimated 1.4 million to 2 million Indians experienced catastrophic spending in 2004, and 600,000 to 800,000 people were impoverished by the costs of caring for cardiovascular disease and cancer. The findings of another study also revealed that one in four families living in the world’s poorest countries borrows money or sells assets to pay for health care.
- Decrease in national productivity and income, while the healthcare bill burgeons.
Days off work due to NCDs result in a decrease in national productivity and income. It has been estimated that in 2005, China lost S$18 billion in national income from heart disease, stroke and diabetes. In addition, China and India are projected to lose International $ (I$) 12,558 billion (0.93 percent of the GDP) and I$ 237 billion (1.5 percent of the GDP) respectively as a result of these same illnesses between 2005 to 2015.
This study on health and poverty suggests a vicious cycle – where poverty leads to NCDs and NCDs lead to poverty. So what can be done to help developing nations escape this cycle?
Preventing NCDs: The Role of Governments
- Reducing tobacco use.
The most cost effective way to reduce tobacco use is by increasing taxes on tobacco products, as this deters many would-be buyers and forces consumers to cut down on their consumption. The revenue from the tobacco tax could even help subsidize health care. Implementing policies that result in smoke-free work and public places reduce second hand smoke, which in turn reduces the incidence of lung cancers from passive smoking. Smokers looking to cut down or quit smoking will also benefit from this policy. No health intervention is complete without public education. Studies have shown that graphic warnings on tobacco packages and regular mass media campaigns are effective in reducing demand.
- Promoting physical activity.
Numerous studies have shown that regular physical activity is protective against cardiovascular disease and various types of cancer. Exactly how much physical activity is recommended? 60 minutes of moderate- to vigorous-intensity physical activity every day for those aged 5-17. For adults 18 and above, 150 minutes of moderate-intensity aerobic physical activity throughout the week, or at least 75 minutes of vigorous-intensity aerobic physical activity, or an equivalent combination of the two, is recommended. This policy is particularly effective if schools and workplaces are targeted. Exercise should be incorporated into daily life at a young age, and schools can help achieve this by implementing a physical activity component taught by trained teachers in a supportive environment. Workplaces that provide space for fitness and involve workers in program planning and implementation tend to do well in increasing the physical activity levels of their employees.
- Reducing harmful alcohol use.
- Increasing excise taxes on alcoholic beverages.
- Regulating availability of alcoholic beverages, including minimum legal purchase age, restrictions on outlet density and on time of sale, and, where appropriate, governmental monopoly of retail sales.
- Restricting exposure to marketing of alcoholic beverages through marketing regulations or comprehensive advertising bans.
- Drink-driving countermeasures including random breath testing, sobriety check points and blood alcohol concentration (BAC) limits for drivers at 0.5 g/l, with reduced limits or zero tolerance for young drivers.
- Treatment of alcohol use disorders and brief interventions for hazardous and harmful drinking.
This can be achieved through the following measures.
- Promoting healthy diets.
- Achieving a balance between energy intake from food, and energy expenditure from physical activity to maintain a healthy weight.
- Limiting energy intake from total fat (not to exceed 30 percent of total energy intake), and shifting fat consumption away from saturated fat to unsaturated fat, and towards elimination of trans-fatty acids.
- Limiting intake of free sugars.
- Limiting sodium consumption from all sources and ensuring that salt is iodized.
- Increasing consumption of fruits, legumes, whole grains and nuts.
Unhealthy diets increase the risk of NCDs including cardiovascular disease, some cancers and diabetes. Eating habits are, and always will be, a personal choice. While a government can educate its population on healthy eating, the reality is that fast food tastes good and junk food is cheap. To struggling families on a tight budget, it is an attractive option despite what the health boards say. To tackle this issue, governments need to raise taxes on unhealthy foods while reducing taxes on healthy options. Studies have shown these measures to be particularly effective in lower-income populations.
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Source: World Health Organization.
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