Introduction to NCDs

In this lecture we will be discussing the most important public health challenge of the 21st Century in terms of the global burden of death and disability, that is, non-communicable diseases. In September 2011, the United Nations convened a high level meeting of heads of state to discuss the response to this growing global threat. The second time ever that heads of state met to discuss a health issue under the United Nations. The first one being a meeting on HIVAIDS in 2001. This is because the four major non-communicable diseases, cardiovascular diseases, cancer, respiratory diseases and diabetes together account for the largest number of deaths as well as the highest burden of disability in the world. Of course there are other non-communicable diseases that are chronic diseases like for example cirrhosis of the liver or kidney diseases and of course mental health which is a very major chronic disease. And we also have other problems like oral health, or eye health, which also qualify for non-communicable diseases. But if you take these four major disorders, that is heart diseases and blood vessel diseases, cancers, respiratory diseases and diabetes, they’re linked by four common risk factors. That is, unhealthy dietary patterns, physical inactivity, tobacco and alcohol consumption. And that’s why these were clumped together in that high level meeting which the United Nations and the WHO convened. If we look at how this has become a major global threat from 57% of all deaths occurring in the world in 1990, it has grown to contribute to over 65% of deaths in the world by 2010. But that’s not the only problem.

The problem is that a large majority of these deaths are occurring in the developing countries and are occurring in very young people. If you look at the deaths that occurred in 2008, about 60% of all deaths in the world were because of non-communicable diseases. But 80% of them occurred in the developing countries. A quarter of all NCD related deaths occurred below the age of 60 years. And 90% of them occurred in the developing countries, the low and middle income countries. So it is the question of prematurity of these deaths in the productive prime of midlife which is a major threat to development and sustainable development. And the pattern of these diseases also has been changing. In the developed countries heart attacks or ischemic heart disease and stroke or brain attacks due to blood vessel disease of the brain have been the dominant killers over the last 20-25 years and have remained so. However, in the developing countries, infections, particularly among children used to be the major cause of death in 1990, but now both stroke or brain attacks and ischemic heart disease or heart attacks have risen to the top, even among the developing countries. And this is a major threat to development. And we find that because people are dying young in the developing countries, what we call the age standardized mortality rates are much higher in the low and middle income countries. Even though, at the proportion of deaths occurring in the population, the high income countries still have NCDs as the major killer. But even the proportional mortality is rising in the developing countries and the problem of premature death continues to haunt them. And this is a major consequence for development, because we do recognize that as health transition occur, the poor among countries and the poor within countries are increasingly becoming vulnerable. This has been so in the high income countries for the last 30 years. But even in the developing countries, we are now finding that the poorer socioeconomic groups are much more affected by chronic diseases because of the risk factors are becoming much more common among them. And even deaths due to non-communicable diseases are occurring much more frequently among the poor than among the rich who now know how to protect themselves. So this is a huge directed development and sustainable development. And the economic impact of this is tremendous. NCDs by themselves have been estimated by a study of the Harvard School of Public Health to lead to a cumulative loss of $30 trillion dollars globally between 2011 and 2030. And if you add the loss due to mental illness, this loss rises to $47 trillion dollars. And many of the developing countries are going to be experiencing a serious threat to their economic and social development if we do not stem this epidemic with concerted global response. And we recognize also that this is a threat to health equity because the poor are suffering much more, because of lack of knowledge, lack of access to health services, and inability to obtain timely and efficient care. But it’s also a threat to the sustainable development because many of the determinants of NCDs are also linked to the determinants of environmental degradation. And we need to look at this as a common problem in the context of what we are attempting for sustainable development over the next 15 years. As NCDs rise year by year, between 2010 and ’25, we will see a rise of NCD related deaths by 10.5 million per year. And 9.5 million of these additional 10.5 million deaths in 2025 will be in the low and middle income countries. But fortunately we have the knowledge to act and save many of these. It has been estimated that about 37 million lives can be saved in these 15 years if we act on six risk factors of non-communicable diseases, which have been identified as targets for action by the United Nations and the World Health Organization. And if we act even more effectively on tobacco we will be able to reduce it even further in terms of the total number of deaths that can be prevented. And if we add effective treatments which are available but become, need to become more accessible, then we are likely to save even more lives. So we do have the knowledge and tools to bring about a substantial reduction in the total burden of non-communicable diseases if we act effectively. And in order to help us do that, the United Nations has now set up a goal globally for 25 by ’25, which means that we need to try and reduce the number of premature deaths in the age group of 30 to 70 years which are occurring because of non-communicable diseases, by 25% by the year 2025 compare to the baseline year of 2010. So 25 by 25 means we are preventing premature deaths by utilizing effective interventions against risk factors as well as effective treatments. So now we recognize that non-communicable diseases are the major public health challenge of this century affecting not only the developed countries, but sweeping across the low and middle income countries, where it is particularly a threat because of the age at which these diseases kill. Cardiovascular diseases or heart and blood vessel diseases, cancers, diabetes and chronic respiratory diseases are now accounting for the largest number of deaths in the world, but are also killing a large fraction of them in the developing countries below the age of 60 years. And this is a major threat to economic development, particularly in these countries and is a threat to sustainable development globally. But fortunately we also recognize that these risk factors are modifiable and many of these diseases are treatable. And in that, we can save many valuable lives through effective interventions. We know that by acting on the important modifiable risk factors like tobacco, healthy dietary patterns and alcohol consumption, we can substantially modify the projected disease burden of non-communicable diseases and by coupling it with effective treatments we can save many lives across the world. And that is why the goal of 25 by 25 which asks us to reduce premature mortality due to NCDs by 25% by the year 2025 is not unrealistic. We can do it.

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