The Nation Sunday,
May 31, 2015 Clipboard
Today is World No
Tobacco Day
Two-thirds of
all cancer deaths occur in low-and middle-income countries. Lung, breast,
colorectal, stomach and liver cancers cause the majority of cancer deaths. In
high-income countries, the leading causes of cancer deaths are lung cancer
among men and breast cancer among women. Some countries have created components
of the health infrastructure that is essential to containing the spread of
NCDs, but have not effectively funded or implemented them.
Non-Communicable
Diseases - Leading global cause of death
By Manjari Peiris
The Global Status
Report on non-communicable diseases 2010 developed by WHO is the first report
on the worldwide epidemic of cardiovascular diseases, cancer, diabetes and
chronic respiratory diseases.
This report reviews
the current status of non-communicable diseases and provides a road map for
reversing the epidemic by strengthening national and global monitoring and
surveillance, scaling up the implementation of evidence-based measures to
reduce risk factors like tobacco use, unhealthy diet, physical inactivity and
harmful alcohol use, and improving access to cost-effective healthcare
interventions to prevent complications, disabilities and premature death.
Burden
Of a total of 57
million deaths occurred in the world during 2008, 36 million were due to NCDs,
principally cardiovascular diseases, diabetes, cancer and chronic respiratory
diseases. Nearly 80 percent of these NCD related deaths (29 million) occurred
in low -and middle-income countries. NCDs are the most frequent causes of death
in most countries in the Americas, the Eastern Mediterranean, Europe, South
East Asia, and the Western Pacific in the African Region.
The leading causes of
NCD deaths in 2008 were: Cardiovascular diseases (17 million deaths, or 48
percent of NCD deaths); cancers (7.6 million, or 21 percent of NCD deaths); and
respiratory diseases, including asthma and Chronic Obstructive Pulmonary
Disease (COPD), (4.2 million). Diabetes caused an additional 1.3 million
deaths.
More than two thirds
of all cancer deaths occur in low- and middle-income countries. Lung, breast,
colorectal, stomach and liver cancers cause the majority of cancer deaths.
In high-income
countries, the leading causes of cancer deaths are lung cancer among men and
breast cancer among women. In low- and middle-income countries cancer levels
vary according to the prevailing underlying risks.
Most NCDs are
strongly associated and causally linked with four behaviours: Tobacco use,
physical inactivity, unhealthy diet and the harmful use of alcohol.
Tobacco
Tobacco use and
exposure comes in both smokeless and smoking forms. Smokeless tobacco is
consumed in un-burnt forms through chewing or sniffing and contains several carcinogenic,
or cancer-causing, compounds. Smokeless tobacco has been associated with oral
cancer, hypertension, heart disease and other conditions. Smoking tobacco, by
far the most commonly used form globally, contains over 4000 chemicals, of
which 50 are known to be carcinogenic.
Risks to health from
tobacco use result not only from direct consumption of tobacco, but also from
exposure to secondhand smoke. Almost six million people die from tobacco use
and exposure each year, accounting for six percent of all female and 12 percent
of all male deaths in the world. Of these deaths, just over 600, 000 are
attributable to second-hand smoke exposure among non-smokers, and more than
five million to direct tobacco use (both smoking and smokeless)
Insufficient physical
activity
Approximately 3.2
million deaths each year are attributable to insufficient physical activity.
People who are insufficiently physically active have a 20–30 percent increased
risk of all-cause mortality compared to those who engage in at least 30 minutes
of moderate intensity physical activity on most days of the week. Participation
in 150 minutes of moderate physical activity each week (or equivalent) is
estimated to reduce the risk of ischemic heart disease by 30 percent, the risk
of diabetes by 27 percent, and the risk of breast and colon cancer by 21–25
percent. Additionally, physical activity lowers the risk of stroke,
hypertension and depression. It is a key determinant of energy expenditure and
thus fundamental to energy balance and weight control.
Alcohol consumption
There is a direct
relationship between higher levels of alcohol consumption and rising risk of
some cancers, liver diseases and cardiovascular diseases. The relationship
between alcohol consumption and ischemic heart and cerebrovascular diseases is
complex. It depends on both the amount and the pattern of alcohol consumption.
Unhealthy diet
Adequate consumption
of fruit and vegetables reduces the risk for cardiovascular diseases, stomach
cancer and colorectal cancer. There is convincing evidence that the consumption
of high levels of high-energy foods, such as processed foods that are high in
fats and sugars, promotes obesity compared to low energy foods such as fruits
and vegetables. The amount of dietary salt consumed is an important determinant
of blood pressure levels and overall cardiovascular risk. A population salt
intake of less than five grams per person per day is recommended by WHO for the
prevention of cardiovascular disease. However, data from various countries
indicate that most populations are consuming much more salt than this quantity.
It is estimated that decreasing dietary salt intake from the current global
levels of 9–12 grams per day – to the recommended level of 5 grams per day –
would have a major impact on reducing blood pressure and cardiovascular
disease. There is convincing evidence that saturated fat and trans-fat increase
the risk of coronary heart disease and that replacement with monosaturated and
polyunsaturated fat reduces the risk.
Blood pressure
Worldwide, raised
blood pressure is estimated to cause 7.5 million deaths, about 12.8 percent of
the total of all annual deaths. Raised blood pressure is a major risk factor
for coronary heart disease and ischemic as well as hemorrhagic stroke). Blood
pressure levels have been shown to be positively and progressively related to
the risk for stroke and coronary heart disease. In addition to coronary heart
diseases and stroke, complications of raised blood pressure include heart
failure, peripheral vascular disease, renal impairment, retinal hemorrhage and
visual impairment. Treating systolic blood pressure and diastolic blood
pressure so they are below 140/90 mmHg is associated with a reduction in
cardiovascular complications.
Overweight and obesity
Overweight and
obesity lead to adverse metabolic effects on blood pressure, cholesterol,
triglycerides and insulin resistance. Risks of coronary heart disease, ischemic
stroke and type 2 diabetes mellitus increase steadily with increasing Body Mass
Index (BMI), a measure of weight relative to height. Raised BMI also increases
the risk of cancer of the breast, colon/rectum, endometrial, kidney, esophagus
(adenocarcinoma) and pancreas. Mortality rates increase with increasing degrees
of overweight, as measured by BMI. The prevalence of raised BMI increases with
income level of countries, up to upper middle-income levels.
The prevalence of
overweight in high-income and upper middle-income countries was more than
double that of low- and lower-middle income countries.
Cholesterol Raised
Cholesterol levels
increase the risks of heart disease and stroke. Globally, a third of ischemic
heart disease is attributable to high cholesterol. Overall, raised cholesterol
is estimated to cause 2.6 million deaths. Raised total cholesterol is a major
cause of disease burden in both the developed and developing world as a risk
factor for ischemic heart disease and stroke. In low-income countries around a
quarter of adults had raised total cholesterol, in lower-middle income countries.
This rose to around a third of the population for both sexes. In high income
countries, over 50 percent of adults had raised total cholesterol; more than
double the level of the low-income countries.
Cancer associated
infections
A wide range of
environmental causes of cancer, encompassing environmental contaminants or
pollutants, occupationally related exposures and radiation, together make a
significant contribution to cancer burden and are often modifiable at low cost.
Notable examples of environmental causes of cancer are asbestos, benzene,
indoor and outdoor air pollution and contaminants such as arsenic. Ionizing
radiation increases the risk for several cancer types. Impact on development
The NCD epidemic
exacts a massive socioeconomic toll throughout the world. It is rising rapidly
in lower-income countries and among the poor in middle and high-income
countries. Each year, NCDs are estimated to cause more than 9 million deaths
before the age of 60 years with associated negative impacts on productivity and
development. The increasing burden of NCDs also imposes severe economic
consequences that range from poverty of families to high health system costs
and the weakening of country economies.
Lack of monitoring
The WHO points out
that current capacity for NCD surveillance are inadequate in many countries and
urgently require strengthening. High quality NCD risk factor surveillance is
possible even in low-resource countries and settings. A surveillance framework
that monitors exposures (risk factors and determinants), outcomes (morbidity
and mortality) and health-system responses (interventions and capacity) is
essential. A common set of core indicators is needed for each component of the
framework. Cancer morbidity data are essential for planning and monitoring
cancer control initiatives. Population-based cancer registries play a central
role in cancer control programs, because they provide the means to plan,
monitor and evaluate the impact of specific interventions in targeted
populations.
Interventions
The majority of NCD
can be averted through interventions and policies that reduce major risk
factors. Many preventive measures are cost-effective, including for low-income
countries. Some preventive actions can have a quick impact on the burden of
disease at the population level. Interventions that combine a range of
evidence-based approaches have better results. Comprehensive prevention
strategies must emphasize the need for sustained interventions over time.
WHO states
That there is robust evidence
that tobacco control is cost-effective compared to other health interventions.
Promoting physical
activity and healthy diet through the media is a cost effective and highly
feasible intervention.
Cost-effective
measures for reducing harmful alcohol use include increasing alcoholic beverage
taxes, regulating the availability of alcoholic beverages, restricting
marketing of alcoholic beverages and drink-driving countermeasures.
The majority of
non-communicable diseases can be averted through interventions and policies
that reduce major risk factors.
Currently, many low-
and middle income countries have health systems that do
not meet the
requirements for chronic care.
Cardiovascular
mortality rates have declined substantially in high-income countries. The
decline is due to both prevention and treatment interventions.
Access to care, oral
morphine and staff trained in palliative care is limited in many low- and
middle-income countries, so that most cancer patients die without adequate pain
relief.
When cost-effective
healthcare interventions are complemented with population-wide prevention
strategies, a significant impact can be made on the global NCD epidemic.
To improve
efficiency, health-system policies should prioritize interventions that are
essential for preventing the progression of NCDs. Limited resources and weak
health systems in low- and middle-income countries, demand prioritization of a
package of essential NCD interventions, including best buys (high impact, very
cost-effective, affordable and feasible interventions). Financing and
strengthening health systems to deliver the best buys through a primary heal and
12 percent of all male deaths in the world. Of these deaths, just over 600, 000
are attributable to second-hand smoke exposure among non-smokers, and more than
five million to direct tobacco use (both smoking and smokeless)
Impact on development
The NCD epidemic
exacts a massive socioeconomic toll throughout the world. It is rising rapidly
in lower-income countries and among the poor in middle and high-income
countries. Each year, NCDs are estimated to cause more than 9 million deaths
before the age of 60 years with associated negative impacts on productivity and
development. The increasing burden of NCDs also imposes severe economic
consequences that range from poverty of families to high health system costs
and the weakening of country economies.
Lack of monitoring
The WHO points out
that current capacity for NCD surveillance are inadequate in many countries and
urgently require strengthening. High quality NCD risk factor surveillance is
possible even in low-resource countries and settings. A surveillance framework
that monitors exposures (risk factors and determinants), outcomes (morbidity
and mortality) and health-system responses (interventions and capacity) is
essential. A common set of core indicators is needed for each component of the
framework.
Cancer morbidity data
are essential for planning and monitoring cancer control initiatives.
Population-based cancer registries play a central role in cancer control
programs, because they provide the means to plan, monitor and evaluate the
impact of specific interventions in targeted populations. Interventions The
majority of NCD can be averted through interventions and policies that reduce
major risk factors. Many preventive measures are cost-effective, including for
low-income countries. Some preventive actions can have a quick impact on the
burden of disease at the population level.
Interventions that
combine a range of evidence-based approaches have better results. Comprehensive
prevention strategies must emphasize the need for sustained interventions over
time.
WHO states That there
is robust evidence that tobacco control is cost-effective compared to other
health interventions. Promoting physical activity and healthy diet through the
media is a cost effective and highly feasible intervention. Cost-effective
measures for reducing harmful alcohol use include increasing alcoholic beverage
taxes, regulating the availability of alcoholic beverages, restricting
marketing of alcoholic beverages and drink-driving countermeasures. The
majority of non-communicable diseases can be averted through interventions and
policies that reduce major risk factors.
Currently, many low-
and middle income countries have health systems that do not meet the
requirements for chronic care. Cardiovascular mortality rates have declined
substantially in high-income countries. The decline is due to both prevention
and treatment interventions. Access to care, oral morphine and staff trained in
palliative care is limited in many low- and middle-income countries, so that
most cancer patients die without adequate pain relief. When cost-effective
healthcare interventions are complemented with population-wide prevention
strategies, a significant impact can be made on the global NCD epidemic.
To improve
efficiency, health-system policies should prioritize interventions that are
essential for preventing the progression of NCDs. Limited resources and weak
health systems in low- and middle-income countries, demand prioritization of a
package of essential NCD interventions, including best buys (high impact, very
cost-effective, affordable and feasible interventions).
Financing and
strengthening health systems to deliver the best buys through a primary
healthcare approach is a realistic first step to achieve the long-term vision
of universal coverage.
According to WHO, in
the past decade, countries have expanded their capacities to respond to the
epidemic of non-communicable diseases. Real progress, though uneven, has been
made. Many countries have developed NCD strategies, plans and guidelines,
although a substantial proportion of them are not yet operational.
Some
countries have created components of the health infrastructure that is
essential to containing the spread of NCDs, but have not effectively funded or
implemented them. However, the existence of initiatives to combat the NCD
epidemic in a growing number of countries provides a strong foundation to
extend progress in the coming years through increasingly robust efforts.
High-income countries were nearly four times more likely to have NCD services
and treatments covered by health insurance than low-income countries. The
availability of NCD treatments in low-income countries is one quarter that of
high-income countries.
Even in hospital settings in low income countries, there
is limited availability of basic technologies required for NCD care.
WHO states that
Country capacity for the prevention and control of NCDs have seen significant
improvements in the past decade. Growing country capacity for combating the NCD
epidemic indicates that there is a significant opportunity for progress over
the coming years. Current evidence unequivocally demonstrates that NCDs are largely
preventable. Countries can reverse the advance of these diseases and achieve
quick gains, if appropriate action is taken.
The WHO points out
that reversing the epidemic of NCDs is not only a key responsibility of all
governments. It also requires engagement from civil society and the business
sector. Civil society institutions are uniquely placed to mobilize political
awareness and support for NCD prevention and control. They play a key role in
advocating for NCDs to be a part of the global development agenda.
Civil society
institutions and nongovernmental organizations contribute to capacity building.
They are also significant providers of prevention and treatment services for
cardiovascular disease, cancer, diabetes and respiratory diseases, often
filling gaps between services provided by the private and government sectors.
At a global level,
nongovernmental organizations have grouped together to collectively support and
influence global tobacco control efforts and, more recently, wider NCD prevention
control, providing a strong platform for advocacy and action.
The role and capacity
of civil society should be supported and strengthened at the national and
international levels. Companies should also adopt and strengthen programs to
improve the health and well-being of their employees through workplace health
promotion and specific NCD prevention schemes. Virtually all industries can
help to reduce pollution and promote healthy lifestyles.
