Non-Communicable Diseases (NCDs)
What are NCDs?
NCDs are usually considered to be - chronic conditions not passed from person to person.
The World Health Organisation (WHO) includes four main groups:
- cardiovascular disorders e.g. such as ischaemic heart disease and stroke,
- respiratory disorders e.g. chronic obstructive pulmonary disease and asthma,
These account for around 80% of NCD deaths.
The burden of NCD mortality falls largely on the poorest.
(It should be remembered that poor data collection systems and diagnostic services in low income countries mean many cases of NCDs go unreported and undiagnosed.)
Not included in the WHO groups, but contributing to the other 20% of NCD deaths
The definition does not include all causes of morbidity and disability not passed from person to person. Others include conditions that are
musculoskeletal (osteoarthritis, rheumatoid arthritis),
neurological (Parkinsons disease, epilepsy)
mental health conditions (depression, schizophrenia).
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The scale of the problem (which is increasing)
NCDs account for 63% of all global deaths each year - 36 million people. 80% of these are in low and middle income countries (LMICs).
The "Double Whammy"
Low and middle income countries overcoming the problems of poverty and communicable diseases are now being faced at the same time with the emergence of NCDs.
Stunting and obesity in children co-exist as does increasing obesity in adults, greater consumption of processed foods and reduced physical activity.
Cardiovascular disease (CVD)
Over 80% of CVD deaths occur in low and middle income countries and occur almost equally in men and women.
Lung Cancer : The majority of cases of lung cancer occurs in developing countries (55%).The primary cause of lung cancer globally is smoking tobacco.
Chronic Respiratory Conditions : More than 50% of those suffering chronic respiratory conditions live in low and middle income countries or deprived populations.
Men : In some developing countries, the proportion of male respiratory deaths resulting from tobacco is over twice that resulting from indoor air pollution.
Women : The highest proportion of female deaths in those countries is due to indoor air pollution, reflecting the greater proportion of time women spend cooking using biofuels in confined spaces.
Diabetes prevalence is increasing. It is expected to grow by an astonishing 98% over the next 20 years - from 12.1 million in 2010 to 23.9 million in 2030.
Sub Suharan Africa : 6% of early deaths in subSaharan Africa are attributable to diabetes Highest mortality rates in the 20 - 39 year age group - the most economically active group.
Asia : the increase in Type 2 diabetes has been particularly marked; developing in a shorter time period, in a younger age group and in people with substantially lower bodymass index (BMI) than elsewhere.
India : urban and migrant men are 2.4 and 2.1 times more likely respectively to have diabetes than rural men. Urban and migrant women are both 2.3 times more likely to have diabetes than rural women.
The burden from NCDs will increase - this because there is an ageing population with longer life expectancy, population growth, urbanization and increasing exposure to risk factors.
The global costs are already huge and will also increase.
||Cost in 2010 (US$)
||Projected cost by 2030 (US$)
||863 billion (125/capita)
NCDs are an urgent global health priority - the UN conference on sustainable development (2012), Rio 20+, referred to NCDs as “one of the major challenges for sustainable development in the 21st century".
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What does the UN say about it?
In 2011 the United Nations held a High Level Meeting on the Prevention and Control of Non-Communicable Diseases in response to the global epidemic of NCDs. It recognised that tackling NCDs was a priority for Global Health and called for action to be taken. Conclusions of the meeting included :
a) The socioeconomic and development impact : NCDs as a ‘major challenge’ of the 21st century, which undermines social and economic development, and therefore increases inequalities between nations
b) Whole of government/Whole of society effort is required : Prevention is considered as the ‘cornerstone’ of the global response to NCDs, recognizing the importance of the decrease in exposure of populations to common modifiable risk factors for NCDs, namely tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol.
Effective prevention and control requires crosssector approaches and different players
c) Reduction of risk factors and creating healthy promoting environments : These are attainable through advance interventions in relevant international agreements and strategies; policies; marketing of foods and nonalcoholic beverages to children; cost effective interventions to reduce salt, fatty acid intake; promotion, protection and support of breastfeeding; role of private sector
d) Strengthening national policies and health systems : Multisectoral national policies required to strengthen and integrate into health planning processes. Focus should include, for example, primary care interventions for NCD risk factors, palliative care, local knowledge contribution, universal coverage, strengthening of health infrastructure etc.
e) International Cooperation : Strengthening of international cooperation through
- North/South, South/South and triangular cooperation
- inclusion of NCDs in development agenda
- providing technical assistance
- enhancing quality of aid etc.
f) Research & Development : promoting activity through national and international investments, strengthen capacity for quality R&D; use of information and communications technology to improve programme implementation; supporting and facilitating NCD disease related research to enhance knowledge base for ongoing national, regional and global action
g) Monitoring & Evaluation : strengthening of surveillance and monitoring systems to include the monitoring of exposure to risk factor, outcomes, social and economic determinants; considering development of national targets and indicators based on national situations
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What do we do about it?
The WHO four conditions responsible for 80% of NCD deaths share the following FOUR risk factors :
PREVENTION IS KEY
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What works best? WHO "Best Buys"
Dahlgren and Whitehead’s model of the factors that affect health provide a policy framework for how to tackle the problem.
Evidence of effectiveness accumulated by WHO about specific interventions that work has resulted in WHO's "Best Buys" to tackle NCDs.
WHO "Best Buys" for Non-Communicable Diseases in Low and Middle Income Countries
- Tax increases
- Smoke-free indoor workplaces and public places
- Health information and warnings
- Bans on tobacco advertising, promotion and sponsorship
|Harmful alcohol use
- Tax increases
- Restricted access to retailed alcohol
- Bans on alcohol advertising
|Unhealthy diet and physical inactivity
- Reduced salt intake in food
- Replacement of trans fat with polyunsaturated fat
- Public awareness through mass media on diet and physical activity
|Cardiovascular disease and diabetes
- Counselling and multi-drug therapy for people with a high risk of developing heart attachs and strokes (including those with established CVD
- Treatment of heart attacks with aspirin
- Hepatitis B immunization to prevent liver cancer (already scaled up)
- Screening and treatment of pre-cancerous lesions to prevent cervical cancer
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WHO. Global + status report on noncommunicable diseases 2010.
WHO Fact Sheet on Non-Communicable Diseases
United Nations. The future we want. New York: United Nations, 2012.
WHO Social Determinants of Health : Progress on the implementation of the Rio Political Declaration