Why non-communicable diseases have become killer kings across the entire world
We did not take it very seriously when the World Health Organisation (WHO) released a factsheet on the top 10 causes of death in 2018.
But almost eight months thence, it has been established — non-communicable diseases are becoming the top killers of humankind, closely followed by substance abuse and psychological disorders.
The global burden of noncommunicable diseases is high, with 40 million deaths per year, including 15 million deaths in individuals younger than 70 years.
According to the WHO factsheet, non-communicable diseases (NCDs) kill 41 million people each year and account for 71 per cent of all deaths globally. Each year, 15 million people die from an NCD between the ages of 30 and 69 years — over 85 per cent of these "premature" deaths occur in low- and middle-income countries.
Cardiovascular diseases (heart attacks and stroke) have been the world’s biggest killers for 15 years now — accounting for a combined 17.9 million deaths annually.
That is nearly 18 times the deaths caused by HIV/AIDS. In 2016, one million people died of AIDS — which is no longer among the world’s top 10 causes of death. This is followed by cancers (9 million), respiratory diseases (3.9 million), and diabetes (1.6 million) — up from less than 1 million in 2000.
Chronic obstructive pulmonary disease claimed three million lives in 2016, while lung cancer (along with trachea and bronchus cancers) caused 1.7 million deaths. Lower respiratory infections remained the most deadly communicable disease, causing three million deaths worldwide in 2016.
The death rate from diarrhoeal diseases caused 1.4 million deaths in 2016, and the number of tuberculosis deaths is still among the top 10 causes with a death toll of 1.3 million. Deaths due to dementias more than doubled between 2000 and 2016, making it the 5th leading cause of global deaths in 2016 — compared to 14th in 2000.
The growing toll to NCDs, the lack of new technologies to deal with them and the resistance to societal change have left healthcare professionals and policymakers troubled.
“Non-communicable diseases will radically disrupt the future of global health, and we don’t have the right institutional competencies to deal with it. They are not just disruptive because of the epidemiological damage that they cause. They are equally disruptive in terms of the political, economic, technological, societal, and health systems responses needed to make a sustained difference,” says Sania Nishtar, the co-chair of the WHO independent high-level commission on NCDs.
According to WHO’s report titled Economic Burden of Non-communicable Diseases, in the low- and middle-income countries, NCDs account for 78 per cent (around 31 million) all deaths — yet only one per cent of global health funding goes towards preventing these diseases.
The cost of not taking action against such diseases is enormous — not only in diagnosis and treatment costs but also in premature deaths. Estimations suggest that economic loss from premature deaths due to non-communicable diseases will be over 30 trillion United States dollars in the next 20 years, equivalent to half the global gross domestic product in 2010.
To mount an effective response to tackling NCDs, we need a societal transformation towards healthier lifestyle choices, a re-engineering of health systems for chronic care, new cross-government norms in trade, commerce and fiscal decision making, new values underpinning profitability and investment, and a culture of cross-government and public-private partnerships that delivers on public outcomes, Nishtar adds.
At the UN High-Level Meeting on the Prevention and Control of Non-Communicable Diseases, held in New York in September 2011, seven risk factors for NCDs were identified —poor diet, physical inactivity, tobacco abuse, alcohol consumption, prenatal nutrition, maternal diseases, and household air pollution.
While the latter three causes have to be addressed at a policy level, the former four causes can be addressed at a micro level. It involves lifestyle changes, including adopting a healthy diet and exercise regimen, taking certain precautions and giving up substance abuse.
The UN Sustainable Development Goal 3.4 for 2030 — to reduce by one-third pre-mature mortality from non-communicable diseases (NCDs) through prevention and treatment, and promote mental health and wellbeing — has led to a huge demand for technical assistance from the first world. However, technical assistance has a narrow influence, given the limited leverage of health ministries of the recipient countries on the determinants of NCDs.
National and international organisations need to be better prepared with the skills and resources in the healthcare sector to deal with NCDs. Modus operandi developed for dealing with infectious diseases will have a very limited scope on working for non-communicable diseases — hence, better R&D needs to be deployed.
Most importantly, societal attitudes need to change in terms of a better lifestyle and a healthier attitude towards dealing with psychological health. In a country like ours, where psychological health is often scoffed at or stigmatised, much better awareness and education are key.
Without a better attitude towards self and society, coupled with organisational setbacks by policymakers, we are progressing rapidly towards nurturing a country of the sick and infirm. It translates to one step forward and ten behind in terms of economic development.
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