By Asmita Anand
Published 5:22 PM EST, Mon March 22, 2021
Introduction
Unlike communicable diseases, non-communicable diseases haven’t seen a drop in figures in recent years. Known as ‘the product of economic development and globalisation of western lifestyle and diets’, they kill over 40 million people annually (70% of deaths worldwide)[1] and dominate mortality and morbidity in advanced countries. Today they affect people in every continent and from all cultures.
What Are Non-Communicable Diseases (NCDs) and How Are They Caused?
NCDs can be known as chronic diseases and cannot be spread from person to person.They are usually caused by a combination of genetic vulnerabilities combined with physiological, lifestyle and environmental factors. For example, factors range from living in poverty or polluted surroundings to poor diet, tobacco and alcohol use.
Figure 1 showing chronic disease risk factors for the four most common types of NCDs
NCDs include a variety of diseases ranging from 5 main groups: cancer, cardiovascular diseases (e.g. heart attacks or stroke), diabetes, chronic respiratory diseases (e.g. asthma) and mental disorders and other mental health conditions. Previously, mental health has been overlooked as a part of NCDs but recently UN member states expanded to a ‘five-by five approach’ to effectively tackle the prevention and control of NCDs [2]. Mental health’s integration along with these 4 common groups of NCDs is important as mental conditions often occur in conjunction with other physical NCDs and their risk factors often overlap. Another large misconception around NCDs is that they mainly affect the developed world, whilst diseases of poverty mainly affect the developing world. This sometimes leads to failure in regarding iit as a global health priority.
What Are The Risks of NCDs?
Over-nutrition and excessive consumption of sugar, carbohydrates, fats and salts are becoming increasing health risks. These heightened risks are exacerbated by obesity and physical inactivity, which are increasingly apparent in younger age groups. Today these factors are being encouraged due to lifestyle and society changes.
The prevalence of non-communicable diseases is increasing in richer countries. Unlike the popular belief of NCDs mostly afflicting the wealthy, the incidence of cancer is rising in poorer countries and expected to double by 2030. In 2016 around 70% of cancer deaths were in low to middle income countries [3]. However the incidence of cancer by age is still much greater in advanced countries than in LIDC’s and MIC’s.
Global Impact
NCDs impact both the rich and poor causing a large burden of disease globally.
As can be seen above in Figure 2, the majority of countries affected by NCDs, such as Africa and Eastern Europe, are all middle and lower income countries. This is especially true as the estimated percentage increase in cancer incidence by 2030, (compared to 2008) will be higher in both low (82%) and lower-middle-income countries (70%) compared with the upper-middle (58%) and high-income countries (40%) [4]. Differentiating NCDs by just affluence or poverty isn’t particularly useful to understand the global pattern of disease but instead the result of economic development. Those of lower social and economic positions are more likely to die sooner from NCDs compared to those in higher positions, often resulting in driving these poorer members into more poverty. Reasons for this range from the negative effects of rapid globalisation and development in these poorer countries which often result in undeveloped infrastructure and resources to protect members from NCDs and to prevent engagement in behavioural risk factors for NCDs.
Why Is There An Increase In NCDs?
An increase in NCDs is likely due to the ongoing shift in global lifestyles. This is especially occurring in developing countries, hence forming the global pattern above. A number of factors support the growth of NCDs, including:
- Population ageing
- Increase in consumption of sugar, carbohydrate and fat (unhealthy diets), which can lead to both raised cholesterol and blood pressure.
- Global marketing which encourages unhealthy eating habits (Smoking, alcohol, junk food) targeted at children, adolescents and women in developing countries. These habits then stay with them their entire life and will get passed to the next generation.
- Growing urbanisation that has an impact on people’s lifestyle (e.g. poor diet and insufficient physical activity leading to obesity, rising levels of air pollutants).
- In developing countries, governments tend to make less restrictions (e.g. on smoke-free laws, pollution control, education on diet/alcohol use, urban planning to encourage physical activity). People in developing countries are more likely to have low life expectancies due to the harsh conditions they live in resulting in higher incidence of disease & illness compared to rich developed economies.
The Link to Environmental Risks
NCDs and environmental factors are intrinsically linked, hence climate change and NCDs share the similar goal to reduce emissions that is the cause of air pollution and global warming. Steps to control emissions across energy production, transport systems and food systems will produce benefits for both health and the environment.
In Figure 2, we can see that in 2016 the second largest risk factor was air pollution after tobacco smoking. Depending on the population and other factors, in places such as Southeast Asia, air pollution would be one of the biggest causes of NCDs.
Figure 3, Graph depicting selected risk factors by disease group, 2016.
More than 40% of people, mainly in low and middle income countries, are cooking with inefficient technology and fuel combinations leading to the accumulation of harmful smoke in their homes. Evidence is emerging that this has caused an increase in NCDs that includes 24% of cases of stroke, 25% of ischaemic heart disease, 28% of lung cancer, and 43% of chronic obstructive respiratory disease [5].
Neurological and mental disorders can also be associated with chemicals and around 1.3 million deaths from NCDs were caused by risks related to chemicals in 2016. To stop this form occurring, safer use of chemicals and more health measures are being carried out. Apart from health benefits, combating air pollution could also reduce climate change.
Focused Research on Diabetes
At the moment, 422 million people have diabetes worldwide and it is becoming a major issue [6].
This figure can be translated to 1 in 11. With the rise of diabetes cases, Technavio analysts have predicted that in 2019 to 2023, the global blood glucose test strips market will grow at a CAGR of over 6%. Around 39% of this growth will be Americans alone and such a high surge means a lot more money will be spent in this area too. In the UK an estimated £14 billion pounds is spent a year on treating diabetes and its complications [7]. This equates to over £25,000 being spent on diabetes every minute.
One reason for an increase in these figures could be again due to the shifting lifestyles the world is facing. Obesity rates are one of the main drivers behind the rise of type 2 diabetes. Equally it is also entirely possible that the increasing prevalence of type 2 diabetes is due to earlier and better detection strategies as the symptoms can be hard to spot.
Many are unaware of the real cause behind a disease such as type 2 diabetes. It is a popular myth that sugar triggers diabetes, as many assume the increased blood sugar levels in diabetic patients must be its root cause.
It is in fact not caused by a high carbohydrate diet or sugar but a diet that builds up the amount of fat in the blood. An accumulation of microscopic fat particles within muscle and liver cells leads to glucose being unable to reach where it needs to in the cells despite the efforts of insulin. As a result the pancreas produces extra insulin and glucose builds up in the bloodstream, hence increased blood glucose levels. The combination of insulin resistance and pancreatic cell failure leads to type 2 diabetes, making fat the real culprit. In order to decrease insulin resistance, fat intake needs to be decreased. However one should note a diet high in sugar will also lead to many other serious medical conditions if not contributing to the root cause of diabetes. Furthermore a study by HSPH researchers has found a strong association between both processed and unprocessed red meat and an increased risk of diabetes [8]. This reaffirms the idea that a diet avoiding meat, dairy products and overall fatty foods is a much better precaution to developing type 2 diabetes.
Case Study on Type 2 Diabetes in Sri Lanka
A case study in Sri Lanka has provided the evidence that Type 2 Diabetes is linked mainly to diet, smoking and a poor & inactive lifestyle. Around 25% are suffering from diabetic or pre-diabetic symptoms, and this could double by 2050 [9]. There has also been a rise in BMI in children between the ages of 10-14 and a high number of risk factors are present within the young urban population. In countries like Sri Lanka, there has been a rapid growth of type 2 diabetes.
This can be attributed to a number of reasons:
- Urbanization is increasing up to 59% and influences sedentary lifestyles [9].
- Diets in Sri Lanka are carbohydrate heavy as rice and curry is a staple meal. This is eaten 3 times a day but is not a problem for agricultural workers as much as it is for office workers, who will have a higher sugar intake.
- Many marketing campaigns encourage the use of alcohol and tobacco as currently 29.4% men and 0.1% women smoke [10].
- Around 68% of people work in industry and services and most use cars and public transport opposed to walking or cycling to travel to work [9].
- Exercise has not been a priority as many adults work long hours and so have little time for physical activity. Children also follow their parents path as new generations live in a world full of technology coupled with Sri Lanka’s ‘tuition culture’, leaving them with little free time for exercise as well.
- Another important factor contributing to the onset of diabetes is stress. Sri Lanka experienced a long civil war which led to stress and fear. A Swedish study found that chronic stress for 1-5 years was associated with a 45% increase in risk of both type 1 and 2 diabetes [11]. In response to stress, the body releases hormones which can upset the body’s glucose balance.
Figure 4 showing the distribution of diabetes in Sri Lanka
What Is Being Done in Sri Lanka to Combat Diabetes?
There is an increased media coverage raising awareness for diabetes as the government is focusing more of their attention on health issues. There has been development of fitness facilities (such as new jogging tracks), more education and public awareness (such as lectures, workshops, screening and treatment centers) and research into diabetes. The Diabetes Association of Sri Lanka has set-up walk-in screening centers in Colombo that people can attend at a modest cost. They have also collaborated with a research team from Kings College London on an intensive screening, education and monitoring program which has identified young people at risk from developing diabetes. As of 2016, they had managed to lower the risk of people developing Type 2 diabetes by 26% in the previous 5 years. A developing economy like Sri Lanka is finding it challenging to afford the cost of treatment that is rising by 25 US$ each year.
They have also found out in a study last year (i.e. 2020) that there is a genetic overlap between type 2 diabetes and depression for female participants [12].
To help lower the risk, prevention is key as attitudes to diet and exercise need to change, which includes the control of sugar, fat and salt.
What Is the UK Doing to Combat NCDs?
In the UK itself, NCDs account for around 89% of all adult deaths(2016) [13]. The UK is using systems at both local and national levels to try and prevent and intervene early in NCDs. The national government mainly monitors population behaviors and health indicators with a responsibility to enact policies that will optimize the health of their citizens. In 2012, public healthy responsibilities were deferred to local authorities. Local governments are able to work with the community, respond to local needs and also create settings that support healthier lifestyle behaviors. Examples include the NHS health check and National Child Measurement Programme. Both play a key role in preventing NCD, as even local nutrition prompts in a school or leisure centre could make the difference.
There are many studies and research being done to tackle the epidemic of NCDs as actions such as early immunisations to help lower the risks. Screening programmes and social marketing campaigns such as Change4Life are also making a change. These are run by Public Health England (PHE), who are working with the NHS, to solve this issue nationally and globally.
Conclusion
Overall, by reducing the four main behavioural risk factors (tobacco use, physical inactivity, harmful use of alcohol and poor diet), a large proportion of NCDs could be prevented. In order to end the huge toll they take in forms of human suffering and the damage they cause to economic human development, serious action is needed on a global, national and even a personal scale to end this horrible epidemic.
Asmita Anand, Youth Medical Journal 2021
References
[1]“C3 Collaborating for Health | What Are Non-Communicable Diseases (NCDs)?” C3 Collaborating for Health, 17 May 2018, www.c3health.org/work-with-us/why-prevention/what-are-non-communicable-diseases/#:%7E:text=40%20million%20people%20are%20killed,for%2070%25%20of%20deaths%20worldwide.
[2]Stein, Dan. “Integrating Mental Health with Other Non-Communicable Diseases.” The BMJ, 28 Jan. 2019, www.bmj.com/content/364/bmj.l295.
[3]“The Global Cancer Burden | American Cancer Society.” The Global Cancer Burden, www.cancer.org/health-care-professionals/our-global-health-work/global-cancer-burden.html#:%7E:text=In%202016%2C%20out%20of%20nearly,in%20cancer%20incidence%20by%202030.
[4]Page 13,World Health Organization. “Global Status Report on Noncommunicable Diseases 2010.” World Health Organization, 5 Oct. 2015, www.who.int/nmh/publications/ncd_report2010/en.
[5]Prüss-Ustün, Annette. “Environmental Risks and Non-Communicable Diseases.” The BMJ, 28 Jan. 2019, www.bmj.com/content/364/bmj.l265.
[6]“Diabetes” World Health Organization, 13 May 2019, www.who.int/health-topics/diabetes#tab=tab_1.
[7]Editor. “Cost of Diabetes.” Diabetes, 11 Mar. 2020, www.diabetes.co.uk/cost-of-diabetes.html.
[8]“Red Meat Linked to Increased Risk of Type 2 Diabetes.” News, 13 Jan. 2014, www.hsph.harvard.edu/news/press-releases/red-meat-type-2-diabetes.
[9]Curriculum Press. “A Tsunami of Non-Communicable Diseases?” Curriculum Press, 5 Apr. 2019, https://curriculum-press.co.uk/resources/a-tsunami-of-non-communicable-diseases
[10]Tobacco Tactics. “Sri Lanka- Country Profile.” TobaccoTactics, 5 Jan. 2021, tobaccotactics.org/wiki/sri-lanka-country-profile.
[11] A. Perceived stress and incidence of type 2 diabetes: a 35-year follow-up study of middle-aged Swedish men. https://pubmed.ncbi.nlm.nih.gov/23075206/
[12]Kan, Carol. “Genetic Overlap Between Type 2 Diabetes and Depression in a Sri Lankan Population Twin Sample.” PubMed, 2020, pubmed.ncbi.nlm.nih.gov/31794442.
[13]“Noncommunicable Diseases Country Profiles 2018.” World Health Organization, 24 Sept. 2018, www.who.int/nmh/publications/ncd-profiles-2018/en.
Figure 1 – “Chronic Diseases Fact Sheet.” GACD, www.gacd.org/research/what-are-ncds/chronic-diseases-fact-sheet.
Figure 2 and 4 – Fenton, Kevin. “Tackling the Epidemic of Non-Communicable Diseases.” Public Health Matters, 27 Feb. 2014, publichealthmatters.blog.gov.uk/2014/02/27/tackling-the-epidemic-of-non-communicable-diseases.
Figure 3 – “Environmental Risks and Non-Communicable Diseases.” The BMJ, 28 Jan. 2019, www.bmj.com/content/364/bmj.l265.
Glossary
NCD – Non-Communicable Disease
LIDC – Low Income Developing Countries
MIC – Middle Income Developing Countries
Youth Medical Journal 