Noncommunicable Diseases: A Global 'Slow-Motion Disaster'

Megan Brooks

May 04, 2017

Of all the major health threats to emerge over the past 10 years, none has challenged the very foundations of public health so profoundly as the rise of chronic noncommunicable diseases (NCDs), says a new report from the World Health Organization (WHO).

Heart disease, cancer, diabetes, and chronic respiratory diseases — once considered a problem only of affluent societies — are now global concerns, with the heaviest burden concentrated in low- and middle-income countries.

"These are among the most democratic of all diseases, affecting populations at every income level in every country, but the poor suffer the most," the WHO says.  Combatting the root causes of these NCDs — tobacco use, alcohol abuse, unhealthy diets, and physical inactivity — requires collaboration across all of governments and societies.

Commemorating 10 Years in Public Health

The report on NCDs is part of a series of  reports to be released over the next 6 weeks that will chronicle the evolution of global public health over the past decade that Margaret Chan, MD, has served as director-general at WHO.

The report, "Ten Years in Public Health 2007-2017," evaluates "successes, setbacks, and enduring challenges during my administration" and shows "what needs to be done when progress stalls or new threats emerge," writes Dr Chan in a letter introducing the report.  

At the turn of the century, chronic NCDs were not on the public health radar, being overshadowed by the HIV, tuberculosis, and malaria epidemics, as well as the large number of maternal and childhood deaths, the report notes.

Much of WHO's work in the earliest years of the past decade focused on collecting the data and making the arguments that would elevate NCDs on the global health and development agendas, the report notes. Those efforts culminated in 2011, when the United Nations General Assembly held a high-level meeting on NCDs and adopted a "far-reaching" political declaration, which acknowledged that the threat of NCDs is a major challenge for development in the 21st century, one that could undermine social and economic progress throughout the world. The declaration also made the WHO the principal agency for leading the global response to this challenge.

" Profound Implications"

Chronic NCDs have overtaken infectious diseases as the leading cause of death worldwide. "In terms of its significance for health development, this shift in the disease burden has profound implications, as it challenges the very way socioeconomic progress is defined," the report notes.

According to the WHO, NCDs take the lives of an estimated 40 million people each year, accounting for 70% of all deaths worldwide. The annual number of deaths includes 15 million people who died between the ages of 30 and 70 years. "The majority of these premature deaths could have been prevented or delayed," the WHO says.

Most early deaths (85%) occurred in developing countries, including 41% in lower- to middle-income countries where the probability of dying of a chronic disease between the ages of 30 and 70 years is up to four times higher than in wealthy countries, the WHO says.

"The implications for health systems and the care they provide are profound, calling for a change in the mindset of public health. The traditional approach to health that relies on the biomedical model, focused on the cure of individual diseases, is inadequate," the report says.  "The essential emphasis on prevention requires a greater reliance on the social and life sciences."

NCDs are a "slow-motion disaster" taking years to develop overt signs. The fact that predisposing risk factors start early in life calls for a "life-course approach to prevention and control," the WHO says.

A proactive approach is critical, the agency notes. In their quest to "democratize" the benefits of clinical care, in 2013 the WHO introduced the Package of Essential Noncommunicable Disease Interventions, or WHO PEN, an "action-oriented set of cost-effective interventions that can be delivered to an acceptable quality of care, even in resource-poor settings," the agency notes.

Tools in the package help with early detection and management of cardiovascular diseases, diabetes, chronic respiratory diseases, and cancer in order to prevent life-threatening complications, such as myocardial infarction, stroke, kidney failure, amputations, and blindness. A protocol on counseling for behavior change is also included.

Other dimensions of the global NCD "crisis" highlighted in the WHO report include issues related to mental health, substance abuse, healthy aging, dementia, malnutrition, violence prevention, road safety, and disability. 

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