Public health issue: non-communicable diseases

Just as Nigeria is still battling with the prevention and control of communicable diseases, the burden of non-communicable diseases has begun to rise in the most populous black nation in the world, Nigeria. Now, we have a dual epidemy.

In 2008, WHO estimated that 36.1 million people died from conditions such as heart disease, stroke, chronic lung disease, cancer and diabetes. Nearly 80 per cent of these deaths occurred in low and middle income countries. People in developing countries with low incidence of NCDs compared with those of the developed countries are dying from NCDs more than people in the high income countries.

This is probably the reason why the UN General Assembly has decided to hold a UN Summit on NCDs in order to agree on a global strategy to address NCDs which is now regarded as a developmental issue. There may now be a global focus on non-communicable diseases.

WHO said NCDs cause more than twice the number of deaths globally than are caused by all infectious diseases (including HIV/AIDS, TB and Malaria), all maternal and childhood conditions and nutritional deficiencies combined. There is some concern in the infectious disease community that funding could be diverted away from communicable disease funding.

Worldwide, chronic NCDs account for 60 per cent (35 million) of deaths, making these under-acknowledged diseases the leading cause of death in most regions of the world (except Sub-Saharan Africa, where too they are expected to overtake mortality from infectious diseases by 2030). This is according to Arogya World. So Nigeria must make sure that the increasing burden of NCDs in the country is curtailed before it becomes uncontrollable and a major health problem. The first WHO Global Status Report on NCDs has already listed Nigeria and other developing countries as the worst hit with death from NCDs.

The Director-General of WHO, Dr. Margaret Chan has said the “rise of chronic NCDs present an enormous challenge. Chronic NCDs deliver a two-punch blow to development. They cause billions of dollars in loss of national income and they push millions of people below the poverty line each and every year”. There is no doubt , NCDs will further pauperize the citizens and affect economic development just like communicable diseases such as Malaria, HIV/AIDS and Tuberculosis which are some of the causes and consequences of poverty.

Research has shown that CVD accounts for most NCD deaths or 17 million people annually, followed by cancer (7.6 million), respiratory disease (4.2 million) and diabetes (1.3 million). These four diseases are regarded as the most prominent NCDs. Interestingly, they are all linked by shared common modifiable risk factors including tobacco use (which is the one implicated the most for all NCDs), alcohol abuse, unhealthy diet and physical inactivity.

The challenge of reducing the increasing burden and deaths from NCDs is starring us all in the face just as we are struggling to reduce the burden and deaths from communicable diseases. Our lifestyle is fast contributing to the burden of disease due to NCD. According to Lancet, tobacco use alone accounts for one in six of all deaths resulting from NCD. Everyday, more than 1 billion people smoke or chew tobacco because of their addiction to nicotine and about 15,000 die from tobacco-related diseases. Also, consumption of foods high in saturated and industrially produced trans-fats; salt and sugar are the causes of at least 14 million deaths or 40 per cent of all deaths every year from NCDs. Overconsumption of salt causes up to 30 per cent of all cases of hypertension. Physical inactivity causes about 3 million or 8 per cent of all deaths per year from NCDs. Furthermore, alcohol consumption leads to 2.3 million deaths each year, 60 per cent of which are due to NCDs and has adverse health, social, economic effects and not just for people drinking.

Governments at all levels have to double their efforts in ensuring that Nigerians do not suffer and die unnecessarily from both communicable and non-communicable diseases especially now that we have a dual epidemy. We have been battling with communicable diseases for many years up until today and one can only imagine what would happen if the increasing burden of NCDs is not curtailed. Leaders of government cannot afford to be insensitive to the epidemiological transition in the country.

Four out of five chronic disease deaths are in low and middle income countries and a third are in people younger than 60 years says The Lancet. Definitely, NCDs are no longer diseases of affluence because the risks from NCDs are greatest in poor and developing countries.

Two out of three deaths each year are attributable to NCDs. Overall, age-specific NCD death rates are nearly two times higher in low income and middle income countries than in high income countries. NCDs often cause slow and painful deaths after prolonged periods of disability.

This double burden of disease places enormous strains on resource-deficient health systems. The Lancet further said.

Our lifestyle is mainly responsible for the increasing incidence of NCDs. We are the architect of our own misfortune. What used to be the nations health problems were diseases such as poliomyelitis, malaria, tuberculosis, HIV/AIDS and so on but now, coronary heart disease, cancer, chronic lung disease, diabetes, stroke, hypertension, road traffic injuries, obesity and cardiovascular disease are beginning to kill our people.

These are definitely not the best of times for developing countries that are still struggling to strengthen their health systems in order to cope with the 21st century challenges. If urgent and adequate measures are not taken to reduce the incidence and prevalence of NCDs in Nigeria, the health system we are trying to strengthen to provide effective, efficient, quality, accessible and affordable health care may collapse.

You would observe that many health workers are emigrating from developing countries to developed countries, this is due to the strain having an elderly population with different chronic diseases put on a nation’s health system even though the developed countries have better health facilities and equipments. But Nigeria rates high among other developing countries in deaths from NCDs because we do not have an effective and efficient health system.

The past and present state of the nation’s health system has led to the unnecessary and preventable deaths of many citizens with its attendant effect on economic development.

“Age-Standardized mortality rates by cause for NCDs in 2008 was 809 per 100,000 population while for communicable diseases, it was 832 per 100,000 population” reported the 2011 World Health Statistics which is a yearly report based on more than 100 health indicators reported by WHO’s 193 member state.

WHO strategy for preventing NCDs is similar to the ones proposed by the NCD Alliance and The Lancet NCD Action Group as the UN General Assembly High-Level meeting on the prevent and control of NCDs takes place between 19-20 September, 2011 in New York. They include strong anti-tobacco control, promoting healthier diets, improving physical activity, reducing harmful use of alcohol and providing universal access to essential drugs and technologies. But tobacco control, salt reduction and treatment of people at risk of cardiovascular disease are seen as cost-effective among other interventions.

The success of these interventions lies in behavioral change and/or modification. A modification and/or change in lifestyle is a major way of treating, preventing and controlling NCDs besides western medicine has not found cure for NCDs — I stand to be corrected! There is no doubt that reducing alcohol intake; using safety equipment such as seat belts; stopping tobacco and drug use; taking appropriate and healthy diet/nutrition; avoiding sedentary lifestyle; reducing salt and sugar intake (especially sweetened drinks

) and following preventive guidelines all have the capacity to reduce an individual’s risk of coming down with NCDs. There is no other way out for now except adhering strictly to these lifestyle changes and/or modifications. We as citizens must not contribute further to the disease burden in the country and now that the prevention and control of NCDs partly lie in our hands, it behooves us to have a good health behavior. Governments at levels must address the social, economic, cultural and political factors that affect the health of the Nigerian people.

Written by
Bolaji Aregbeshola
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