Non-communicable diseases in a changing world

Samlee Plianbangchang

( Dr. Samlee Plianbangchang is Regional Director, WHO South-East Asia.)

For many health care planners around the world, non-communicable diseases such as diabetes, hypertension, stroke and cardiovascular problems have hardly been a priority. South-East Asian countries are no exception. Like so many other developing and transitional countries, they have been rightly preoccupied with the communicable diseases that were the core concern of epidemiologists and public health workers over much of the last century.

New diseases

But the focus on communicable diseases has prevented many health planners from paying sufficient attention to a rapidly growing health feature of our societies — new, non-communicable diseases (known as NCDs). These health problems are emerging, and, in some cases, becoming more prominent than communicable diseases that we continue to confront.

Diabetes, hypertension, stroke and cardiovascular diseases, all of which are disabling and life-threatening, have increased in South-East Asian countries silently and relatively unnoticed. Today they constitute a growing threat to national health and national health-care systems. In South-East Asia, deaths from NCDs are far in excess of those from communicable, maternal, perinatal and nutritional conditions combined. Costly in terms of long-term care, these diseases call for a type of social and financial investment that many countries will have difficulty making unless they quickly begin to re-prioritise their efforts and funding.

Social, lifestyle component

The fact that most if not all the major non-communicable diseases have a strong social and lifestyle component calls for new thinking and preventive action. Dietary patterns have changed fundamentally in our region, and there is now a real danger that the diets of both children and adults will produce serious health challenges.

In some cases it is simply a case of over-eating. There is also the issue of eating foods that lead to obesity, and that are linked to related problems such as diabetes and heart disease.

Exercise is another feature of lifestyle. Today, we walk less and exercise less, and we simply do not use up the calories that we are taking in. Even children have become more sedentary, and schools have failed to provide the physical activity that would reduce the risk of obesity. Today our region is faced with a growing epidemic of children who are grossly overweight and who are facing serious disabilities and illnesses as a result.

Migrants

Around the world, there is growing evidence that migrants are especially vulnerable to a variety of non-communicable diseases, such as type 2 diabetes, cardiovascular and chronic respiratory diseases, reproductive problems and mental health issues. In a region that has seen massive movements of people from rural to urban areas and across borders, this raises special concerns.

Irrespective of the causes, however, prevention of NCDs must be given high priority. This will not simply be the task of ministries of health. Other sectors, such as education and labour, food and nutrition, transport and communications, must all come together to design interventions that encourage people to remain physically active and to raise awareness of what they need to do to avoid these diseases.

We will also have to think of new staff who can work at the community level — educating, informing and motivating people of all ages and in all walks of life to be proactive in preventing the onset of these diseases. This challenge will have to be taken up in schools, in the workplace, and in the home. Health-promoting activities and behaviours will have to become a part of our everyday life and awareness.

Tools are available

But prevention will not be enough. Major non-communicable diseases have already taken root in many of our countries and must be urgently dealt with as systematically and rapidly as possible. The tools are available. Early diagnosis of diseases such as diabetes can, with effective treatment, avert potentially life-threatening and disabling consequences. For this to happen, routine screening or check-ups and timely treatment of NCDs will have to be given far more priority than it has before. This will in turn mean redesigning many of our health policies, services and health care financing plans.

Non-communicable diseases also call for long-term commitments to care, and this can be very costly if the care remains hospital-based. We must think of new ways of care–giving, and care-givers who are trained in community public health and capable of working with families in the home environment.

This is not to say that we can neglect the many communicable diseases that still plague our countries, for we must remain committed to their prevention and control.

But at the same time, we must accept that the South-East Asian region is now faced with a double burden of disease, and unless we adapt our policies and plans to this reality, we will face growing morbidity and mortality from NCDs, highly elevated health care costs, and disabilities that will reduce workforce productivity and the quality of life of our citizens.