File Name: communicable and noncommunicable diseases .zip
- Global Handbook on Noncommunicable Diseases and Health Promotion
- Non-communicable disease
- Non-communicable disease
- Controlling Noncommunicable Diseases in Transitional Economies
Non-communicable chronic diseases NCDs have rapidly become the largest health problem facing the world. Prevention and control of NCDs is an urgent global and national public health priority. We also explore innovative ways to promote health through multiple behavioral changes, use of information and communication technology, improvement of healthcare quality, health systems research, and others. Our emphases are on wellness, prevention and how to translate scientific evidence into practical uses. See below for more details about our projects.
Global Handbook on Noncommunicable Diseases and Health Promotion
It argues that the complex nature of these conditions and of causality require a nuanced and context-specific picture in terms of understanding the social and economic patterning of NCDs and the implications for poor people.
Within an overall consideration of health justice, these issues fall under two broad areas: firstly, prioritization and resource allocation; and secondly, questions of responsibility with respect to prevention measures. The chapter focuses on the tension between emphasizing individual-level action and a systems approach that pays attention to broader structural factors, global and national inequalities, health system drivers, and sociopolitical determinants of NCDs.
Keywords: noncommunicable diseases , poverty , low- and middle-income countries , LMICs , justice , responsibility , resource allocation , prevention , public health ethics.
This chapter reviews global issues in primary and secondary prevention of noncommunicable diseases NCDs. Within an overall consideration of health justice, it reflects on two areas for ethical attention: questions of disease prioritization, and questions of individual responsibility.
The World Health Organization WHO has been active for some time in pressing for greater concern, but other central players in international development, such as the World Bank and the United Nations Development Programme, have also released key reports calling for action and assisted in raising the attention of governments to problematize the issue Reubi, Herrick, and Brown, Noncommunicable diseases are conventionally defined as conditions that are not transmitted from person to person.
While there might be treatments, there currently are no cures for most of these illnesses. The WHO has indicated four main types of NCD: cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes.
The bracketing of these conditions as the main NCDs has drawn a range of critical opinion. It excludes, for instance, other chronic conditions such as mental illnesses, which have significance in terms of morbidity globally Prince et al.
Human immunodeficiency virus HIV infection is a case in point: it becomes a chronic disease with treatment, and indeed associations have been identified with NCD risk see, for example, Carr, Thus, the value of a rigid category distinction between infectious and noncommunicable disease is increasingly questioned. For example, research has revealed connections between infections and the etiology of conditions such as cancers that have been classified as noncommunicable, and there is a need to better understand these direct interactions, especially in countries with a dual disease burden Remais et al.
However, the distinction persists. It has been argued that global burden of disease studies have played a significant role in revealing NCDs as an issue in the Global South in epidemiological terms, and in drawing public health attention to the changing global distribution of disease. However, political attention to the issue and the consequences of such shifts has lagged behind Reubi, Herrick, and Brown, Only in the African Region are communicable diseases and maternal, perinatal, and nutritional conditions still the most common causes of death, and the double burden of communicable and noncommunicable disease is becoming a significant challenge UN, a.
The increase in the proportionate contribution of NCDs to the global disease burden can partly be attributed to improvements in combating infectious disease and maternal and child health MCH problems. The increase in NCDs has also increased the overall burden of chronic lifelong conditions infectious and noncommunicable globally, which has significant implications for countries where health systems were set up to focus primarily on acute disease and MCH Atun et al.
Until relatively recently, concern about the rising burden of NCDs in LMICs was not reflected to a large extent in global health goals, spending priorities, or policy implementation Horton, ; Alleyne et al. In some donor agencies, until a few years ago, such illnesses were still explicitly considered as an issue primarily for rich countries and their health systems. NCDs did not feature in the Millennium Development Goals of , which specifically named other disease categories for priority attention.
A recent shift to redress this inattention is discernable in donor and research funding agencies, and a reduction of premature death from NCDs is a target of the Sustainable Development Goals adopted in September WHO, In particular, the infiltration across the globe of the processed and fast food, soft drink, and tobacco industries are cited alongside urbanization to point to significant changes in food systems, diets, and patterns of food preparation, as well as more sedentary lifestyles.
The impacts on health of widening global inequalities that have accompanied these large-scale processes of change have received less attention—increasingly these diseases are also linked to poverty and socioeconomic disparity associated with economic globalization Narayan, Ali, and Koplan, A sweeping evocation of globalization as the causal factor for a rising burden of NCDs can thus override more nuanced accounts of the factors contributing to changing disease burdens and a consideration of political-economy and the contexts and local environments in which these changes and diseases are experienced.
As the global prevalence of noncommunicable disease rises, it is pertinent to consider the ethical issues associated with framings of the disease burden and the priorities for primary and secondary prevention responses, especially in low-resource settings. These issues will be addressed in this chapter under two broad areas: firstly, prioritization and resource allocation; and secondly, questions of responsibility with respect to prevention measures.
I focus on the tension between an emphasis on individual-level action and a systems approach that pays attention to broader structural factors, global and national inequalities, health system drivers, and sociopolitical determinants of NCDs. Ethical debates about how to prioritize NCDs in LMICs revolve around questions of who is affected, what causes these diseases, and what effects these diseases have on the productivity and well-being of people in these countries.
Justice-based arguments for p. Others go further, arguing that addressing NCDs is a key to promoting equity in other domains, pointing to the role that the NCD burden places on the economic prospects of the most disadvantaged Anand, Peter, and Sen, The prioritization of NCDs, as opposed to other disease areas such as infections, undernutrition, or MCH , has attracted divergent views with respect to decisions about resource allocation for research funding and donor budgets at the international level.
One approach to setting health priorities would be to compare the disability-adjusted life years DALYs that are averted by scaling up programs to address NCDs versus other diseases. However, priority-setting by burden of disease has drawn criticism, not least for measuring the problem rather than examining solutions, for making value-based assumptions about health and well-being that cannot necessarily be taken as universals, and for sidelining considerations such as equity Mooney and Wiseman, ; Anand and Hanson, Disease burden is not sufficient to account for broader factors that complicate the ability to make simple decisions on prioritization.
For instance, a parameter such as cost-effectiveness can provide one of several criteria for disease prioritization, and must be balanced by considerations of equity Johri and Norheim, A study examining potential NCD programs in Mexico found that while there was wide variation in effectiveness, many programs would provide excellent cost-effectiveness ratios Salomon et al.
This argument was articulated strongly in when the United Nations General Assembly held a high-level meeting on noncommunicable disease. Thus, the particular discursive framing around NCDs as a development issue was foregrounded in the political positioning for greater recognition Reubi, Herrick, and Brown, The declaration that followed the summit traced this argument for NCDs as an issue for development attention, outlining the links between poverty and NCDs.
The declaration emphasized the greater impact of such illnesses on poor households, both on account of catastrophic health expenditure in the face of an illness exacerbation and ongoing expenditure from household incomes due to the chronic nature of illnesses and the need for care.
This argument underscores the view that the effects of living with an NCD are greater for poor people, and particularly for people in countries with weak health systems and public sector health financing mechanisms. If people have to pay out of pocket for health care, this can quickly lead to a downward spiral into deeper poverty.
This argument assumes that taking nonhealth factors into account in health resource allocation is fair and consistent with providing the greatest amount of good in society. Poor access to quality health care can lead to inadequate treatment of NCDs and earlier development of serious sequelae Bhojani et al. This can cause incapacity of economically active members of households, or a working person might stop earning to care for a relative.
The high cost to hospital care and social care systems of untreated NCDs is a further societal-level impact that provides a rationale for investing in primary and secondary prevention of NCDs. A paucity of fine-grained epidemiological data from LMICs compared to high-income settings on the nature of the NCD burden, and disaggregated data to reveal the relationship between prevalence and socioeconomic status, has also prevented clear conclusions.
Thus, for example, data from Bangladesh clearly show that the proportion of deaths due to NCDs has increased in the rural demographic surveillance site there Matlab Health and Demographic Surveillance System over the past three decades, and that the proportion of deaths due to communicable diseases has dropped Chowdhury et al. A different picture has emerged from the analysis done by Lloyd-Sherlock et al. These findings conclude that hypertension affects poorer groups as much as the rich, if not more.
Other studies e. The literature on obesity, for example, also shows a complex relationship with income. Increasingly, malnutrition is understood as p. Another reason why securing NCD funding may seem less urgent is that NCDs tend to have a more insidious course, and the benefits of interventions might not be as immediately evident as those for infectious conditions with acute and swift consequences. However, since there is not dramatic evidence of death in the public eye, such as can be associated with epidemic-prone infectious diseases, NCDs might seem less apparent to the public.
Ethicists have debated whether it is just to give priority to identified victims, especially where more good can be done helping the widely dispersed Daniels, Others have drawn attention to the fact that there has not been the same level of activism for NCDs as there has been for infectious conditions like HIV.
Although different disease-specific advocacy organizations came together to form the NCD Alliance, there has not been the same degree of cohesion, and involvement of pharmaceutical interests has been a complicating factor Stuckler and Basu, ; Reubi, Herrick, and Brown, A second ethical issue related to how NCDs might be framed refers to assumptions about the role of personal responsibility in disease etiology.
Such assumptions can be significant in terms of what primary and secondary prevention responses are implemented. Should personal responsibility be included in health considerations? An argument can be made that, given that the four main NCDs have been linked to individual behavioral factors, that people should be held accountable for their behavior. If individual choice is responsible for the burden of NCDs, then one might claim that less societal priority should be provided for such illnesses.
However, an argument could be made that, even if some diseases reflect choice, a just society should place greater emphasis on preventing avoidable inequality than on assigning blame Wikler, Furthermore, the drivers of NCDs are complex and linked to structural predictors, and not merely to individual behaviors. In fact, the behavior of an individual might be considerably less relevant, as in the example of disease risk of metabolic syndrome linked to early-life p. Moreover, the ability of people to do something about their NCD risk or to prevent progression of disease is likewise restrained by their resources and environment, which includes political and sociocultural factors over which they might have limited agency.
This point about the relevance of structural predictors for NCD prevalence is illustrated by considering the situation of those living in urban areas in the Global South. The share of the poor living in urban areas is rising, and a third of urban dwellers live in low-income urban settlements Mitlin and Satterthwaite, Such contexts often do not enable physical activity.
People have limited cooking space and rely on unhealthy, pre-prepared street food. The broader food environment is likely to make healthy lifestyle choices difficult or unaffordable. Moreover, where alternative choices may be available, cultural and socioeconomic factors can militate against adoption of the proposed changes. This has led to considerable emphasis on individual behavioral change. In some cases, these suggestions for self-management include attempts to think creatively about ways of addressing chronic lifelong conditions in the context of low levels of human resources for health e.
More effort could be given to assessing innovative social protection programs that link to the health sector Roelen and Davies, In some countries, social grants for chronic illness have been discussed as a form of social protection entitlement for those with a diagnosed chronic illness where certain lifestyle changes that are expensive can have a significant impact on disease progression Schneider et al. Not all public health responses have been focused on individual behavior, and there is growing attention on societal influences, with a policy focus on the food, infrastructure, p.
Findings have been emerging from such a measure in Mexico which indicate that this area remains one for lively debate see, for example, Nakhimovsky et al.
There is an argument that population-level measures such as soda or fat taxes could place a greater burden on particular groups, such as people who are poor. Food luxuries might become harder for them to afford, thus limiting their choices. On the positive side, it could be argued that the health benefits that would arise outweigh the burdens Brownell and Frieden, Debates about who should bear the cost of these measures continue. It could be argued, however, that the public health urgency is great enough, and the population-level gains potentially large enough, to justify such measures, even if poor people bear a higher cost.
The policy domain of strategic regulation of key industries requires more research to evaluate the potential for unintended consequences and ensure greater efficacy. These challenges all need to be considered in responses to NCDs at national and global levels.
This chapter has highlighted factors related to the global burden of NCD, poverty, and inequality that are relevant to justice. The link between NCDs and poverty is also clear from emerging data, which, along with arguments that NCDs add a further financial burden on poor households, create even deeper justice concerns. Moreover, NCDs are linked to structural drivers at least as much as to individual behaviors, and the ability of people to take action with respect to their NCD risk is constrained by their resources and environment.
Given that debates are happening in the presence of inadequate data and inadequate health systems, it is likely that all current responses will be flawed and imperfect. This points to the need for building up a wider evidence base and capacity to address these challenges.
From the perspective of justice, addressing NCDs will require a deeper engagement with political factors and with the social determinants of health. Broader considerations of social justice require us to see the NCD burden against the backdrop of social and economic inequality, at global, national, and local scales. Given the reality that the resources for allocation are often limited with respect to discussions of funding or provision in LMICs, it is inevitable that assessments of historical and current inequalities and assessments of means and levels of access to safety nets affect how particular groups are identified for the allocation of resources.
An ethical account of public health approaches to NCDs would need to balance the competing demands that come from populations that have claims based on redressing historical inequalities—such as unjust access to affordable health—with current pressing health needs.
A non-communicable disease NCD is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease , autoimmune diseases , strokes , most heart diseases , most cancers , diabetes , chronic kidney disease , osteoarthritis , osteoporosis , Alzheimer's disease , cataracts , and others. NCDs may be chronic or acute. Most are non- infectious , although there are some non-communicable infectious diseases, such as parasitic diseases in which the parasite's life cycle does not include direct host-to-host transmission. NCDs are the leading cause of death globally.
In many parts of the world, cardiovascular diseases, stroke, cancers, diabetes, and chronic lung diseases are major causes of mortality and morbidity, leading to the death of 15 million people between the ages of 30 and 69 years annually. Tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diets the major risks of NCDs are still commonly practiced, especially in transitional economies with rapid urbanization and industrialization. While improving healthy behaviors and strengthening the health system in NCDs screening and treatment among communities are key components of the response to NCDs, these strategies require better a understanding of the multiple transitions in the population, economy, disease models, and social contexts. This special issue aims to introduce the latest research findings about NCDs in transitional economies: evidence to inform clinical, management, and policy development. Journal overview.
Rapid urbanization and industrialization drives the rising burden of Non-Communicable Diseases NCDs worldwide that are characterized by uptake of unhealthy lifestyle such as tobacco and alcohol use, physical inactivity and unhealthy diet. In India, the prevalence of various NCDs and its risk factors shows wide variations across geographic regions necessitating region-specific evidence for population-based prevention and control of NCDs. To estimate the prevalence of behavioral and biological risk factors of NCDs among adult population 18—69 years in the Puducherry district located in Southern part of India. A total of individuals were selected from urban and rural areas 50 clusters in each through multi-stage cluster random sampling method.
Controlling Noncommunicable Diseases in Transitional Economies
A noncommunicable disease is a noninfectious health condition that cannot be spread from person to person. It also lasts for a long period of time. This is also known as a chronic disease. A combination of genetic, physiological, lifestyle, and environmental factors can cause these diseases. Some risk factors include:.
Progress on the prevention and control of non-communicable diseases : report of the Secretary-General. Add to List. Title Progress on the prevention and control of non-communicable diseases : report of the Secretary-General. Authors UN.
targets to prevent and control non-communicable diseases. (NCDs) such as cancer, health and development challenges, addressing NCDs requires significant 0for%20womens's%20health%20and%kirstenostherr.org]. A/RES/70/1.