09 October 2010

CHRONIC NONCOMMUNICABLE DISEASE

---A NEW EPIDEMIC IN DEVELOPING COUNTRIES


For most of our short-term UMVIM Health Care Teams the main diagnostic and treatment concerns have involved acute infections. Evaluation is relatively straightforward for these diseases, and they usually can be managed successfully in one or two visits. Our teams have provided much needed immediate health care to the people we serve. However, we need to be very much aware of the massive changes in the health needs of developing countries that have taken place in the past few decades. Chronic noncommunicable diseases have replaced infections as the major cause of illness throughout the entire world. In fact, chronic disease now causes 60% of deaths and nearly 50% of disability in developing countries. These chronic noncommunicable conditions can in large part be considered diseases of life style.

They include:

1. Cardiovascular disease—including coronary artery disease, hypertension and stroke
2. Chronic lung disease, including COPD and asthma
3. Type 2 diabetes
4. Certain types of cancer

They are no longer just diseases of affluence, restricted to developed nations. Cardiovascular disease now accounts for 30% of deaths in poor countries. Three times as many people die from cardiovascular disease in developing countries than the total for HIV, malaria and tuberculosis combined. Four out of 5 deaths from chronic diseases now occur in low and middle-income countries. To add to this burden these chronic diseases affect all age groups, resulting not only in premature death, but also long term disability and lack of productivity. It is also important to note that these conditions, because of their chronicity and long-term disability contribute to a vicious cycle of increasing poverty in countries that are already poor.

A recent comprehensive report from the World Health Organization named the leading risk factors associated with these chronic diseases. They include high blood pressure, physical inactivity, high glucose levels, obesity, high cholesterol levels, and above all tobacco use. Some demographic changes have contributed to the increasing incidence of these risk factors, including

1. Urbanization: the past few decades have seen a massive migration from rural areas to the cities. Soon over 50% of the world’s population will live in cities. Inactivity has increased as many go from farm work to no work. Diets go from grains, milk and eggs to high fat, high sugar processed food with little nutritional value. Obesity and elevated cholesterol develop, as well as increased stress from cultural and family upheaval.

2. Globalization has brought many life style changes, more than just the presence of McDonald’s. Traditional cultures, customs, family ties, and even languages are disappearing. Processed, high caloric foods are uniformly available, highly promoted and sought after. Increased industrialization has stimulated further urbanization.

The critically important question is, What can be done to combat this epidemic of chronic disease? Health systems, particularly in developing countries are currently not equipped to handle the demands placed on them by this burden. These health systems cannot ignore acute infectious disease, but they can place greater emphasis on, and devote funding to an integrated model aimed at more continuity of care, preventive measures and above all on health education. Some of the funding support from aid organizations should be redirected from a single disease elimination model to a more comprehensive integrated approach, one that supports a broad scope of community-based preventive measures and health education programs. Some have suggested that dealing with this new epidemic should wait until infectious diseases, including the vexing problems of malaria, HIV and tuberculosis, are further controlled. Others have voiced concern that delays will further devastate the health and economies of countries that are already impoverished. They feel that we can’t wait. Others worry about the cost. In actuality, according to WHO, inexpensive, effective screening programs are already available. A most important factor is that 80% of these devastating conditions can be prevented or modified by community-based programs that provide health education and continuity of treatment. These programs need to promote education and preventive measures aimed at life style changes, including healthy diets, activity and exercise, and cessation of alcohol and tobacco abuse. What is needed now is better international recognition of the extent and importance of these chronic diseases and support for local health systems enabling them to gear up for this integrated approach.

For our health volunteers this new epidemic requires no less than a change in our way of thinking, from an acute care quick intervention oriented model, to one with more emphasis on health education and prevention, working in conjunction with the local health system We need to raise our awareness about the presence of these chronic diseases in the populations we serve. Most of all, we need to support and partner with local health systems in providing ongoing health education and ongoing care for these important problems.

References:

1. Preventing chronic diseases: a vital investment---WHO global report. Geneva; World Health Organization, 2005.

2. Narayan, et al: Global Noncommunicable Diseases---Where Worlds Meet NEJM 363, 1196-8: 2010

3. Anderson, G.F Expanding Priorities---Confronting Chronic Diseases in Countries with Low Income: NEJM, 356: 209-11; 2007.

Submitted by Roger Boe MD

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