The eyes and ears of the global health world were firmly fixed on Geneva last week for the 2012 World Health Assembly, the annual meeting of the World Health Organization’s (WHO) member states. One of the focus points of this year’s meeting was an acronym you may have encountered in the media recently – NCDs or non-communicable diseases.
Non-communicable diseases are a group of diseases defined by what they are not – you can’t catch them from another person. To simplify things, the WHO defines NCDs as cancers, cardiovascular diseases, chronic respiratory diseases and diabetes.
Together, this group kills more people each year globally than any other cause: approximately 35 million deaths worldwide annually. If you include road-traffic accidents and mental illnesses, which are NCDs by definition, then this group also represents the largest contributor of suffering and disability worldwide.
UN Secretary-General Ban Ki-Moon describes NCDs as a global epidemic; the World Economic Forum nominates them as one of the most serious global threats to development; and, in her speech last week, WHO Director-General Dr Margaret Chan warned of the “the longest dark shadow: the relentless rise of chronic non-communicable diseases”, noting that “these are the diseases that can cancel out the gains of modernization and development”.
Yet, despite such strong words, much of society (even the political and scientific communities), continue to misunderstand or lack awareness of the implications of NCDs.
A number of myths surrounding NCDs result in policy-level inaction from governments and stifle crucial, meaningful progress on prevention and mitigation strategies. These are compounded by a societal lack of understanding, which further affords governments and industries carte blanche for inaction.
Myth #1: NCDs are diseases of affluence
In reality, NCDs are drivers of, and result from poverty. Around 80% of global deaths from NCDs occur in the worlds’ poorest nations. While these are also the most populous countries in the world, NCDs selectively burden lower-socioeconomic groups, even in high-income nations, such as Australia.
The diseases result from fundamental inequities in health-care access, health information, urban living environments and other social factors, such as employment and educational opportunities. These diseases also act as a driver for disadvantage, leading to inter-generational ill health and cycles of poverty.
Myth #2: NCDs mainly affect older people
More than 50% of the global burden of NCDs falls on people younger than 70 years. So, while the diseases are associated with ageing, the global burden is not simply an outcome of ageing populations.
First, disease later in life is an outcome of lifestyle and exposures in the middle of life. Second, the age of onset of diabetes, heart disease and cancers is becoming younger. Many are now calling for the abolition of the term “adult onset” diabetes, for instance, as more and more children develop obesity-related disease.
In fact, we now suspect that poor conditions during pregnancy can “pre-program” a person for diabetes later in life.
Myth #3: NCDs are diseases of laziness and are self-inflicted
Many argue that NCDs occur as a result of poor choices by individuals and parents, and should therefore not be the responsibility of government or society.
This ignores the fact that states have a responsibility to make being healthy easy through education, initiating societal change and providing incentives to make good health choices.
Smart urban planning, affordable and accessible healthy foods, quality health education and limitations on the advertising of products that drive the growth of NCDs are just some examples of changes essential to reducing the burden of NCDs.
Myth #4: NCDs are too difficult and expensive to tackle effectively
In reality, we have cost-effective strategies available now for stopping the rise of NCDs. These strategies are estimated to be able to prevent 80% of global heart disease and diabetes. Medications for high blood pressure are effective and cost a mere few cents per day, for instance, yet they remain consistently unavailable to people who need them most.
Ban Ki-Moon says progress on tackling these diseases is not resulting from a void in the public health armament, but from a lack of political and social will for their implementation.
Myth #5: NCDs represent a health crisis for future generations, not our own
NCDs are often seen as a problem society will face in coming decades, when, in fact, the global community is already in the midst of a chronic disease epidemic, and their mitigation is something we cannot afford to postpone.
NCDs must be addressed now because societies simply can’t afford the NCD epidemic the WHO predicts. The World Economic Forum estimates their global cost at US$30 trillion in the coming two decades.
In the words of Margaret Chan, “these are the diseases that tax health systems to the breaking point. These are the diseases that break the bank.”
What now?
In 2012, the global and Australian communities must follow the WHO in “giving these diseases, and [their] role in their prevention and control, the utmost priority”.
They must begin to appreciate the scale, urgency and ethical imperatives of tackling NCDs and see these diseases as issues of inequity linked to poverty: both global and local. We must recognise the significant shared benefits to society and the environment in implementing mitigation strategies for NCDs.
NCDs are not a problem of the future – they must be addressed now, or they will continue to represent the biggest threat to health and, arguably, to development in the new century.
Acknowledgements: Dr Fred Hersch, Dr Jenny Jamieson and Kyra-Bae Snell contributed to this article.
Patrick McPhee
Analyst at large
Correction, paragraph #2:
"an acronym you may have encountered in the media recently – NCDs or non-communicable diseases."
'NCD' is a capitalisation, not an acronym.
Jason Calvert
logged in via Twitter
Could you elaborate on why you believe NCD is not an acronym?
Ned Stephenson
Environmental Manager
An acronym produces a word. A capitalisation or initialism is just a group of letters joined together. World Health Organistion (WHO) is an acronym, Commonwealth Scientific, Industrial and Research Organisation (CSIRO) is an initialism. Pedantic observation perhaps...
Stiofán Mac Suibhne
Contrarian / Epistemologist
Pedantry is seldom a virtue...
Ben Heard
Director, ThinkClimate Consulting
Perhaps????
Interesting though...
Tomas Heard
logged in via Facebook
While we're nitpicking, CSIRO is both an initialism and an acronym, as many employees pronounce it as sye-roe.
You could also just accept that language evolves. The word initialism has fallen out of use (it's not even in my browser spell-checker) and the word capitalization now refers only to capitalizing the first letter of a sentence or the market value of a company. However it was defined last century, the word acronym has now absorbed the meaning of both.
Edward Grandi
logged in via LinkedIn
The American Sleep Apnea Association, a nonprofit patient advocacy group, applauds the decision of the WHO regarding ncds. Our hope is that sleep apnea, a chronic respiratory disease, can get the attention it deserves. Raising awareness about the importance of sleep in general and treating OSA can have a postive impact on the other conditions.
Geoff Russell
Computer Programmer, Author
Significant amounts of chronic disease is provably self inflicted. I wouldn't say it's the result of laziness, but of ignorance in the face of seriously bad official nutritional advice coupled with effective marketing by the pushers of junk food.
Consider what happened to Japanese bowel cancer rates with the introduction of (more) red and processed meat (both unequivocally stated to cause bowel cancer by the World Cancer Research Fund). Bowel cancer went from a "minor" cancer impacting both sexes…
Read moreBen Heard
Director, ThinkClimate Consulting
My brain had these issues pegged as "diseases of affluence" or perhaps more specifically, that the disease burden in poorer nations was still strongly weighted toward other issues, giving these a comparatively smaller priority. The article has given me something to think about, thank you.
Karen Price
GP, Chair of women in GP VIC, Juggler of domestic chaos
Interesting and I enjoyed the pedantic little debate, alas and however back to the topic which is more difficult to solve and requires global big picture thinking. (Sorry nit pickers) .
Read moreAt the AMA National Conference recently had a very interesting and enjoyable lecture on the role of environmental and town planning in managing at least some of the Obesogenic ( is that a word, I am sure someone will tell me or correct me...??!!) factors at play here. Prof Rob Adams discussed how in the outer urban…