Dr. Raies Ahmad
Non Communicable Diseases (NCDs), also known as chronic diseases are non-infectious medical conditions that are associated with long durations and slow progress and are the result of several factors, including genetic, physiological, behavioural and environmental factors.
According to the World Health Organization, NCDs are the leading cause of death worldwide, responsible for more than 71% of the total number of deaths each year. The top four killers among NCDs with the highest number of deaths are cardiovascular diseases, cancers, respiratory diseases and diabetes.
Historically, many NCDs have been directly linked to economic growth and were called “diseases of the rich.” Now, the burden of NCDs in developing countries has increased.
Risk Factors of NCDs :
The risk factors of NCDs can be classified as modifiable or non-modifiable factors.
1.Modifiable Risk Factors involve high blood pressure, smoking, diabetes mellitus, physical inactivity, obesity, and high blood cholesterol.
2.Non Modifiable Risk Factors involve age, gender, genetic factors, race, and ethnicity.
Age : While NCDs are usually associated with elderly people, all ages are at risk, even before birth. These diseases may start in the earliest years of life and keep progressing during childhood, adolescence, and old age. However, 15 million deaths due to NCDs were recorded from people aged between 30 and 69 years of age.
Diets and Lifestyle : In the past, infectious and parasitic diseases were the main causes of death, but in the recent decades, NCDs have replaced them and have become the main cause of deaths. This may be attributed to the change of diet habits and lifestyle over the years, which can be classified as a shift of disease patterns in humans. Traditional food in most countries is healthier, natural, and richer in fiber, and cereal has been replaced by unhealthy processed food that is rich in sugars and fats, animal-source foods, and refined carbohydrates. Hence, low and middle-income countries have seen rapid changes in nutrition transition and rapid increases in NCDs. High food consumption and declining physical activity rates occur simultaneously, resulting in NCDs. The main factor, attributable to physical inactivity, is the rapid and continuous development in technology. The easy access to modern technology and manufacturing in houses and workplaces, including machines, vehicles and labour-saving technology, make life easier but unhealthier from the perspective of reducing the risk of NCDs.
Key Diseases :
1.Cardiovascular Diseases (CVDs) : CVDs are the leading contributors to the global burden of disease among the NCDs and account for the most deaths worldwide each year—even more than the number of deaths from cancer and chronic respiratory diseases combined. CVDs are a group of disorders that are not only related to heart conditions, such as ischemic heart disease (IHD), stroke, congenital heart disease, coronary heart disease, cerebrovascular disease, peripheral arterial disease and rheumatic heart disease, but also to blood vessels that involve hypertension, and conditions associated with cerebral, carotid, and peripheral circulation.
Cancer : Cancer is the main public health problem and the second main cause of death globally. The causes of cancer can be classified into three categories, including:(i) Biological carcinogens (e.g., viral, bacterial, or parasites infections, hormonal and genetics factors)(ii) Chemical carcinogens (such as food and water contamination, and tobacco smoking)(iii) Physical carcinogens (such as ultraviolet and ionizing radiation). However, tobacco smoking is considered to be the main cause of cancer, followed by poor diets. Moreover, together, body weight and lack physical activity are also associated with the most common cancers, including breast (postmenopausal), colon, endometrial, kidney and oesophagus cancers
Chronic Respiratory Diseases : It cover a wide range of diseases in the airways and the other structures of the lungs which include chronic obstructive pulmonary disease (COPD), occupational lung diseases, asthma and respiratory allergies, sleep apnoea syndrome, and pulmonary hypertension. Asthma and COPD account for most of the deaths among such diseases in low and middle-income countries. Genetic and environmental factors are the risk factors of CRDs; environmental factors are more dominant. These factors include air pollution exposure, including tobacco smoke and second-hand tobacco smoke, indoor and outdoor air pollution, occupational exposures, and socioeconomic factors.
Diabetes Mellitus: Diabetes has attracted global attention due to its elevating prevalence and incidence. It is not only a chronic disease, but also an acutely life-threatening condition. Further, it may cause other serious diseases such as heart diseases, kidney failure, and eye damage, which may subsequently lead to blindness, and foot ulcers, which may require limb amputation. The main two types of diabetes are both lead to hyperglycaemia. In type 1, the pancreatic β-cells cannot produce a sufficient amount of insulin, while in type 2, the body cells cannot respond properly to insulin. Other types of diabetes involve gestational diabetes mellitus, which occurs in pregnant women with glucose intolerance, and type 3 diabetes, which is associated with Alzheimer’s disease, where neurons in the brain cannot respond to insulin.
Preventive Management of NCDs :
NCDs are the silent killers threatening health without showing any symptoms until the problem progresses to an advanced stage. Patients with NCDs, or people with a susceptibility to develop one, need long term care. Primary health care can organize and deliver healthcare strategies to manage NCDs in each community and to detect diseases at early stages.
The best preventive management include ;
a)Individual (Lifestyle Management) which involve changes in lifestyle with respect to diet, physical activities, cessation of smoking, and the control of metabolic disorders.
b)Societal (Awareness Management) which involve focus on actions, such innovations, which can help the society to increase the awareness of risk factors management
c)National (Health Policy Decisions) which involve health policy decisions at a country level
d)Global (Health Strategy) to develop a health strategy at the global level
The most common causes of NCDs are metabolic and behavioural risk factors and can be largely preventable by several means. Most global discussions concern the risk factors of self–management (tobacco and alcohol consumption, physical activity, weight and food) and focus on the role of individual responsibility to manage the risk factors of NCDs. Health care specialists should educate patients about their nutrition. Further, the management of NCDs is the priority of the public health sector in most countries, because management in society is the main direction of NCD prevention strategies. Interventions are used in public health management in an effort to promote good health behaviour. India is implementing multi-sectoral actions to prevent NCDs, including National Program for Control of Diabetes, Stroke, and Cardiovascular Diseases initiatives (NPCDCS), school health programs, National
Cancer Control Programme, National Trauma Control program, National Program for Control of Blindness, National Mental Health Programme and the National Tobacco Control Program.
Since diet and lifestyle is a common risk factor among most NCDs, it attracts more attention in an effort to find effective strategies to provide healthy food to the community and at all stages of life. Lifestyle activities include healthy diets and focus on limiting the use of salt, sugar, and saturated fats. Food supplements are concentrated sources of nutrients (minerals and vitamins) or other substances with a nutritional or physiological effect, which are marketed in the form of pills, capsules, and/or liquids. These dietary supplements offer many benefits, including the maintaining of an adequate intake of certain nutrients, to correct nutritional deficiencies, or to support specific physiological functions.
The main risk factors of cancer are age, gender, alcohol, smoking, family disease history, and food. Cancer can be prevented by changing behaviour: dietary improvements, physical activity, weight control, obesity management, tobacco prevention, safe sex and control of oncogenic viruses, sun protection, medications, and lower alcohol consumption.
Dr. Raies Ahmad ,Community Health Officer, JKNHM BLS and ERTC Certified (Directorate of Health Services, Kashmir), can be reached at firstname.lastname@example.org