Causes & Drivers of NCDs

A number of political, social and economic drivers fuel the NCD epidemic, resulting in a set of key risk factors and intermediate risk factors that manifest as non-communicable diseases (NCDs). The resulting burden of these diseases have drastic social and economic consequences for communities across the globe. Luckily though, there are simple, cost-effective and politically feasible solutions available.

 

The political drivers

 

Political leadership is undoubtedly an essential ingredient for action against NCDs (Yach, Hawkes et al. 2004; Sridhar, Morrison et al. 2011). For the most part these diseases are largely preventable – it is for political reasons that this pandemic continues. So what is preventing political action on the prevention of NCDs?

 

At heart, tackling NCDs involves challenging the dominant global development model of economic growth at all costs – the costs being the health of children and communities (CSDH 2008). Structural adjustment programs and trade agreements between government leaders often do not adequately consider human health (Hawkes 2006; Hawkes 2010).

 

Despite causing 60% of world deaths in 2007, only 3% of the $22 billion in global health funding went to NCDs (Nugent, Feigl et al. 2010). At the WHO, NCDs receive only 12% of extra-budgetary funding, primarily because of donor country restraints (Stuckler, King et al. 2008). This misalignment of funding and problem is clearly political (Shiffman 2009).

 

Public health can be greatly improved in communities that actively participate in political decision-making (CSDH 2008). A lack of resources to actively monitor health amongst these same communities results in a ‘silent’ pandemic - one unobserved by decision-makers (WHO 2005).

 

New governance structures are needed to recognize that solutions to NCDs often lie outside of the health sector; engaging with agriculture, trade, finance, education, transport and urban planning, media & communications is vitally important. Health in all policies is an ideal yet unrealized goal for action against NCDs (Kickbusch 2000; Kickbusch 2010; Beaglehole, Bonita et al. 2011).


Social & Economic Drivers

 

The political drivers described above create the conditions in which countries develop both socially and economically. Also fueling the NCD pandemic are globalization, urbanization, population ageing, trade and foreign direct investment (Woodward, Drager et al. 2001; Beaglehole, Bonita et al. 2011). Together these shape the conditions in which people live, grow and work (CSDH 2008).

 

The economic conditions resulting from the current global development agenda allow transnational tobacco, food and alcohol corporations to flourish through marketing and sales to previously unexposed communities. Many of the world’s top 100 transnational corporations sell these harmful products (Valentin F. and Kelly B. 2010).

 

Governments in developing countries are also encouraged to attract foreign direct investment (FDI) to grow and develop their economies, supported by unfair international trade policies (Hawkes 2002; Hawkes 2004; Hawkes 2006). Saturated and declining markets in the developed world have led the tobacco, alcohol and processed foods industries to invest heavily in developing economies to grow their sales and profits.

 

For example, annual sales growth of processed foods in LMICs is around 29%, compared to 7% in upper to middle income countries. While food companies can have both positive and negative impacts on population nutrition, the 'nutrition transition' or 'coca-colanization' underway in many LMICs is having deleterious effects on population health. Foods high in salt, sugar, trans and saturated fats are becoming increasingly common in almost all countries with evident impacts on health (Hawkes 2005).

 


Key Shared Risk Factors

 

The above creates a toxic environment where tobacco, foods high in saturated and trans fats, salt, and sugar (especially in sweetened drinks), physical inactivity, and alcohol are widely available, accessible and affordable. Exposure to these risk factors can begin early on, in childhood and even before birth (Ben-Shlomo and Kuh 2002; Lynch and Smith 2005).

 

The is especially unjust, given that many international and national laws, policies and international institutions recognize the rights of the child to adequate health, which are enshrined in the UN Convention on the Rights of the Child (Hodgkin, Newell et al. 2007).

 

Intermediate Risk Factors

 

This results in the widely recognized intermediate risk factors, which include high blood pressure, abnormal blood lipids (such as high cholesterol), high blood sugar and overweight / obesity. For example, the onset of childhood obesity, elevated blood pressure, and type-2 diabetes is now occurring in low and middle income countries (LMICs) (Chiolero, Madeleine et al. 2007; Gupta, Shah et al. 2010).


Non-communicable diseases (NCDs)

 

Non-communicable diseases result. Here is how the World Health Organization describes NCDs. You will probably know someone affected by at least one of these (WHO 2005):

 

  • Heart disease: also known as coronary artery disease or ischaemic heart disease, is the leading cause of death globally. It is caused by disease of the blood vessels (atherosclerosis) of the heart.
  • Stroke: is a disease of the brain caused by interference to the blood supply.
  • Stroke and heart disease are the main cardiovascular diseases (CVD) which is now responsible for 30% of the total deaths worldwide (Tunstall-Pedoe 2006), is the second leading cause of death in Africa, and the leading cause of death in those aged 30 or older (Gaziano 2008). The fastest growing region for CVD is in the African region (27%) and it is estimated that over the next 10 years the burden from NCD will rise by 17% whilst those from communicable diseases will fall by 3% which translates to approximately 28 million deaths due to NCD over that period (Tunstall-Pedoe 2006).
  • Cancer: describes a range of diseases in which abnormal cells proliferate and spread out of control. Other terms used are tumours and neoplasms. There are many types of cancer and all organs of the body can become cancerous.
  • Diseases of the lungs: Chronic obstructive respiratory disease and asthma are the most common forms. Chronic obstructive respiratory disease is caused by irreversible obstruction of the larger airways in the lung; asthma is caused by reversible obstruction of the smaller airways in the lung.
  • Diabetes: is characterized by raised blood glucose (sugar) levels. This results from a lack of the hormone insulin, which controls blood glucose levels, and/or an inability of the body’s tissues to respond properly to insulin. The most common type of diabetes is type 2, which accounts for about 90% of all diabetes and is largely the result of excessive weight and physical inactivity.


The Social Consequences

The consequences of this are profound and far-reaching. Consider this: In contrast to our experience of NCD being a disease of old age, in LMICs, it is often men and women in their most productive years (40s and 50s) who are most affected (Leeder 2004). On a personal level this is a tragedy for a family struggling for survival. At a societal level this lost productivity further compounds the challenges of economic growth. For these reasons NCDs can contribute to poverty, trapping poor households in a cycle of debt and illness, and further increasing economic and social inequality. You can read more about the consequences here.

 

The Solutions

 

The good news it that there are simple, cost effective and politically feasible solutions available. You can read more about our proposed solutions to NCDs here.


 

References

 

Beaglehole, R., R. Bonita, et al. (2011). "Priority actions for the non-communicable disease crisis." The Lancet.

Ben-Shlomo, Y. and D. Kuh (2002). "A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives." International Journal of Epidemiology 31(2): 285-293.

Chiolero, A., G. Madeleine, et al. (2007). "Prevalence of elevated blood pressure and association with overweight in children of a rapidly developing country." J Hum Hypertens 21(2): 120-127.

CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva, World Health Organisation.

Gaziano, T. A. (2008). "Economic burden and the cost-effectiveness of treatment of cardiovascular diseases in Africa." Heart 94(2): 140-144.

Gupta, N., P. Shah, et al. (2010). "Imbalanced dietary profile, anthropometry, and lipids in urban Asian Indian adolescents and young adults." J Am Coll Nutr 29(2): 81-91.

Hawkes, C. (2002). Marketing Activities of Global Soft Drink and Fast Food Companies in Emerging Markets: a Review. Globalisation, Diets and Noncommunicable diseases. WHO. Geneva, WHO.

Hawkes, C. (2004). Marketing food to children: the global regulatory environment. Geneva, World Health Organisation.

Hawkes, C. (2005). "The role of foreign direct investment in the nutrition transition." Public Health Nutrition 8(4): 357–365.

Hawkes, C. (2006). "Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases." Globalisation and Health 2(4): doi:10.1186/1744-8603-1182-1184.

Hawkes, C. (2010). Trade, food, diet and health : perspectives and policy options. Chichester, U.K.; Ames, Iowa, Wiley-Blackwell Pub.

Hodgkin, R., P. Newell, et al. (2007). Implementation handbook for the Convention on the Rights of the Child. New York, UNICEF.

Kickbusch, I. (2000). "The development of international health policies -- accountability intact?" Social Science & Medicine 51(6): 979-989.

Kickbusch, I. (2005). "Tackling the political determinants of global health." BMJ 331(7511): 246-247.

Kickbusch, I. (2010). "Health in all policies: where to from here?" Health Promotion International 25(3): 261-264.

Leeder, S. et al. (2004). A Race Against Time: The Challenge of Cardiovascular Disease in Developing Countries (New York: Trustees of Columbia University).

Lynch, J. and G. D. Smith (2005). "A life course approach to chronic disease epidemiology." Annu Rev Public Health 26: 1-35.

Nugent, R., A. B. Feigl, et al. (2010). "Where have all the donors gone? scarce donor funding for non-communicable diseases." from http://www.cgdev.org/content/publications/detail/1424546.

Shiffman, J. (2009). "A social explanation for the rise and fall of global health issues." Bull World Health Organ 87(8): 608-613.

Sridhar, D., J. S. Morrison, et al. (2011). Getting the politics right for the September 2011 UN high-level meeting on noncommunicable diseases. Washington, DC, Center for Strategic and International Studies.

Stuckler, D., L. King, et al. (2008). "WHO's budgetary allocations and burden of disease: a comparative analysis." Lancet 372(9649): 1563-1569.

Tunstall-Pedoe, H. (2006). "Preventing Chronic Diseases. A Vital Investment: WHO Global Report. Geneva: World Health Organization, 2005. pp 200. CHF 30.00. ISBN 92 4 1563001. Also published on http://www.who.int/chp/chronic_disease_report/en." Int J Epidemiol.

Valentin F. and Kelly B. (2010). "Promoting cardiovascular health in the developing world a critical challenge to achieve global health." from http://books.nap.edu/catalog.php?record_id=12815.

WCRF (2007). Food, Nutrition, Physical Activity, and the Prevention of Cancer: a global perspective, World Cancer Research Fund.

WHO (2002). World Health Report. Reducing Risks, Promoting Healthy Life. Geneva, World Health Organisation.

WHO (2005). Chronic diseases and their common risk factors. W. H. Organization. Geneva.

Woodward, D., N. Drager, et al. (2001). "Globalization and health: a framework for analysis and action." Bulletin of the World Health Organization 79: 875-881.

WHO. (2005). WHO steps surveillance manual : the WHO stepwise approach to chronic disease risk factor surveillance. Geneva, WHO.

Yach, D., C. Hawkes, et al. (2004). "The Global Burden of Chronic Diseases." JAMA: The Journal of the American Medical Association 291(21): 2616-2622.

Yach D. and Hawkes C. (2004). Towards a WHO long-term strategy for prevention and control of leading chronic diseases. World Health Organization. Geneva.

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