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HMG7120 - Global Challenge - Non-Communicable Disease - Victoria University


Write an essay on Evolution of global non-communicable disease epidemic.


Non-communicable diseases (NCDs) are defined as physiological complications or disorders which are not transmitted from one person to the other. These diseases are of the (normally) long duration as well as it progresses slowly. It has become the major cause of global death as compared to the combination of all other diseases (Ding, Lawson, and Kolbe-Alexander 2016). According to the survey of the World Health Organisation (WHO), the data reveals that more than 80% of deaths related to NCDs occur in middle to low-income nations (Jan, Laba, and Essue 2018).

In such cases, the fragile healthcare system usually struggles to satisfy the basic health requirements of the population. The common NCDs diseases include diabetes, chronic respiratory diseases (including the osteoma and obstructive pulmonary disease), cardiovascular diseases (heart stroke and attacks) and cancer. The primary causes of these diseases are the economic transition, changing lifestyles and rapid urbanization (Slama, Kim, and Roglic 2017). Some of the common risk factors associated with NCDs are physical inactivity, harmful alcohol consumption, unhealthy diet, and tobacco use. This is considered as a global epidemic because only the cardiovascular disease has alone killed population more than that of the combined output of malaria, HIV, and TB.

The epidemiological change of these diseases is stimulated by the socioeconomic, environmental and behavioral risk factors. The majority of these effects fall in the poorer people bearing the socioeconomic determinants. These groups of people the least sufficient to afford the medical expenses resulting from such diseases, which eventually increases the death rates. The present report outlines the evolution of non-communicable diseases as an epidemic on a global scale. It further describes the major current and future challenges and threats associated with it.

Non-communicable disease as a global epidemic

NCDs have presently replaced malnutrition and infectious disease as a prime cause of global death. It is also considered as a contributor to disability and financial burden over a period of time. Once these diseases are only limited to high-income Nations, which now mostly transferred to the low-income nations. The rapid progress in morbidity and mortality from non-communicable diseases has highly affected the available resources within and across international borders. Based on the report provided by the Global Burden of Disease, the death caused by NCD is almost 28 times higher than the human immunodeficiency virus.

On the other hand, it only receives 17 times less funding for medical treatment. A few years back, these diseases were termed as ‘epidemic' as the level of most of the diseases in the community has suddenly increased above the expected levels. However, presently these diseases are termed as ‘pandemic' as these epidemic has crossed international borders and continents by affecting a wide range of the population. The four major categories of these diseases include chronic respiratory diseases (10%), cardiovascular diseases (33%), cancer (18%), diabetes (4%), and mental health conditions (35%) (Stanaway, Flaxman, and Naghavi 2016). The report of WHO depicts that the growth of such diseases mostly affects the low-income nations as compared to developed nations. There exist both modifiable as well as non-modifiable risk factors for the increased rate of such diseases. The modifiable risk comprises of an unhealthy diet, smoking, harmful consumption of alcohol, lack of physical fitness, and economic deficiency and substantially it results in obesity with increased cholesterol level and blood pressure. This means that the factors that are responsible for the onset or are acting as a trigger for the NCDs can be modified depending on the motivation or situational will of the individual.

On the contrary, non-modifiable risk factors primarily include population aging (Niessen, Mohan, and Akuoku 2018). Based on the current WHO global status report on the proportion of mortality rate under 60 years related to NCDs for low-income countries is 40%, lower to medium income countries is 38%, upper to medium income countries is 35% and higher-income countries are 31% (Stanaway et al 2016). The report is a clear indication that these diseases are the leading cause of disability and death, especially in medium income and low-income nations, experiencing an unbalanced high burden. It is considered remarkable in low-income countries, not only of its prevalence but also because of its high economic burden, which is expected to substantially increase in the coming decades. Notably, the possible reason for the onset of these complications is associated with physiological stress, difficulty in performing a routine business, as well as the disability factor that comes with an increase of age. These diseases are increasing in a rapid way, which results in continuous drainage of family resources and reduces productivity.

At present, Africa holds the highest NCDs death rate as compared to other nations in the world. In the last three decades, the developed nations have managed to reduce NCD death rate, however, the same is not reflected in low and medium income nations (Nugent, Bertram, and Jan 2018). It is estimated that 54% of death results from NCDs in the Eastern Mediterranean region of WHO is because of cardiovascular disease. According to the report of de Souto Barreto et al. (2015), in 2015, the WHO reported a 23% increase in death rate in the medium to high-income Nations, especially in Africa and South East Asia and a 13% rise in high-income nations. On the other hand, there exists a possibility of a 43% increase in death rate in the medium to low-income nations and a 21% rise in high-income nations. In accordance with the report by Bollyky et al. (2017), these diseases are considered a serious threat to the development of low and medium income nations. The reason behind this is it increases health risk for the population under 60 years of age and these peoples tend to become disable or die at a younger age due to NCD. As a matter of fact, this eventually restricts productivity and economic development as compared to the developed economies.


Current challenges and difficulties from non-communicable diseases
Presently, the disease burden has been shifted from communicable diseases to non-communicable diseases as more than 60% of deaths are due to NCDs. Moreover, the social and economic cost incurred from non-communicable diseases is much expensive than treating communicable diseases. Non-communicable diseases describe a high expense on society as well as create social inequalities. The financial expenditure on health treatment creates an increasing burden on individuals, families, and the government of the country. For example, the economic burden in Latin America and the Caribbean related to diabetes has been estimated to be $65 billion each year (Mendenhall, Kohrt, and Norris 2017).

Similarly, the obesity-related health cost in China and India is estimated to be 1.1% and 2.1% of the gross domestic product (GDP), respectively (McMahon, Corcoran, and O'Regan 2017). In addition to this, the complications associated with NCDs further incur significant costs. For instance, the diabetic nephropathy method is considered the costliest treatment in diabetes all over the world (Stephani, Opoku, and Quentin 2016). Furthermore, the population affected with NCDs are more susceptible to other communicable and non-communicable diseases. Also, it is important to note that individuals with a high prevalence of diabetes are more prone to get affected with infectious diseases like malaria, tuberculosis, dengue, and diarrhea which then becomes harder to treat. Smoking tobacco, lack of physical activity, and poor nutritional culture are some of the highlighted risk factors that are associated with the mentioned complications that are under the scope of NCDs. The threat is reflective is also reflective in the statistics that 41 million people lose their lives out of NCDs per year, which approximately contributes 71% of the total global death rate (Arokiasamy, Kowal, and Capistrant 2017). Among these, 85% population are from low and medium income nations. Despite this epidemic situation, the government has provided only 2% of global health financing for non-communicable diseases (Riley, Guthold, and Cowan 2016). Notably, the patients suffering from chronic diseases like cancer, heart stroke have to suffer catastrophic health expenditure, which is expected for more than 60% of total patients.

In contrary, the uninsured patients or those who are not within the universal health coverage have to suffer a higher health expenditure for treatment. The NCD burden often falls on the poorest group in society, which leads to premature death. Reports suggest that 87% premature NCD death occur in mostly low and medium income nations (Bollyky, Templin, and Cohen 2017). Taking reference from the recent report of WHO and Organisation for economic cooperation and development (OECD), the economic loss accounted from NCDs premature death is approximately 115 billion euros each year. Thus, these diseases not only create suffering for the patients but also for their families by impending economic growth and overburden health expenditure (Bollyky, Templin, and Cohen 2017).

Chronic NCDs are widely spreading among the adult population. This is conclusive based on the facts described in detail, in relevance to both developed as well as developing nations. The major challenge to control this epidemic is the lack of developed monitoring systems; while the barrier of controlling this issue is the cost-effective diagnostics (and requisite equipment). These factors make it difficult to identify the effect on health and effective treatment procedure. Also, it affects the precautionary measures that are essential for the control of NCDs. In accordance to the report of Nyaaba et al. (2017), while some healthcare institutions are having the capacity to effectively manage the burden of NCDs (are able to diagnose the disease), most of them lack the basic treatment resources requisite for the medication. In addition to this, the lack of education among the patients makes it difficult to understand the causes, impact, and treatment of NCDs. The existing stigma among the population is also another obstacle for the patient accessing health care treatment. For example, most of the people hold a pre-assumption that cancer is an untreatable disease, as it is mostly detected in the later stage. This creates a situation of psychological dilemma within the patients willing to approach for medical treatment.


Future threats of No-communicable diseases
In 2015, the United Nations and WHO have organized the 2030 agenda for sustainable development addressing NCD pandemic (Lozano, Fullman, and Abate 2018). The premature mortality rate from cardiovascular diseases was on a continuous decline state until 2013. However, from 2014 there is a continuous increasing rate which is expected to remain constant until 2025 (Stanaway et al 2016). Similarly, the premature mortality rate from the cancerous tumors between the ages of 30 to 70 years has been decreasing over the years. However, presently the decreasing rate has plateaued out with 7% of all mortality rates (Nyaaba, Stronks, and Aikins et al 2017).

Based on the prediction, the rejection is expected to have a continuous decline until 2025 at a slower rate to reduce premature mortality. The premature mortality rate from the respiratory diseases is expected to decline by 50% probability by 2025 (Jan et al 2018). Finally, the premature mortality rate from diabetes has experienced a sudden drop in 2014, which is further expected to have a declining tendency until 2025. Thus, the overall mortality rate from NCDs is expected to have a slowly declining trend by 2030. However, another report by McMahon et al (2017) states that the global burden related to NCD is expected to rise by 17% till the year 2025. It can be concluded that, in the future, it is expected to have a slow declining mortality rate from NCDs. The measure that is essential to control the burden of NCDs among the community members include the following consideration:

- Government support for the health care institution, with requisite experts (professionals, instruments, and allied healthcare personnel) must be accessible.
- Facilities such as free health check-ups, follow-ups, and support from social health workers must be facilitated.
- Community members must be aware of the physiological consideration and health issues. This will help them in remaining attentive towards health needs.
- Health awareness programs that include physical activities, good nutrition, and avoiding substance abuse (tobacco, alcohol, and other additives) must be used as an effective tool for controlling the burden of NCDs.
- Campaign including open-place check-ups for NCDs, social media platforms, and media such as newspapers and television must be used for raising awareness among the community members.

Altogether, cancer, cardiovascular diseases, respiratory diseases, and diabetes results in 81% of the total NCDs deaths. In the future, the global burden of NCDs is expected to rise by 17% by 2025. The cardiovascular disease has been reported as a major and foremost killer among the non-communicable diseases. According to the study of the global burden of disease, in 2015, more than 400 million people suffered from cardiovascular diseases and out of them, 18 million deaths have been recorded on a global scale. Thus, there are nearly 393 deaths due to cardiovascular disease per 100,000 people. However, this rate has been observed to be decreased by 286 per 100,000 in the present years.

Actions are taken by the local government
The development of non-communicable diseases has ignited political members all over the world. The important initiatives taken by the United Nations are "25 by 25" recommendations, which aims to reduce the mortality rate associated with NCD by 25% until the year 2025 (Riley et al 2016). Similarly, the UN sustainable development agenda has the objective to minimize the NCD mortality rate by one third till 2030. Furthermore, to transform political ambition two practical actions, the World health organization has designed a preventive action. The action plan aims to mitigate NCDs in the European region of WHO. The stakeholders involved in this action plan are the European Chronic Disease Alliance (ECDA), the European heart network, and the European society of hypertension. The ECDA is a joint effort 11 professional organization along with the European society of cardiology (Arokiasamy, Kowal, and Capistrant 2017). The action plan has the objective is promoting the appropriate and required health legislation for the betterment of the people. These form of preventive legislation has found to be effective as it provides information campaigns related to the unhealthy impact of smoking. In this context, the legislation has restricted people used to smoke in public areas and has imposed taxation on its advertisement. This effort has reduced smoking as well as the effect of second-hand smoking to a maximum extent.

In summary, the present report has illustrated the concept of non-communicable diseases, the rising burden its challenges, and future threats on a global basis. The report has emphasized the impact of NCDs, especially in low-income nations. Important concepts and actions taken by the local government of different countries have been mentioned. NCDs are neither infectious or communicable in nature, however, it has become more epidemic than the communicable diseases. These diseases not only increase physical burden but also creates a financial burden on the patient and family members. Therefore, there is a requirement of a strong clinical practice as well as legislation to combat the rising global threat of NCDs, particularly cardiovascular disease. The government and other stakeholders should collaboratively take strong action against the use of tobacco and alcohol and promote physical fitness as well as healthy food options for a healthy population.


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