Question

We know that noncommunicable diseases continue to affect U.S. citizens despite the achievements in public health in the past century. What are your thoughts, what have you found in research that would provide reasoning for the continued increase in noncommunicable diseases, despite our efforts?

Answer 1

“Noncommunicable diseases (NCDs) have long been a burden on the lives of people in United States, and a drain on government resources. But today, they increasingly impact lower- and middle-income countries as well. Globally fifteen million people ages 30 to 70 die annually from NCDs, according to a recent U.N. General Assembly report.  

We can’t wish away the NCDs challenge. Addressing NCDs requires identifying and pursuing comprehensive, cost-effective, evidence-based, and multi-sectoral strategies and applying them in a way that engages individuals and entire communities.

People of all age groups, regions and countries are affected by NCDs. These conditions are often associated with older age groups, but evidence shows that 15 million of all deaths attributed to NCDs occur between the ages of 30 and 69 years. Of these "premature" deaths, over 85% are estimated to occur in low- and middle-income countries. Children, adults and the elderly are all vulnerable to the risk factors contributing to NCDs, whether from unhealthy diets, physical inactivity, exposure to tobacco smoke or the harmful use of alcohol.

These diseases are driven by forces that include rapid unplanned urbanization, globalization of unhealthy lifestyles and population ageing. Unhealthy diets and a lack of physical activity may show up in people as raised blood pressure, increased blood glucose, elevated blood lipids and obesity. These are called metabolic risk factors that can lead to cardiovascular disease, the leading NCD in terms of premature deaths.

Modifiable behavioural risk factors

Modifiable behaviours, such as tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol, all increase the risk of NCDs.

• Tobacco accounts for over 7.2 million deaths every year (including from the effects of exposure to second-hand smoke), and is projected to increase markedly over the coming years.
• 4.1 million annual deaths have been attributed to excess salt/sodium intake.
• More than half of the 3.3 million annual deaths attributable to alcohol use are from NCDs, including cancer.
• 1.6 million deaths annually can be attributed to insufficient physical activity.

Metabolic risk factors

Metabolic risk factors contribute to four key metabolic changes that increase the risk of NCDs:

• raised blood pressure
• overweight/obesity
• hyperglycemia (high blood glucose levels) and
• hyperlipidemia (high levels of fat in the blood).

In terms of attributable deaths, the leading metabolic risk factor globally is elevated blood pressure (to which 19% of global deaths are attributed), (1) followed by overweight and obesity and raised blood glucose.

Socio economic impact

Poverty is closely linked with NCDs. The rapid rise in NCDs is predicted to impede poverty reduction initiatives, particularly by increasing household costs associated with health care. Vulnerable and socially disadvantaged people get sicker and die sooner than people of higher social positions, especially because they are at greater risk of being exposed to harmful products, such as tobacco, or unhealthy dietary practices, and have limited access to health services.

In low-resource settings, health-care costs for NCDs quickly drain household resources.

The exorbitant costs of NCDs, including often lengthy and expensive treatment

Loss of breadwinners, force millions of people into poverty annually and stifle development.