Non-Communicable Diseases: An Introduction

 When diseases are called chronic?

According to the Commission on Chronic Illness in the USA   "chronic diseases" have one or more of the following characteristics :

• They are permanent. 
• They leave residual disability.
• They are caused by nonreversible pathological alteration.
• They require special training of the patient for rehabilitation.
• They may be expected to require a long period of supervision, observation or care."

What are Non-Communicable diseases(NCDs)?

Non-communicable diseases include:

• Cardiovascular, renal, nervous, and mental diseases,
• Musculoskeletal conditions such as arthritis, and allied diseases 
• Chronic non-specific respiratory diseases (e.g., chroni~bronchitis, emphysema, asthma) 
• Permanent results of accidents 
• Senility, blindness, cancer, diabetes, obesity
• Various other metabolic and degenerative diseases (Disorders of unknown cause and progressive course are often labeled "degenerative".) and
• Chronic results of communicable diseases. 

What is the problem statement?

• The prevalence of chronic diseases is increasing in most countries due to several reasons.
• A total of 57 million deaths occurred worldwide during 2016. Of these, 41 million were due to NCDs, principally cardiovascular diseases, cancer, and chronic respiratory diseases. 
• NCDs are estimated to account for about 63 percent of all deaths in India.
• The impact of chronic diseases on the lives of people is serious when measured in terms of loss of life, disablement, family hardship, and poverty, and economic loss to the country. 
• Developing countries are now warned to take appropriate steps to avoid the "epidemics" of non-communicable diseases likely to come with socio-economic and health developments.

What are the risk factors for NCDs?

1. Tobacco: Around 7 million people die from tobacco use every year, both from direct tobacco use and second-hand smoke.
2. Insufficient physical activity: Around 1.6 million people die each year due to physical inactivity & people having insufficient physical activity have a 20% to 30% increased risk of all-cause mortality. 
3. Harmful use of alcohol: Around 3.3 million people die each year from the harmful use of alcohol, accounting for about 5. 9% of all deaths in the world. 
4. Unhealthy diet: Adequate consumption of fruit and vegetables reduce the risk for cardiovascular diseases, stomach cancer, and colorectal cancer.
5. Raised blood pressure: It is estimated to cause 9.4 million deaths, about 12.8% of all deaths. It is a major risk factor for cardiovascular diseases.
6. Overweight and obesity: At least 2.8 million people die each year as a result of being overweight or obese. Risks of heart disease, stroke, and diabetes increase steadily with increasing body mass index (BMI).
7. Raised cholesterol: Raised cholesterol is estimated to cause 2 .6 million deaths annually. It also increases the risk of heart disease and stroke.
8. Cancer-associated infections: The principal infectious agents are human papillomavirus, Hepatitis B virus, Hepatitis C virus, and Helicobacter pylori. These infections are largely preventable through vaccinations and measures to avoid transmission, or treatable.
9. Environmental risk factors: occupational hazards, air, and water pollution. and possession of destructive weapons in case of injuries.

What are the preventive measures?

NCDs are multifactorial in causation, so prevention demands a complex mix of interventions. But, now with the identification of risk factors, health promotion activities aimed at primary prevention:

1. Protecting people from tobacco smoke and banning smoking in public places, warning about the dangers of tobacco use, enforcing bans on tobacco advertising, promotion and sponsorships, and raising taxes on tobacco.
2. Restricting access to retailed alcohol, enforcing bans on alcohol advertising, and raising taxes on alcohol.
3. Reduce salt intake and salt content of the food.
4. Replacing trans-fat in food with polyunsaturated fat.
5. Promoting public awareness about diet and physical activity including through mass media.

There are many other cost-effective and low-cost population-wide interventions that can reduce risk factors for NCDs. These include :

1. Nicotine dependence treatment.
2. Enforcing drink-driving laws.
3. Restrictions on the marketing of foods and beverages high in salt, fats, and sugar.
4.  Food taxes and subsidies to promote healthy diets.
5. Healthy nutrition environments in schools.
6. Nutrition information and counseling in health care; and
7. National physical activity guidelines (school-based physical activity programs for children and workplace programs for physical activity and healthy diets).
8. Integrated approach: Simultaneously attacking several risk factors known to be implicated in the development of non-communicable diseases. Such concerted preventive action should reduce not only cardiovascular diseases but also other major NCDs, with an overall improvement in health and length of life. 

References:

1. Park, K., 2019. Park's Textbook Of Preventive And Social Medicine. 25th ed. Jabalpur: M/s Banarsidas Bhanot Publishers, p.1000.
2. Kadri, A., 2019. IAPSM's Textbook Of Community Medicine. 1st ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd, p.1221.
3. https://www.cdc.gov/globalhealth/healthprotection/fetp/training_modules/new-8/overview-of-ncds_ppt_qa-revcom_09112013.pdf
4. http://www.bmrat.org/index.php/BMRAT/article/view/411
5. https://extranet.who.int/ncdccs/documents/
6. https://www.nhp.gov.in/healthlyliving/ncd2019
7. https://www.change4health.gov.hk/en/saptowards2025/ photo credit