Strategic Plan for Surveillance and Prevention of Non Communicable Diseases in Bangladesh 2011-2015
By convention non-communicable diseases (NCDs) are cardiovascular disease, diabetes, chronic respiratory disease and certain cancers. NCDs evolve from the complex interaction of multiple determinants and risk factors. Interventions need to address these determinants and risk factors simultaneously, integrating policy and public health interventions that target entire populations and communities, as well as high-risk individuals and those with early or established disease.
Population ageing has altered the nature of death and disease. Success in increasing life expectancy has ensured that a significant proportion of the population manage to survive the risks of dying during the perinatal period and early childhood, and has allowed chronic NCDs to overtake communicable diseases as the major cause of mortality and morbidity. While not discounting the inevitability of death, the evidence indicates that non-communicable diseases often cause death prematurely, usually after years of increasing disability and ill health.1 Objective measurement of burden of disease and death following standard definitions are needed.
Common risk factors underlie NCDs. An estimated 80% of premature heart disease, stroke and type 2 diabetes, and 40% of cancer, could be avoided through healthy diet, regular physical activity, and avoidance of tobacco use.2 Globalization and urbanization serve as conduits for the promotion of unhealthy lifestyles (e.g. tobacco and alcohol use, unhealthy diets, and physical inactivity) and environmental changes (e.g. indoor and outdoor air pollution). These common risk factors give rise to intermediate risk factors such as raised blood pressure, raised blood glucose, unfavourable lipid profiles, obesity and impaired lung function. In turn, the intermediate risk factors predispose individuals to the "fatal four": cardiovascular disease (heart disease and stroke), cancer, chronic respiratory disease and diabetes.3
The health care costs related to NCDs are significant. For the socio-economically disadvantaged, the out-of-pocket expenditure for NCDs can be catastrophic. On top of the direct health care costs, the economic impact of early death and disability, i.e. before age 60, is potentially devastating. NCDs contribute to the nation's burden of poverty; retard national development and can widen the health inequities within country. Unfortunately, investment in NCD prevention and control remains inadequate despite the growing burden and evidence for effective interventions.