Noncommunicable diseases

Noncommunicable diseases (NCDs) are a group of diseases that affect individuals over an extended period of time causing socio-economic burden to the nation. The major NCDs share four behavioral risk factors- unhealthy diet, lack of physical activity, and use of tobacco and alcohol. Factors contributing to the rise of NCDs also include ageing, rapid unplanned urbanization and globalization.

In 2008, NCDs accounted for 5.2 million deaths in India. A rising trend in the burden of NCDs is expected in the years ahead.

There are primarily four type of noncommunicable diseases: cancer, chronic respiratory disease, stroke and diabetes, which are responsible for a majority of morbidity and mortality in the country. Mental health and injuries also have a considerable burden.

In South-East Asia, including India, NCDs affect relatively younger population as compared to the western countries, thus causing severe economic burden to the nation.

In order to reduce the growing burden of NCDs, it is important not only to address the diseases but also their key underlying risk factors, namely tobacco use, unhealthy diet, harmful use of alcohol and physical inactivity. A range of interventions have been identified that constitute as ‘best buys’.

Best-buys for addressing the NCD risk factors

Preventive strategies focus on the common underlying behavioral risk factors for NCDs including tobacco and harmful alcohol use, physical inactivity and unhealthy diet. These will help in controlling the metabolic risk factors like raised blood pressure, blood sugar and cholesterol, and obesity.

Tobacco control

Implementing the key elements of the WHO Framework Convention on Tobacco Control have been found cost-effective. These include increasing taxes, comprehensive legislations creating smoke-free indoor workplaces and public places, health information and warnings about the effects of tobacco, and bans on advertising, promotion and sponsorship.

Harmful alcohol use

Reduction in the harmful use of alcohol not only prevents cancers and cardiovascular diseases, but also prevents conditions like liver cirrhosis, depression and road traffic injuries. Enhanced taxation of alcohol beverages and comprehensive bans on their advertising/ marketing have proved to be beneficial.

Unhealthy diet

Excessive salt intake is related to raised blood pressure. Reducing salt content in foods is an effective strategy. The use of added salt should be discouraged. In India, we need to address both, homemade and processed food. Population based approaches include reaching out through mass media campaigns. Use of polyunsaturated fats as cooking medium, along with avoiding transfats is also recommended.

Physical inactivity

Physical activity promotes healthy lifestyle and lessens the risk of NCDs. It fosters physical and mental wellbeing.

Indoor air pollution

The dependence on solid fuels (coal, wood, animal dung, crop wastes) and traditional stoves for cooking and heating leads to high levels of indoor air pollution. This increases the risk of childhood pneumonia, chronic lung disease and lung cancers. In addition to tobacco control, reducing indoors air pollution is the most important strategy for preventing chronic lung disease, particularly in non-smokers.

Best-buys for tackling major NCDs

Cardiovascular disease (CVD) and diabetes

Counselling and multi-drug therapy (including blood sugar control for diabetes mellitus) for people with risk of developing heart attacks and strokes will reduce the morbidity and mortality due to these conditions. A regimen of aspirin, statin and blood pressure-lowering agents will significantly reduce vascular events in people with cardiovascular risk and is considered a best buy. Preventive measures, such as tobacco cessation and adopting a healthy life style, augment the therapeutic benefits. Administration of aspirin to people who develop a myocardial infarction is another best buy.

Cancer

Hepatitis B immunization beginning at birth can prevent liver cancer. Presently a regimen of three doses- first at birth (only possible in case of institutional deliveries), at six weeks, 10 weeks and 14 weeks along with diphtheria, pertussis, tetanus(DPT) have been included into the Universal Immunization Programme (UIP). Screening and treatment of pre-cancerous lesions is effective for preventing cervical cancer. Pain relief and palliative care is a low cost, yet essential, intervention when judged against societal norms and standards, keeping in mind the human rights perspective.

Chronic respiratory disease

Chronic respiratory disease, including asthma and chronic obstructive pulmonary disease are major contributors towards morbidity and mortality in the country. Treatment of persistent asthma with inhaled corticosteroids and beta-2 agonists like salbutamol are very low cost interventions and feasible to deliver in primary care, but their cost-effectiveness is limited by their modest impact on disease burden. However, as already mentioned above, tobacco cessation and alleviation of indoor air pollution are the key strategies for preventing chronic respiratory disease.

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