Previously they couldn’t keep up with the rising life-expectancy because of uncontrollable epidemics of infection; today many developing countries are struggling to treat a population that has been burdened with obesity, cardiovascular disease, and cancers. For a while, many of these diseases were only seen as diseases of the rich, since they took over industrialized nations first; but today they have exposed developing countries to the double burden of infectious and non-communicable diseases. “According the World Health Organization's statistics, chronic NCDs such CVDs, diabetes, cancers, obesity and respiratory diseases, account for about 60% of the 56.5 million deaths each year and almost half of the global burden of disease. In 1990, 47% of all mortality related to NCDs was in developing countries, as was 85% of the global burden of disease and 86% of the DALYs attributable to CVDs” (Boutayeb and Boutayeb, 2005). The already struggling health systems of many of these countries face the challenge of prolonged and costly treatment of NCDs.
There are four types of NCDs that cause the largest burden among developing countries. Cardiovascular disease contributes to 17 million deaths per year and, in 1999, contributed to a third of global deaths with 78% in low and middle-income countries (Beaglehole and Yach, 2003). Boutayeb points out, “The trend is increasing, indicating that by the year 2010 CVDs will be the leading cause of death in developing countries as a consequence of lifestyle changes brought about by industrialization and urbanization in developing countries engaged in the socio-economic transition”(2005). Diabetes can cause costly health complications and currently is still more prominent in developed countries. In developed countries, however, most people with diabetes are above the age of retirement, whereas in developing countries those affected are aged between 35 and 64, which makes the burden in terms of DALYs and YLDs heavier in poorer countries (Skolnik, 2008). Cancers, specifically lung, colon, breast, and prostate cancer, contribute to another 5 million deaths per year in low and middle income countries (Skolnik, 2008). Lung cancer is currently to most prominent killer among cancers, and 80% of these cases can be attributed to smoking (Boutayeb, 2005). Lastly, chronic respiratory disease presents a large burden for developing countries because of the lack of standard protocol to deal with asthma or COPD. Boutayeb points out, “the population afflicted by poverty and illiteracy, having very little (or no) access to health services, will die before the age of 40 years. They comprise 15% of the population in Latin America, 34% in Arab world, 45% in Sub-Saharan Africa and south-east Asia…and COPD is expected to become the third most common cause of mortality in the world” (2005). These NCDs account for a large portion of deaths in developing countries and put a huge burden on health care spending in low and middle income countries.
Although the above evidence strictly points out the need for prevention in low and middle income countries, is it enough to make non-communicable disease a priority. Different studies show that the probability of a woman aged 15 to 60 dying from an NCD is 12% in sub-Saharan Africa, where it is only 5% in developed countries. However, she still has a 17% of dying from obstetric complication and malaria an HIV/AIDS still remain the leading causes of death (Ebrahim and Smeeth, 2005). The ethical argument of turning away from the leading causes of death to tackle health issues that haven’t surpassed AIDS comes into question when talking about NCDs in developing countries. Ebrahim and Smeeth point out “The world's poor face a double jeopardy: the highest risk of communicable disease and the highest risk of NCDs…It must be recognized that the issue is not simply replacing strategies for communicable disease by new ones for NCDs—for example, maintaining effective vaccination programs and tobacco control should be priorities in all countries” (Ebrahim, 2005). Policy makers and health care providers in these countries need to realize the importance of the shift in NCD burden and be prepared to incorporate proper treatment plans into their care.
The developed world has seen the effective forms of prevention and treatment of NCDS, developing countries however, “lose lives prematurely because of inadequate acute and long-term management of non-communicable disease, many of which have simple and cheap treatments” (Beaglehole, 2003). Therefore, there is an increasing need to establish global norms in health care. “In these countries, 2.8 billion people live with less than 2 dollars, 1.2 billion live with less than one dollar and 1.3 billion live on fragile and often remote rural ecosystems. So, the behavior can be partly explained by lack of means and poor budget affected to health care” (Boutayeb, 2005). Poor populations lack the resources to invest in their health, and the health systems of low and middle income countries lack the infrastructure to support a costly population. Global norms are needed to effectively treat the large populations of low and middle incomes burdened by NCDs.
The war on NCDS in developing countries must begin with primary prevention. A shift is needed from individually-targeted health promotion to policy measures. Secondary prevention may be more effective at the individual level and education on eating habits and activity are still vital. The World Bank Report, “Public Policy and the Challenge of Chronic Noncommunicable Disease”, presents two key messages in tackling NCDS in low and middle income countries.
“One is the need for public policies to prevent NCDS to the greatest extent possible, and in doing so to promote health ageing and avoid premature deaths. The other is a concurrent need to recognize that the burden of NCDS will increase because of population aging, and therefore public policy has a role to play in dealing with the pressures that this will impose on health services” (Adeyi, 2007).
During the past decades, great efforts have been made to impede the burden of NCDs in developed countries. Many of the risk factors have been identified and appropriate treatment and prevention programs have been put in place. The life expectancy is rising, but along with this the economic cost of treatment and prevention of NCDs are taking its toll on health systems. Developing countries have neither the financial resources, nor the medical technology to make such advances on the war against NCDS. Furthermore, they still face the challenge of combating the infectious diseases that contribute to a large percentage of morbidity and mortality. Primary prevention is needed, but policy action needs to address the need for improved health care systems.
References
Adeyi, O., Smith, O., and Sylvia Robles. Public Policy and the Challenge of Chronic
Noncommunicable Diseases. The World Bank: Washington DC., 2007.
Beaglehole, R. and D. Yach. “Globalisation and the Prevention and Control of Noncommunicable Disease: the Neglected Chronic Diseases of Adults”. The Lancet 2003: 362, 903-908.
Boutayeb, Abdesslam and Saber Boutayeb. “The Burden of Noncommunicable Disease in Developing Countries.” International Journal for Equity in Health 2005: 4.
Ebrahim, Shah and Liam Smeeth. “Non-communicable Diseases in Low and Middle Income Countries: a Priority or a Distraction?” International Journal of Epidemiology. 2005, 34: 961- 966.
Skolnik, Richard. Essentials of Global Health. Jones and Bartlett Publishers: Boston, 2008.
No comments:
Post a Comment