The Rise of the Accidentally Unwell, and its Unforeseen Impact

Nabta Health

Published in

The Future of Women’s Health

8 min readMay 13, 2020

By Sophie Smith, MBA and Saba Alzabin, PhD

It is the 15th May 2020.

For the past five months, the world has existed in the shadow of COVID-19, the illness caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2).

The COVID-19 axioms have become deeply embedded in our collective prefrontal cortex: stay home, stay safe, wash your hands, wear a mask, maintain a “social” distance. The things that make you high risk for COVID-19 are also widely known: being elderly, being immunosuppressed, or having an underlying health condition. But less has been said on the subject of these underlying health conditions, known to the medical community as Non-Communicable Diseases or NCDs.

NCDs are the primary reason we are currently enduring an economic meltdown the likes of which we haven’t seen since the Great Depression. “Stay home, stay safe” has become a global, government-enforced mandate because we have a disproportionately high percentage of vulnerable people in society. 78% of people admitted to ICU in the US and 94% of those who have died with or from COVID-19 have had NCDs. Moreover, the presence of one or more NCDs in individuals who were hospitalised has shown to be directly proportionate to age. Close to 27% of individuals with an NCD were between the ages of 19–64.

If these vulnerabilities were less widespread — if, for example, only 1 in 20 adults in the US was obese as opposed to almost 1 in 2, would the threat of COVID-19 loom so large, if at all?

The problem posed by NCDs

First, let’s recap what we know about NCDs:

NCDs are chronic conditions, mostly lifestyle-related
Because NCDs are mostly lifestyle-related, they are also largely preventable
NCDs include conditions such as obesity, diabetes and cardiovascular disease.

The extent to which NCDs threaten the ambitions of countries around the world to achieve universal access to health and sustainable health coverage for their populations has only recently been acknowledged. At the turn of the century, overshadowed by the devastating epidemics of HIV, tuberculosis, and malaria and the large number of maternal and childhood deaths, NCDs were not widely recognised as a barrier to development and were not included in the Millenium Development Goals.

But this has changed.

Today, the World Health Organisation (WHO) refers to NCDs as a “slow motion disaster”:

“Of all the major health threats to emerge, none has challenged the very foundations of public health so profoundly as the rise of chronic noncommunicable diseases. Heart disease, cancer, diabetes, and chronic respiratory diseases, once linked only to affluent societies, are now global, and the poor suffer the most. These diseases share four risk factors: tobacco use, the harmful use of alcohol, unhealthy diets, and physical inactivity. All four lie in non-health sectors, requiring collaboration across all of government and all of society to combat them.”

Already responsible for 71% of all deaths each year (40.5 million deaths globally), this figure is expected to increase to 80% by 2040.

Again, to put this in context: from when the virus first emerged in China at the end of 2019 until today, over three hundred thousand people have died worldwide with or from COVID-19. In the same period (using the latest statistics from WHO) we can approximate that 16 million people have died from NCDs alone. Over 75% would have lived in low- and middle-income countries with less advanced healthcare systems; a significant proportion of those (46%) would have died before the age of 70. These approximations do not take into account the effects that COVD-19 and other unprecedented events have on higher income nations such as the US and the UK, which have been more severely affected by the pandemic due to the high prevalence of NCDs.

So what can or should be done about NCDs?

Treating the accidentally unwell

Traditional methods of identifying, diagnosing and treating NCDs are inadequate.

There are two main reasons for this:

Traditional healthcare systems are not designed to treat the “accidentally unwell” — otherwise healthy individuals whose health has been compromised due to poor diet and lifestyle choices; and,
Traditional healthcare infrastructure — be it the facilities, the equipment, the procedures, the tests, or the drugs — have mostly been designed to accommodate only 50% of the population: the male portion.

Until the mid-1990s, clinical research and clinical trials largely excluded women. Only since 1994, when the United States’ National Institutes of Health (NIH) mandated that women and minorities were to be included as subjects in clinical research, has the research community entertained the fact that sex and/or gender differences might affect clinical outcomes.

Today, women using drugs that were approved by the early 90s, are 50–75% more likely than men to suffer adverse reactions to those therapies. Ironically, a significant proportion of drugs in this category are those designed to treat or manage NCDs. Examples include statins and potassium channel-blockers used to manage cardiovascular disease or hypoglycaemic drugs such as Rezulin used to control diabetes.

Take this premise — that the treatment of NCDs in 50% of the population is significantly less effective than in the other 50% — and couple it with three assumptions: one, that modern medicine is not designed to care for the well (or accidentally unwell) but rather for the sick; two, that an increasing number of people are dying from NCDs every year; and, three, that because NCDs are increasingly causing people to die, the perception is that people with NCDs are sick (as opposed to accidentally unwell) and so are the responsibility of conventional medicine, and you have a ticking time bomb in the form of a healthcare ecosystem that could explode under the burden of NCDs at any moment.

But to really get to the bottom of this, we need to understand, fundamentally, what modern medicine is; what it has been for us, and what it should become.

Hidden figures in modern medicine

The history of modern medicine dates back to the 19th century, when meteoric advances in science coupled with rapid industrialisation and urbanisation forced practitioners to adopt new approaches for the diagnosis and treatment of patients. Some examples include the development of powerful new techniques such as anaesthesia, and the implementation of antiseptic and aseptic operating theatres.

Medicine was revolutionised by advances in chemistry, laboratory techniques, equipment and, latterly, technology. But the decline in many of the most lethal diseases was due less to advances in medicine and more to improvements in public health and nutrition. Public health measures became particularly important during the 1918 flu pandemic, which killed at least 50 million people around the world.

What is interesting about the 1918 flu pandemic here, in the context of NCDs, is not the parallels that can be drawn between it and the ongoing COVID-19 pandemic, but rather the extent to which it drew a gendered response from the medical community, and the ways in which this can be extrapolated and applied to our healthcare ecosystem today.

In her book American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic (Oxford University Press, 2012), Nancy K. Bristow talks about the gendered response to the pandemic in the United States. Male doctors were unable to cure the patients, and felt like failures. Female nurses also saw their patients die, but took pride in their success at fulfilling their professional role of caring for, ministering to, comforting and easing the last hours of their patients.

The “fix it now, or fail” response is arguably what we see today in modern medicine as relates to the diagnosis and treatment of NCDs. Every day, a new healthcare facility specialising in diabetes, cardiovascular disease, or one of the various complications associated with tobacco, rises from the dust. As of 2019, there were 700 healthcare projects worth US$ 60.9 billion under various stages of development in the Middle East and North Africa (MENA) region alone. Despite the fact that NCDs are lifestyle diseases, and so are very much at the behest of the individual in question to change their diet and lifestyle choices, they are still treated by prevailing authorities as falling within the remit of advances in medicine (the “fix it, or fail” approach), rather than improvements in public health and nutrition (the “nurture it, with a long-term view of success” approach).

The only way to successfully address the growing threat of NCDs — to population health, and to established healthcare ecosystems — is to remove them as much as possible from the medical realm, and to root them firmly within the spheres of public health: in the offices of public health policy-makers, and, more importantly, in the spaces occupied by the public themselves — in their homes, their public places, their workspaces.

The legacy of COVID-19

Perhaps the single, most positive outcome of the COVID-19 pandemic will be the shift in perceived responsibility regarding population health — from what was increasingly placed, for all aspects of public health (including the diagnosis and treatment of NCDs) on traditional healthcare providers — to us, the public.

For the first time, the global population, fearful of an enemy it can’t see or control, is actively looking for ways to be healthy at home; to exercise at home with their children, to be seen at home by their doctors; to test themselves, and receive their results and associated prescriptions from the comfort of their own homes.

As long as people begin to understand that they can control — and really control — many aspects of their healthcare and wellbeing, the onus on healthcare providers and conventional medicine to address the rising burden of NCDs will begin to wane.

Now is the time to capitalise on an enlightened and reflective population. To reallocate funds reserved for new specialised medical facilities, and instead invest in discovering new ways for individuals to prevent, identify and manage NCDs.

Advances in medicine can only get us so far. As long as we, as a species, refuse to acknowledge that individuals, not medical professionals, are responsible for managing and treating NCDs, we remain vulnerable to pandemics such as the one we are currently enduring.

Time to stop being accidentally unwell, and start being determinedly and deliberately well.

Nabta Health discovers new ways for women to prevent, identify and manage Non-Communicable Diseases (NCDs). For more information, visit https://nabtahealth.com.