The other global pandemic we should be thinking about
More than 7 out of 10 amongst us are likely to die of a chronic, non-communicable disease (NCD). These diseases include ailments of the heart, diabetes, lung disorders, cancer and mental health disorders. The WHO has recognized non-communicable diseases as one of the biggest health priorities, especially given their disproportionate impact on health and economic burden. It is estimated that between 2010 and 2030, these diseases will cost the world more than $47 trillion in economic costs.
When I was in medical school in the 1990s, the NCDs were considered a bigger concern for the developed world. Developmental and economic progress over the last 2 decades have accelerated the burden of NCDs in low and middle income countries (LMICs), faster than we have been able to recognize and respond to. A disproportionate number of premature deaths due to NCDs occur in the low- and middle-income countries (LMICs) — amounting to nearly 85% of the total global “premature” deaths due to NCDs.
Chronic underinvestment in NCDs has contributed to high disease burden
While we have made progress in containing NCDs, the initial gains made in the early 2000s have been foregone, as the annual decline of the risk of dying from a major NCD between the ages of 30 and 70 is slowing since 2010. Premature mortality from diabetes has increased by 5% over this period. Most countries are falling behind in their commitment to reduce the burden of NCDs. WHO progress data from 2020 shows that only half of all countries are fully meeting 2 out of the 10 target indicators. The United Nations SDG target 3.4, focused on NCDs is off track to meet its 2030 goals.
There is a need to do much more, much faster, especially over the next decade and particularly in LMICs that bear the greatest burden and have the least resources to deal with the escalating health and economic costs of NCDs.
COVID -19 has further aggravated the burden of NCDs
The COVID-19 pandemic has further aggravated the challenge of addressing NCDs. The WHO reports that people living with NCDs are more vulnerable to severe infections of dying from COVID. Several recent studies suggest that COVID-19 deaths include a high proportion of hypertensives and diabetics and that patients with severe COVID-19 disease had a very high prevalence of existing cardiovascular diseases.
COVID-19 has also disrupted the provision of essential public health functions and necessary health services, including for people living with NCDs. 122 countries reported a disruption in NCD services with 75 reporting closure of population level screening programs. The Netherlands reported a drop of 25% in the number of people newly diagnosed with cancer.
Finally, early signs point to a change in patients’ health seeking behaviors. Patients are delaying important but seemingly non-urgent medical interventions including elective surgeries. Studies have reported reduced attendance in cardiac OPDs, decrease in elective surgeries and fewer patients reporting for acute cardiac emergencies than a year back.
Investments in systemic solutions essential to address the NCD pandemic
There is an urgent need to address the historic underinvestment in NCDs. The WHO has developed ‘best buys’ — a set of 16 practical and cost effective interventions that work and can be delivered at the primary level. I have previously written about the challenges with primary healthcare, but also that the current pandemic has raised the need to re-prioritize our investments in them. With its emphasis on promoting health and preventing disease, primary healthcare is the most inclusive, effective and efficient way to reduce premature mortality from NCDs and promote mental health and well-being.
Finally, it is critical to prioritize health promotion and disease management. In doing so, we must remember that the democratization of technology in the last 2 decades has helped evolve health consumers into active health-seeking co-participants of health and wellness decisions. Informed and empowered consumers can unlock a new category of health worker in our fight against NCDs, the pandemic that we all will need to unite and fight against.
Dr Aakash Ganju is the CEO of Saathealth, an AI powered, chronic care digital platform.
