Dr Maryam Ba-Break on noncommunicable diseases

In this short video, Dr Maryam Ba-Break gives an introduction to noncommunicable diseases (NCDs). NCDs are described as those that are not passed from person to person. They are also known as chronic diseases and are often of long duration and slow progression. The World Health Organization focus is on four types of non-communicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and type two diabetes; this is because these four types account for around 80% of all NCD deaths globally. In this introductory video, Maryam also includes the public health impact of road traffic accidents, violence, alcohol and substance misuse. The global burden and threat of NCDs constitutes a major public health challenge that undermines social and economic development throughout the world, and inter alia has the effect of increasing inequalities between countries and within populations.

Biography

Maryam is a Teaching Fellow in International Public Health at the Nuffield Centre for International Health and Development, University of Leeds. She leads four modules at undergraduate and Masters level, two of these modules are on non-communicable diseases and global challenges in non-communicable disease control. She supervises students’ research and dissertations in topics related to non-communicable diseases. She is currently involved in preparing a “case management guide” in Arabic for diabetes, hypertension and cardiovascular diseases.

Previously, Maryam has worked as a general practitioner in public and private hospitals in rural and urban Yemen. For 7 years, Maryam worked as a coordinator for public health projects, when she was involved in health education campaigns to promote best feeding practices among women and children and participated in developing policies to promote breast-feeding in Yemen.  As a researcher, she has coordinated many national surveys, project evaluations and studies in Yemen implemented by the Ministry of Health, UNICEF, Dutch Embassy, CARE International and the SOUL Organization for Women and Child Development.  Alongside non- communicable diseases, her other teaching and research interests include nutrition, maternal and child health, health promotion, epidemiology and research methods.

Key facts

The following key facts on NCDs are taken from the World Health Organization Factsheet, which was updated in March 2013.

  • Noncommunicable diseases (NCDs) kill more than 36 million people each year.
  • Nearly 80% of NCD deaths – 29 million – occur in low- and middle-income countries.
  • More than nine million of all deaths attributed to NCDs occur before the age of 60; 90% of these “premature” deaths occurred in low- and middle-income countries.
  • Cardiovascular diseases account for most NCD deaths, or 17.3 million people annually, followed by cancers (7.6 million), respiratory diseases (4.2 million), and diabetes (1.3 million1).
  • These four groups of diseases account for around 80% of all NCD deaths.
  • They share four risk factors: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets.

Resources

The following are key resources for those wanting to gain a better understanding of the burden of noncommunicable diseases.

World Health Organization 2011, Non communicable diseases country profiles: WHO global report.

The report features information about the noncommunicable diseases (NCDs) situation in 193 countries. This includes details of what proportion of each country’s deaths are due to diseases such as cancer, heart and lung diseases, and diabetes.

Using graphs, on a page-per country presentation format, the report provides information on prevalence, trends in metabolic risk factors (cholesterol, blood pressure, body mass index and blood sugar) alongside data on the country’s capacity to address the challenges posed by NCDs. Countries will be able to benchmark progress to date and determine where more efforts are needed.

World Health Organization 2008, 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases.

This document is written primarily for the community of international development partners, as well as those in government and civil society concerned with urgent action to address the rapidly increasing burden of noncommunicable diseases (NCDs) in low- and middle -income countries and its serious implications for poverty reduction and economic development.

The six objectives of the 2008-2013 Action Plan are:

  1. To raise the priority accorded to noncommunicable disease in development work at global and national levels, and to integrate prevention and control of such diseases into policies across all government departments.
  2. To establish and strengthen national policies and plans for the prevention and control of noncommunicable diseases.
  3.  To promote interventions to reduce the main shared modifiable risk factors for noncommunicable diseases : tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol.
  4.  To promote research for the prevention and control of noncommunicable diseases.
  5. To promote partnerships for the prevention and control of noncommunicable diseases.
  6. To monitor noncommunicable diseases and their determinants and evaluate progress at the national, regional and global levels.

The Lancet, February 2013, Non-Communicable Diseases Series. 

This latest Series on non-communicable diseases (NCDs) builds on previous Lancet Series (2010, 2007, 2005), and on a landmark high-level United Nations NCD meeting convened in September 2011. The aim of the new Series is to set out clear plans for countrywide implementation of NCD plans in the post-MDG era, towards the unified goal of ’25 by 25’—reducing NCD mortality worldwide by 2025. Five papers from this series are summarised below.

Horton, R., 2013, Non-communicable diseases: 2015 to 2025. The Lancet; 381(9866); 509-510.

In 2012, the World Health Assembly endorsed an important new health goal: to reduce avoidable mortality from non-communicable diseases (NCDs) by 25% by 2025 (the 25 by 25 goal). It remains a truth today that, despite global rhetoric and resolutions, chronic NCDs remain the least recognised group of conditions that threaten the future of human health and wellbeing. This article highlights the importance of prioritising non-communicable diseases and calls for global action to address them. It provides a history of previous Lancet series on non-communicable diseases (2010, 2007, 2005). It offers an overview of the current Lancet series on non-communicable diseases which focus on country actions (rather than merely global political or multilateral agency responses), inequalities, the harmful effects of the food and drink industries, access to essential medicines, and improving the responsiveness of health systems. The objective of the current series is to present the case for including NCDs as part of the post-2015 framework being developed now and over the next 2 years by governments and the UN system. That framework includes systems of accountability to monitor, review, and act on the commitments and promises made by all partners.

Alleyne, G., Binagwaho, A., Haines, A. et al 2013, Embedding non-communicable diseases in the post-2015 development agenda. The Lancet; 381(9866); 566-574.

The post-2015 development agenda will build on the Millennium Development Goals (MDGs), in which health is a core component. This agenda will focus on human development, incorporate the components of the Millennium Declaration, and will be made sustainable by support from the social, economic, and environmental domains of activity, represented graphically as the strands of a triple helix. The approaches to prevention and control of non-communicable diseases (NCDs) have been elaborated in the political declaration of the UN high-level meeting on NCDs and governments have adopted a goal of 25% reduction in relative mortality from NCDs by 2025 (the 25 by 25 goal), but a strong movement is needed based on the evidence already available, enhanced by effective partnerships, and with political support to ensure that NCDs are embedded in the post-2015 human development agenda. NCDs should be embedded in the post-2015 development agenda, since they are leading causes of death and disability, have a negative effect on health, and, through their effect on the societal, economic, and the environmental domains, impair the sustainability of development. Some drivers of unsustainable development, such as the transport, food and agriculture, and energy sectors, also increase the risk of NCDs.

Bonita, R., Magnusson, R., Bovet, P. Et al, 2013, Country actions to meet UN commitments on non-communicable diseases: a stepwise approach. The Lancet; 381(9866); 575-584.

Strong leadership from heads of state is needed to meet national commitments to the UN political declaration on non-communicable diseases (NCDs) and to achieve the goal of a 25% reduction in premature NCD mortality by 2025 (the 25 by 25 goal). A simple, phased, national response to the political declaration is suggested, with three key steps: planning, implementation, and accountability. Planning entails mobilisation of a multisectoral response to develop and support the national action plan, and to build human, financial, and regulatory capacity for change. Implementation of a few priority and feasible cost-effective interventions for the prevention and treatment of NCDs will achieve the 25 by 25 goal and will need only few additional financial resources. Accountability incorporates three dimensions: monitoring of progress, reviewing of progress, and appropriate responses to accelerate progress. A national NCD commission or equivalent, which is independent of government, is needed to ensure that all relevant stakeholders are held accountable for the UN commitments to NCDs.

Cesare, M., Khang, Y., Asaria,P. et al, 2013, Inequalities in non-communicable diseases and effective responses. The Lancet; 381(9866); 585-597.

In most countries, people who have a low socioeconomic status and those who live in poor or marginalised communities have a higher risk of dying from non-communicable diseases (NCDs) than do more advantaged groups and communities. Smoking rates, blood pressure, and several other NCD risk factors are often higher in groups with low socioeconomic status than in those with high socioeconomic status; the social gradient also depends on the country’s stage of economic development, cultural factors, and social and health policies. Social inequalities in risk factors account for more than half of inequalities in major NCDs, especially for cardiovascular diseases and lung cancer. People in low-income countries and those with low socioeconomic status also have worse access to health care for timely diagnosis and treatment of NCDs than do those in high-income countries or those with higher socioeconomic status. Reduction of NCDs in disadvantaged groups is necessary to achieve substantial decreases in the total NCD burden, making them mutually reinforcing priorities. Effective actions to reduce NCD inequalities include equitable early childhood development programmes and education; removal of barriers to secure employment in disadvantaged groups; comprehensive strategies for tobacco and alcohol control and for dietary salt reduction that target low socioeconomic status groups; universal, financially and physically accessible, high-quality primary care for delivery of preventive interventions and for early detection and treatment of NCDs; and universal insurance and other mechanisms to remove financial barriers to health care.

Moodie, R., Stuckler, D., Monteiro, C., 2013, Profits and pandemics: prevention of harmful effects of tobacco, alcohol and ultra-processed food and drink industries. The Lancet; 381(9867); 670-679.

The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public—private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public—private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.

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