HMG7120 Global Challenge: Non-Communicable Disease, Victoria University, Australia

Evolution Of Global Non-Communicable Disease Epidemic

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Question: Write an essay on the following statement: ‘Evolution of global non-communicable disease epidemic'.

Answer: Introduction: In the 21st Century the major health challenges in the Developing countries i.e., low and middle-income countries are caused by socio-economic issues, malnutrition, susceptibility to infectious diseases with a high economic burden. In the past decadethere has been a rapidincreasein the number of deaths due to noncommunicable diseases such as chronic respiratory diseases, cancers, cardiovascular diseases and diabetes from a 53% to 63%indicating a major threat to socio-economic development in LMIC countries.The number of deaths due to noncommunicable diseases (NCDs) reported in the developing countries and the relative economic burden is at least 3 times higher than in the case of infectious diseases (IDs). The statistics of noncommunicable diseases in developing countries indicate a 71% higher NCD rate than the developed nations where the numbers are relatively stable.

In the lower middle-income countries (LMICs) Heart diseases and stroke are the leading cause of death, in addition to diabetes and lung cancer as a result of increase in smoking and obesity.Deaths due to heart diseases affect the younger population in the developing countries unlike the developed nations where the elderly ages above 60 years are affected.

Across the world the noncommunicable disease pose a greater risk in comparison to infectious, genetic conditions (both paternal and maternal),and nutritional deficiency diseases combined. Early life health exposure of an individual during the infancyin terms of nutrition such as breastfeeding, low fat diets reduce the risk of obesity and cardiovascular diseases in the later stages of life thereby decreasing the susceptibility to NCDs.It is estimated that metabolism in the adulthood is a result of epigenetic changes during the development of a child in the early years of the life (Singhal, 2014).

Global health Epidemiological studies in the developing nations suggest the negative influence of noncommunicable diseases in the socio-economic inequalities between the high income and LMICs(Patel and Webster, 2016).

Global susceptibility and risk

NCDs pose a major threat to national economy. Both low- and high-income countries are vulnerable to the risk factors of NCDs. Those include social and cultural determinants, health behaviours, heritable factors, commercial factors and the immediate physical environment of an individual or societies. However, these factors disproportionately affect these countries due to genetic predisposition and health care.

Social structure and hierarchy in a society directly influences the choices available and associated behaviours in the population belonging to a culture through the limitations of food choices and may sometimes promote risky behaviours such as tobacco use and alcohol consumption. Socially disadvantaged individuals are at high risk as they are vulnerable to social influence. An increasingly evident influence of commercial marketing of various brands on the choices also determine the risk of NCDs. A global shift towards calorie rich foods, less labour intensive jobs reflect the rise in the NCDs(Hatefi et al., 2018).

The underprivileged population are highly vulnerable to NCDs due to higher levels psychological stress, unhealthy physical environment, restricted access to health care, deprivation of basic education to prevent the health complications. It is observed that poor are more prone to tobacco abuse, unhealthy food choices, lead a sedentary lifestyle which holds true for high income societies further broadening the gradient of NCDs in high income and LMICs(Williams et al., 2018).

Epidemiologic transition: Over the recent years there is an increasing trend in the mortality rates of noncommunicable diseases than communicable diseases. The lifestyle diseasessuach diabetes , CVDs and cancers are leading cause of death across the ages of population in infancy and adulthood. (Oni and Unwin, 2015).

Global health awareness in hygiene and the efforts of Global health organisations improved the prognosis of infectious diseases and decreased the cases of malnutrition, whereas an improved economy enhanced the healthcare facilities available for pregnancy complications and delivery reducing the infant mortality rates in the LMICs. However, A concept of emigration from the poor conditions to affluent environment due to rapid economic development heavily influenced the life style of individuals and society as a whole. The changes in the lifestyle are marked by decrease in Physical activity, consumption of refined sugars instead of vegetables and fruits. These modifications lead to obesity, hypertension and ultimately to NCDs. These societal and lifestyle changes occur at a faster pace in developing countries than in developed countries and hence are more likely to develop NCDs (Koopman et al., 2016)

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Evolutionary mismatch of populations in developed countries:

Genetic mismatch: Human beings as a species have survived in diverse environmental conditions until the advent of machines that restricted the labour-intensive jobs.In the case of western countries, the movement from adverse to affluent conditions with abundance of resources occurred over many generations and the populations with the favoured traits to the new environmental conditions survived and thrived. The individuals that are resistant to the diseases and can better adapt are naturally selected. But in the developing countries the shift occurred in a span of less than a generation subjecting the populations to relatively higher levels of stresswith an increased susceptibiliy to NCDs(Koopman et al., 2016)

Cultural mismatch: Culture is a dynamic collection of beliefs, attitudes displayed by a population. Food choices, hygiene and various other life style choices are an integral part of culture. As the environment changes cultural adaptations are observed to meet the existing needs. Culture of fitness in the developed countries had a protective effect on the health despite the resources. Difference in the perception towards physical inactivity as a representation of wealth and higher social status lead to sedentary behaviours in the developing countries.

Epigenetic mismatch: Epigenetic changes are the modifications that occur at the molecular level of an individual. All the changes are a result of exposure to diverse environmental conditions (nutrition, stress etc,) in the early years of life directing the metabolism for the later years of life. For example, a child exposed to food scarcity has impaired growth has the gene expression programmed accordingly in the anticipation of food scarcity throughout the life. Once the transition to economic prosperity occurs the sudden availability of abundance of food shift the feeding patterns with a fixed metabolism thus rendering the individual to an increased risk of NCDs. 

In the developed countries the basic amenities for an individual during the life time remain unchanged thus there is no new developments or metabolic stress on the body. The prevalence of infections and food scarcity is less in the developed countries. The environment at the time of birth, infancy and adulthood are uniform.

Thus, the individuals in the developing countries are exposed to more radical changes in the environment in a relatively short span of time due to economic prosperity rendering them exposed to deleterious effects of NCDs due to their cultural, genetic and epigenetic imbalance.

Lifestyle Factors for NCDs

Lifestyle choices majorly influence the prevalence of NCDs in a population. Contributing factors of NCDs include diet, tobaccos use, alcohol consumption, sedentary lifestyle.

Diet: Food intake directly influences the health outcome of an individual. Recent studies show a remarkable increase int eh consumption of sweetened drinks, refined sugars that are high in glycaemic index. High glycaemic foods increase the blood glucose levels rapidly subjecting the pancreas to produce more insulin and a chronic high plasma glucose levels affect the insulin production and sensitivity of the cells in the body leading to Diabetes mellitus (DM). Elevated increase in the intake of polished grains in the developing countries due to the preference of the flavour further increasing the risk of DM(Sami et al., 2017).

Increased intake of processed oils and hydrogenated oil due to their cost also predispose them to cardiovascular diseases (CVDs). Increase in the soybean production in the western countries promoted the oil industry. A shift from the consumption of canola oil to palm oil resulted in increase in excess saturated fatty acids and trans fats. Evidence based studies prove a strong link between consumption of trans fats and CVDs (Anand et al., 2015).

Tobacco use: The high prevalence of tobacco use, in both smoked and smokeless forms influenced the occurrence of lung cancers. The components of tobacco smoke trigger the cell proliferation in the lungs. Passive smoke is considered equally dangerous. Increase int eh social stress may have been a factor in the increase of tobacco use in the developed countries.

Alcohol consumption: According to WHOHeavy use of alcohol is a risk factor I the development of liver disease as it interferes with the metabolism. Liver is primarily involved in the detoxification of alcohol and excessive consumption leads to inflammation and scar formation thereby further liver cirrhosis. Denigrated condition of liver make it susceptible to infectious diseases (Boutayeb and Boutayeb, 2005).

Physical activity: Sedentary lifestyle is a result of urbanization. Availability of services that include housekeeping, machines that reduce physical activity motivate sedentary lifestyle. On an average an urban individual spends at least 2 times less energy in comparison to the one in the rural areas. This difference exists across all the age groups. Less energy expenditure has become a social norm in the current day scenario leading to overconsumption of foods and thus resulting in obesity.

Studies show a 50 % reduction in the risk of NCD with an introduction of physical activity such as cycling or walking. (Jalayondeja et al., 2017).

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Complicated relationship between communicable and noncommunicable diseases:

Low- and middle-income countries (LMICs) often face double burden of communicable and noncommunicable diseases with an overlap of these as a result of demographic transitions of the individuals (Remais et al., 2013).

Cancers with infectious aetiology:

Cancers are associated with uncontrolled growth of cells in the body. There are diverse risk factors in the development and progression of cancers. The impact of Cancer on LMICs has been disproportionate. In LMIC the stomach cancer rates were extremely high as high as 70 %. An untreated and recurrent infection by Heliobacterium pylori increases the risk of cancer and mortality in the individuals. The lack of hygiene in the LMIC is a primary cause of infection.

Infections with HBV virus has been reportedly associated with the hepatocellular carcinoma. Effective immunization is the ideal approach towards the prevention of HBV (Remais et al., 2013).

Tuberculosis and diabetes

DM is a metabolic disorder with an uncontrolled blood glucose level due to the decreased uptake of glucose by the cells in the body. Type 2 DM increases the risk and outcomes of tuberculosis by three times.

Hyperglycaemic conditions in the peripheral extremities which includes lungs may contribute to the increased chances of TB infection. The inflammation further recruits the blood supply increasing the availability of carbohydrate reserves for the pathogen.

Tuberculosis and chronic obstructive pulmonary disease

Tuberculosis and chronic obstructive pulmonary disorder (COPD) have similar symptoms and are often misdiagnosed. Individuals with COPD are vulnerable to developing TB due to pathological changes i.e., extensive tissue damage in the lungs and a higher rate of associated mortality. These two are interrelated to tobacco as a predisposing factor. Smoking damages the cell lining and impairs the function of lungs which further increases the chances of progressing of the TB infection into disease. According to Oni and Unwin TB plays a significant role in the development of chronic bronchitis (Oni and Unwin, 2015).

Global approaches for reductions in chronic diseases: The best approach to mitigate the noncommunicable diseases is to establish a global health partnership with the developing countriesto improve the access to the nations integral health care systems.

MillenniumDevelopment goals is an organised framework that includes Policies such as restricted use of tobacco, poverty reduction, consumer informative food composition labelling. Strict dietary standards during the food development.

Industrialization of food influences the food choices of the societies encouraging to opt for energy dense foods. Promotion of healthy food is a challenge with the expanding commercial food market on a global scale. Developing countries tend to allow the economic development in the form of establishment of food market thus leading to the rapid increase in the supermarkets and pre-packed and processed foods easily availableto all the levels of society.

A holistic approach towards NCDs through the promotion of health through preventive care measures is ideal. Reducing the risks associated with the behaviours through the usage of social media to create awareness and promotion of procedure adopting a healthy lifestyle in the work places, communities and in schools.

Chronic disease management centres at primary healthcare level to screen and identify the diseases at the initial stages in addition to rapid referral system strengthens the treatment of NCDs. Health information Surveys across the nations and age groups to collect the disease statistics and patterns observed in the health behaviours of individuals aid in assessing the risks. Promotion of health care through the increased coverage in insurance schemes andpolicies also improves the health outcomes in the underprivileged individuals through averting economic implications (Bachani, 2017).

NCD Initiatives to manage Spread of Infections: Clear evidence indicates the relationship between the NCDs and infectious diseases. The demographic changes of the populations promote the reconsideration of risk factors of the disease statistics. Urbanization of individuals increases their vulnerability to the diverse clinical conditions. Uncontrolled NCDs and infections have serious complications and poorer health outcomes in developing countries.

Health risk behaviours especially in the case of rural migrants such as tobacco use and substance use accelerate the progress of the diseases. Integration of health services of communicable diseases and NCDs improves the prognosis(Kostova et al., 2017).

Bidirectional screening programs in LMIC help in preventing the delayed detection of diseases.

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Conclusion: Increasing the life expectancy and an improved health outcome is the primary goal of all the nations and Public health organisations. Considering the disease burden and premature mortality rates due to the NCDs there is an urgent need of action and implementation of strategies to alleviate the ill effects of the NCDs.

Noncommunicable diseases are a threat to economic development of nations. With an increasing economic prosperity in the developing nations there is a shift in the lifestyle of the individuals towards risky behaviours, predisposing them to various NCDs. A shift in the epidemiology is observed from NCDs to communicable disease attributed to the mismatch of their earlier years of growth and the current conditions. The comorbidities of NCDs and infections complicate the diagnosis and treatment resulting in a poor prognosis.

Health awareness programmes customised to the national and regional needs in addition to strict policies that work in alignment with the improved health outcomes are recommended. Integration of data from the screening procedures also helps in the early detection of the diseases. Gaps in the understanding can be addresses through analysis of the genetic, environmental, physical and social factors. Surveillance of the infrastructure available displays the disparities in the facilities.

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