Chapter Twelve

1. Chapter Twelve Importance of Noncommunicable Disease

2. The Importance of Noncommunicable Disease • Growing importance worldwide • Burden of noncommunicable diseases greater than burden of communicable diseases in low-, middle-, and high-income countries • Cardiovascular disease, diabetes, cancer, and mental disorders are most important in low- and middle-income countries • Often prevented at low cost, but expensive to treat

3. Key Definitions • Noncommunicable disease cannot be spread by an infectious agent, they last a long time and they are often disabling • Include cancers, diabetes, endocrine disorders, neuropsychiatric disorders, and sense organ disorders

4. The Burden of Noncommunicable Diseases Cardiovascular disease • Cause of about 30% of all deaths worldwide • Leading cause of death in low- and middle-income countries, and high-income countries • Rates vary by region • 80% of burden of CVD is due to ischemic heart disease, stroke, and congestive heart failure

5. The Burden of Noncommunicable Diseases Diabetes • 200 million people worldwide suffer from diabetes • Loss of 20 million DALYs per year • Prevalence is rapidly increasing due to obesity • Costly complications including blindness, kidney failure, amputation of lower extremities, stroke, and others • 2/3 of people with diabetes have a disability compared to less than 1/3 of the people without

6. The Burden of Noncommunicable Diseases Cancer • Most important worldwide are lung, colon, breast, prostate, liver, stomach, and cervix • 7 million cancer deaths and 10 million new cases each year • More likely to be associated with tobacco use, environmental factors and lifestyle in high-income countries • More likely to be associated with an infectious agent in low-income countries

7. The Burden of Noncommunicable Diseases Mental Disorders • Includes neurological disorders like epilepsy, drug and alcohol abuse, and mental disorders • Responsible for 10% of DALYs lost in low- and middle-income countries • Start at relatively young ages, go on for a long time, often cannot be cured, and produce large amounts of disability • Unipolar depressive disorders are growing in importance

8. The Burden of Noncommunicable Diseases Vision and Hearing Loss • Aging of populations globally and improved life expectancy increase importance • Vision loss responsible for 3.3% of the burden of disease • Hearing loss responsible for 1.7% of the burden of disease • Projected to be in top 10 causes of the burden of disease in 2030

9. The Burden of Noncommunicable Disease Tobacco Use • 5 million deaths annually associated with tobacco use, half of those in low- and middle-income countries • Most common tobacco-related deaths are CVD, diseases of the respiratory system, and cancer • Rates of smoking vary by region and across regions according to sex, age, socioeconomic status, and other factors • Usage increasing in men in low- and middle-income countries and women in all regions

10. The Burden of Noncommunicable Disease Abuse of Alcohol • Responsible for 4% of burden of disease • Increases risk for hypertension, liver damage, heart disease, and other problems • Intoxication associated with injuries and high-risk sexual encounters • Prevalence of high-risk drinking varies by region with men in Europe and Central Asia having the highest rates

11. The Costs and Consequences of Noncommunicable Diseases, Tobacco Use and Alcohol Abuse • Direct costs of treatment • Indirect costs from lost productivity • Low-income countries are simultaneously facing burden of communicable diseases and noncommunicable diseases

12. The Costs and Consequences of Noncommunicable Diseases, Tobacco Use and Alcohol Abuse Cardiovascular Disease • Study found that men die 56% more at the same age of CVD than men in high-income countries and women die 86% more at the same age of CVD than women in high-income countries • Estimated that the countries involved would lose $84 billion in economic production between 2006 and 2015 from CVD

13. The Costs and Consequences of Noncommunicable Diseases, Tobacco Use and Alcohol Abuse Diabetes • Cost of treating diabetes varies between 2.5% and 15% of health expenditures in different countries • Latin America and the Caribbean have highest expenditures, sub-Saharan Africa has the lowest • Indirect costs are probably high because many people do not receive proper treatment

14. The Costs and Consequences of Noncommunicable Diseases, Tobacco Use, and Alcohol Abuse Mental Disorders • Little data from low- and middle-income countries indicative of unappreciated costs of mental illness • Study done in the United States indicated that direct and indirect costs of mental illness were equal to 2.5% of GNP • Significant losses in worker productivity

15. The Costs and Consequences of Noncommunicable Diseases, Tobacco Use and Alcohol Abuse Hearing and Vision Loss • Very little data available • Associated costs could include constraints to the education of children, school days missed by children with disabilities, cost of additional medical visits, high cost of education for students with hearing loss, difficulties for adults with finding employment, lower income levels

16. The Costs and Consequences of Noncommunicable Diseases, Tobacco Use, and Alcohol Abuse Tobacco Use • Estimates from high-income economies suggest that costs of smoking range from 0.1% to 1.1% of GDP • Economic costs are increasing in low- and middle-income countries • Disproportionate impact on relatively poor people because they tend to smoke at higher rates

17. The Costs and Consequences of Noncommunicable Diseases, Tobacco Use, and Alcohol Abuse • Health and productivity costs have to take into account the user as well as anyone that they might injure • One study of middle- and high-income countries found that costs were greater than 1% of GDP

18. Addressing the Burden of Noncommunicable Diseases Tobacco Use • Taxing cigarettes at higher rates would be effective for reducing consumption • Legal restrictions on smoking • Ban on cigarette advertising • Biggest impact in high-income settings has come from comprehensive control programs

19. Addressing the Burden of Noncommunicable Diseases Abuse of Alcohol • Very few countries have made coherent efforts to reduce alcohol consumption • Limiting hours when alcohol can be bought or sold and checking sobriety of drivers has showed some success • Taxing can reduce consumption but could lead to smuggling and consumption of illicit alcohol • Individual counseling shows some success, but would be difficult for countries with limited resources

20. Addressing the Burden of Noncommunicable Disease High Blood Pressure, High Cholesterol, and Obesity • Large-scale health education campaigns to promote healthier eating habits with greater intake of fruits and vegetables and less fat and salt • Public policies and community layouts that promote physical activity

21. Addressing the Burden of Noncommunicable Disease Cancer • Tobacco control is first priority • Addressing infectious agents associated with cancer like H.pyloriand schistosomiasis

22. Addressing the Burden of Noncommunicable Disease Mental Disorders • Little progress in low- and middle-income countries due to lack of understanding, low funds, and stigma • Creating a mental health policy and budget is the first step • Integrating mental health into community-based primary care and psychosocial supports instead of large, centralized hospitals has demonstrated success

23. Future Challenges • Number of new cases of noncommunicable disease will grow because of aging, urbanization, globalization and lifestyle changes • Number of people with disease will also rise because the diseases are chronic • Low-income countries will have to deal with communicable and noncommunicable disease simultaneously, as well as with injuries