Chronic NCDs: The Invisible Epidemic and the Looming Threat to Global Health
Sailee Naik, Oakton High School, Vienna, Virginia, USA
Chronic noncommunicable diseases (NCDs) are currently the leading cause of death in the world, becoming increasingly prevalent in developing countries. It is an epidemic that is nearly invisible in the eyes of many health officials and deserves immediate action. Some of the most common NCDs include cardiovascular disease, cancer, and diabetes and these along with others make up nearly 75% of the disease burden globally. There are several risk factors such as unhealthy diets, smoking, and high blood pressure that contribute to NCDs as well. Additionally, due to the healthcare expenses and decreased labor supply that occur as a result of NCDs, this epidemic is detrimental to the global economy and stunts the economic growth of nations. In order to protect global health and economic security, government intervention and commitment to resolving this issue is necessary in eliminating this imminent threat.
Chronic non-communicable diseases (NCDs) are currently the leading cause of mortality worldwide, with increased prevalence in low and middle-income countries where resources are scarce and knowledge is limited. Causing over 40 million deaths per year, NCDs kill 70% of the world’s population annually, jeopardizing the future of global health (CDC, 2021). This invisible epidemic increases vulnerability to pathogens and affects countries’ ability to effectively handle health threats and outbreak preparedness. The surging rates of chronic NCDs perpetuate poverty and burden national economies; to combat this imminent threat to global health, change at local and government levels holds great importance as healthy populations inevitably improve global economic and health security.
The Centers for Disease Control and Prevention (CDC) defines chronic NCDs as “a disease that has a prolonged course, that does not resolve spontaneously, and for which a complete cure is rarely achieved” and diseases “that do not result from an (acute) infectious process” (CDC, 2013). Some diseases that fall under this category include cardiovascular disease (30% of mortalities), cancer (13%), Alzheimer’s, and diabetes (2%) (Unwin & Alberti, 2006). Specifically, cardiovascular diseases, or CVDs, are the most common cause of death globally and due to the exceedingly high rates of affliction, the CDC estimates 25 million deaths from CVDs alone by 2030. As a whole, chronic NCDs are expected to make up three-quarters of the disease burden by 2030, with 41 million out of the 55 million deaths in 2019 already attributed to NCDs, as shown in Figure 1 below (CDC, 2013; WHO).
Figure 1: Total deaths from non-communicable diseases from 2000-2019. WHO Global Health Estimates (CGTN, 2021).
Considering these staggering statistics, the world is already on track to reach and likely surpass this prediction if immediate action is not taken to reduce the burden of NCDs on global populations, primarily individuals in poor socioeconomic conditions.
While NCDs are preventable, one’s lifestyle and conditions of living largely impact their chances of contracting one of these life-threatening illnesses, hence resulting in the largest impact on impoverished communities. Nearly 80% of deaths attributed to NCDs occur in low- and middle-income regions and according to the World Health Organization, of the NCD-caused mortalities in these areas, 47% of the deaths were of individuals under the age of 70 (NIH, 2022; WHO). This premature NCD mortality rate continues to increase due to a variety of risk factors, both non-modifiable and modifiable, that are more frequently observed in poverty-stricken regions. Some biological risk factors such as high blood pressure, obesity, and blood glucose levels may be more difficult to control but are still impacted by socioeconomic conditions in addition to genetically inherited factors.
Figure 2: Attributable fraction of non-communicable diseases (NCDs) for selected risk factors by disease group, 2016 (The BMJ, 2019).
Behavioral risk factors, some of which are shown in Figure 2 above, that are concentrated in urban areas due to rapid globalization include diets high in saturated fats and low in fruits and vegetables, tobacco smoking, physical inactivity, and excess alcohol (Unwin & Alberti, 2006). These are all modifiable risk factors that can be controlled with effective intervention, which is made more difficult in the presence of clustering, where an individual is affected by two or more risk factors. The 2013 STEPS study conducted in Nepal, a developing country, determined that an insufficient fruit and vegetable intake was present in 99% of the Nepalese population and a subsequent 2019 study concluded that reducing the burden of modifiable risk factors would be a cost-effective strategy in reducing NCD risk factors altogether (Bista, et al., 2021). This could involve infrastructure development, equal education opportunities, and community hygiene or health lessons, all of which would promote better well-being among populations and lower the prevalence of NCD risk factors, ultimately decreasing the rate of chronic NCDs in these areas.
In addition to the devastating effects on the health of individuals, chronic non-communicable diseases further exacerbate conditions of poverty and hinder economic development in countries severely affected by this epidemic. As seen over the past decade, healthcare costs are rapidly rising, draining national reserves and serving as a major impediment to economic progress. NCDs are a key contributor to this sharp increase in healthcare expenses, and the World Bank estimates that by 2030, NCDs will cost the global economy up to $35 trillion (NIH, 2022). Furthermore, over a 20-year period, the cost of CVD in the United States is estimated to be as high as $20 trillion, with 55% due to healthcare expenses and 45% due to loss of productivity as a result of disability or death (Bloom, et al., 2011). In terms of individual households, treatment for NCDs puts families at increased financial risk and when faced with unemployment and salary decreases due to an inability to work, individuals experience less economic stability. Not only do NCDs cost billions of dollars for payment to hospitals and treatment centers, but as shown by the data, diseases such as cancer and diabetes directly impact labor supply, imports and exports, and international trade. This further limits the long-term economic security of nations, leaving developing countries to bear much of that cost. Unfortunately, unstable economies and increased debt deprive countries of essential resources which aggravates existing health crises and sparks the growth of new ones, ultimately resulting in the deterioration of the state of global health.
Evidently, the rise of chronic NCDs threatens global health and economic security and leaves the future of society at risk. Now more than ever, countries need this security to build resilience and decrease fragility of their health systems in order to effectively combat health emergencies and outbreaks. Investment in advanced technologies and government intervention can better equip countries to deal with NCDs and promote economic recovery, particularly in developing nations. The WHO estimates that low and middle-income countries will surpass economic losses of $500 billion per year on NCDs if successful interventions are not put in place immediately (WHO). However, according to the CDC, every $1 invested in proven NCD interventions, particularly those that affect risk factors, will result in at least $7 generated for increased economic development or reduced healthcare spending in developing countries, ultimately saving billions of dollars (CDC, 2021). The design and implementation of some of these cost-effective strategies such as tax increases on tobacco and alcohol, public awareness via mass media, low-cost multi-drug therapy, and immunizations will provide communities with the necessary funding and resources to treat and/or prevent NCDs in citizens of poverty-stricken areas, thus preventing the further spread of this epidemic around the world (CDC, 2013). Eliminating this threat and lowering the morbidity rates of chronic non-communicable diseases should be the number one priority of government health officials; additional research into potential technological solutions as well as medical solutions will promote better health and economic conditions for developing nations and the global community as a whole.
About Global NCDs. (2021, December 17). Centers for Disease Control and Prevention. Retrieved June 1, 2022, from https://www.cdc.gov/globalhealth/healthprotection/ncd/ global-ncd-overview.html
Attributable fraction of non-communicable diseases (NCDs) for selected risk factors by disease group, 2016. [Photograph]. (2019, January 28). The BMJ. https://www.bmj.com/content/ bmj/ 364/bmj.l265/F1.medium.jpg
Bista, B., Dhimal, M., Bhattarai, S., Neupane, T., Xu, Y. Y., Pandey, A. R., Townsend, N., Gyanwali, P., & Jha, A. K. (2021). Prevalence of non-communicable diseases risk factors and their determinants: Results from Steps Survey 2019, Nepal. PLOS ONE, 16(7). https://doi.org/10.1371/journal.pone.0253605
Bloom, D.E., Cafiero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl, A.B., Gaziano, T., Mowafi, M., Pandya, A., Prettner, K., Rosenberg, L., Seligman, B., Stein, A.Z., & Weinstein, C. (2011). The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum.
Chronic, noncommunicable diseases (NCDs) news, resources and funding for global health researchers. (2022, May 24). NIH Fogarty International Center. Retrieved June 1, 2022, from https://www.fic.nih.gov/ResearchTopics/Pages/Chronic Diseases.aspx
Deaths from non-communicable diseases since 2000 [Photograph]. (2021, May 27). CGTN. https://news.cgtn.com/news/2021-05-27/Graphics-Will-we-have-more-deaths-from-non-communicable-diseases--10A1d0tOW1q/img/22e644140b3d 4d2d892f1c01c35b58db/22e644140b3d4d2d892f1c01c35b58db.png
Huguet, A. (n.d.). Arielle Vay, 68 years old, receives care in an MSF mobile clinic at a camp for internally displaced people in Ituri Province, DRC [Photograph]. Médecins Sans Frontières. https://media.msf.org/AssetLink/407080s4p5src3vq pf1mra5oq7t4t8w5.jpg
Muluneh, A. T., Haileamlak, A., Tessema, F., Alemseged, F., Woldemichael, K., Asefa, M., Mamo, Y., Tamiru, S., Abebe, G., Deribew, A., & Abebe, M. (2012). Population based survey of chronic non-communicable diseases at gilgel gibe field research center, southwest ethiopia. Ethiopian journal of health sciences, 22(S), 7–18.
Noncommunicable diseases. (n.d.). World Health Organization. Retrieved June 1, 2022, from https://www.who.int/data/gho/data/themes/noncommunicable-diseases
Overview of Noncommunicable Diseases and Related Risk Factors [PowerPoint slides]. (2013, September 11). Centers for Disease Control and Prevention. Retrieved June 1, 2022, from https://www.cdc.gov/globalhealth/healthprotection/fetp/ training_modules/new-8/ overview-of-ncds_ppt_qa-revcom_09112013.pdf
Unwin, N., & Alberti, K. G. (2006). Chronic non-communicable diseases. Annals of tropical medicine and parasitology, 100(5-6), 455464. https://doi.org/10.1179/ 136485906X97453