Abstract
The global epidemic of noncommunicable diseases (NCDs), such as cardiovascular disease and diabetes, is creating unsustainable burdens on health systems worldwide. NCDs are treatable but not curable. They are less amenable to top-down prevention and control than are the infectious diseases now in retreat. NCDs are mostly preventable, but only individuals themselves have the power to prevent and manage the diseases to which the enticements of modernity and rising prosperity have made them so susceptible (e.g., tobacco, fat-salt-carbohydrate laden food products). Rates of nonadherence to healthcare regimens for controlling NCDs are high, despite the predictable long-term ravages of not self-managing an NCD effectively. I use international data on adult functional literacy to show why the cognitive demands of today’s NCD self-management (NCD-SM) regimens invite nonadherence, especially among individuals of below-average or declining cognitive capacity. I then describe ways to improve the cognitive accessibility of NCD-SM regimens, where required, so that more patients are better able and motivated to self-manage and less likely to err in life-threatening ways. For the healthcare professions, I list tools they can develop and deploy to increase patients’ cognitive access to NCD-SM. Epidemiologists could identify more WHO “best buy” interventions to slow or reverse the world’s “slow-motion disaster” of NCDs were they to add two neglected variables when modeling the rising burdens of disease. The neglected two are both cognitive: the distribution of cognitive capacity levels of people in a population and the cognitive complexity of their health environments.
Highlights
The global epidemic of noncommunicable diseases (NCDs), such as cardiovascular disease and diabetes, is creating unsustainable burdens on health systems worldwide
I describe ways to improve the cognitive accessibility of NCD self-management (NCD-SM) regimens, where required, so that more patients are better able and motivated to self-manage and less likely to err in life-threatening ways
Https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death
Summary
“The Evolution of Idiots,” humorist Scott Adams (1996) describes how “a few thousand amazingly smart deviants” created a world that turned the rest of us into ninnies. My specific concern is that, with advances in treatment regimens for noncommunicable diseases (NCDs), health care providers are unknowingly placing cognitive burdens on. My specific concern is that, with advances in treatment regimens for noncommuni of 14 cable diseases (NCDs), health care providers are unknowingly placing cognitive burdens on patients too heavy for many to bear. NCDs—heart disease, stroke, cancer, diabetes, mortality steadily rising, and their costs becoming unsustainable for rich and poor counandalike: chronic respiratory disease—are epidemicwarned worldwide, their morbidity andp. I use steadily rising, and their costs becoming unsustainable for rich and poor countries alike: adult literacy data to explain why NCDs are so difficult to self-manage and suggest tools a global “slow-motion disaster”, warned the WHO Epidemiologists canfor incorporate the global burdens of NCDs. cognitive risk in their models to identify “best buys” (World Health Organization (WHO).
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