Challenge Of Non-communicable Diseases Research Articles

Trends and patterns of North Korea's disease burden from 1990 to 2019: Results from Global Burden of Disease study 2019.

Evidence for the trends and patterns of disease burden in North Korea is limited, and in-depth analysis based on several health outcomes for a better understanding remains challenging. Therefore, we aimed to investigate the trends and patterns of disease burden in North Korea between 1990 and 2019. We used data from the Global Burden of Diseases (GBD) 2019 study to analyze the North Korean disease burden in comparison with four groups: global, South Korea, low-sociodemographic index (SDI) countries, Central and Eastern Europe, and Central Asia (former socialist countries). We also examined changes in the disease burden between 1990 and 2019 by disease category and age group. In 2019, in North Korea, death rates and disability-adjusted life years (DALYs) rates were reduced by 22.2% and 30.7%, respectively, compared to 1990. The rates showed similar trends and patterns to that in former socialist countries. However, these reductions were lower than those of the global rates and rates in low-SDI countries and South Korea. Death rates and DALY rates for under five years dramatically decreased by more than 78%, similar to the trend in South Korea. In contrast, the decline in the death rates and DALY rates of adults was less than those worldwide and in low-SDI countries and South Korea. The burden of diseases among those aged ≥30 years increased largely due to the persistently high burden of non-communicable diseases (NCDs). Cardiovascular diseases, neoplasms, and chronic respiratory diseases were the leading causes of the disease burden in both 1990 and 2019. North Korea's disease burden patterns and trends show clear improvements over the past 30 years but suggest that the current challenges of NCDs in the country are very serious. NCDs should be no longer neglected and should be prioritized in public health agendas in North Korea.

User experiences and perceptions of health wearables: an exploratory study in Cambodia

BackgroundIn many low- and middle-income countries (LMICs), health system capacities to address the burden of non-communicable diseases (NCDs) are often inadequate. In these countries, wearable health technologies such as smartbands and smartwatches could be used as part of public health programmes to improve the monitoring, prevention, and control of NCDs. Considering this potential, the purpose of this study was to explore user experiences and perceptions of a health wearable in Cambodia.MethodsData collection involved a survey, conducted between November 2019 and January 2020, among different categories of participants (including hypertensive participants, non-hypertensive participants, postgraduate students, and civil servants). All participants were given a sample of a watch-type wearable and advised to use it day and night. One month after product delivery, we conducted a survey to explore their views and experiences. Results were analysed by using descriptive statistics and Chi square or Fisher's exact test to compare responses from urban and rural participants.ResultsA total of 156 adult participants completed the study. Technology acceptance was positive overall. 89.1% of the participants said they would continue using the watch and 76.9% of them would recommend it to either friends or relatives, while 94% said the device stimulated them to think more frequently about their health. However, challenges to technology adoption were also identified, including concerns with the accuracy and quality of the device and unfamiliarity with the concept of health self-monitoring, especially among the elderly. Short battery life and cost were also identified as potential barriers to continued use.ConclusionsHealth wearables are a promising new technology that could be used in Cambodia and in other LMICs to strengthen health sector responses to the challenges of NCDs. However, this technology should be carefully adapted to the local context and the needs of less resourced population groups. In addition, further studies should examine if adequate health sector support and infrastructure are in place to implement and sustain the technology.

Addressing the global Challenge of NCDs using a Risk Factor approach: voices from around the world.

Noncommunicable diseases (NCDs) are growing at an alarming rate around the world, drawing attention in multiple United Nations high‐level meetings, the Sustainable Development Goals, regional alliances for NCDs, and in scientific research agendas. In 2018, the World NCD Federation selected the University of Michigan from seven universities around the world to host the 2nd World NCD Congress in 2020. For the scientific program, we defined an intersecting matrix of “risk factors” and “disease‐oriented” lenses for examining NCDs to highlight the multiple risk factors that contribute to major NCDs. Through deliberation with two committees representing over 50 individuals and 11 countries, eight risk factors were selected for the scientific program: social determinants of health and demographics, climate and environment, stress, sleep, substance use, nutrition, and physical activity, and genetics. These eight risk factors served as submission categories for a call for abstracts as well as topics for the planned plenary sessions. In April 2020, we pivoted our approach when meeting in person for a conference was no longer feasible. Building upon the risk factor model, we shifted the invited talks to invited articles for publication as a special collection for FASEB BioAdvances. We are delighted to launch this collection with 13 invited articles by 32 experts from ten countries. Significant transferable lessons about key risk factors and prevention of NCDs from this collection could be leveraged in various geographic areas and in settings with varying levels of resources, as they cover a diverse range of topics from community‐level interventions to indigenous leadership structures to national policies to intergovernmental programs.

The International Society for Behavioral Medicine (ISBM) and the Society of Behavioral Medicine (SBM) advocate for the inclusion of behavioral scientists in the implementation of the Global Action Plan for the prevention of non-communicable diseases (NCDs) in low- and middle-income countries

Non-communicable diseases (NCDs) are the leading cause of death and disability in the world with the majority of deaths occurring in low- and middle-income countries (LMICs). The financial implications of disease and disability due to NCDs, combined with the costs of long-term management, are major causes of impoverishment and serve as barriers to socio-economic development. The transition from infectious diseases to NCDs as leading causes of mortality in LMICs is driven by several factors, primarily increasing globalization, urbanization, ageing of populations and economic development. Responding to these challenges will require local and comprehensive primary and secondary prevention efforts. The World Health Organization's Global Action Plan provides a road map and an array of policy options to achieve nine voluntary global targets by 2025. The primary responsibility of governments in responding to the challenge of NCDs includes international scientific cooperation to support national and local efforts. The implementation of such efforts to prioritize the prevention of NCDs will create an environment in which the rising trend of the NCD burden could be potentially halted and reversed. When developing NCD policies, stakeholders should consider evidence-based strategies which can be implemented by multidisciplinary teams that are led or have the participation of behavioral medicine scientists. Behavioral medicine strategies should be incorporated into the policy and intervention framework developed to target NCDs in LMICs.

Challenge of Non-communicable Diseases

Challenge of Non-communicable Diseases

P3417Comparison of cardiometabolic profile and left ventricular systolic dysfunction amongst outpatients in a low-income Sub-Saharan African versus high-income European population; the MTIMA I study

Abstract Background Most of the information on modifiable risk factors linked to cardiac dysfunction comes from high income countries and/or hospitalized patients. We sought to evaluate the challenge of non-communicable diseases (NCDs) in the community setting in Malawi, and to compare the cardiometabolic profile of these patients with age, sex and diabetes matched European participants. Methods MTIMA I is a prospective, observational, cohort study of community dwelling patients attending a NCD clinic in Malawi together with age, sex and diabetes matched European participants. All consenting patients were evaluated for clinical history, blood pressure, heart rate, body mass index (BMI), fasting glucose, left ventricular ejection fraction and medications. Results Amongst 251 sub-Saharan African patients and 502 age, sex and diabetes matched European patients, the average age was 61.8±10.6 years, 31% were male and 53% had diabetes and the majority had hypertension (80.0% and 70.7% in the African and European cohorts respectively, p=NS). The African population had poorer pressure control (147/90±21/13 mmHg vs 137/82±19/11 mmHg, p<0.0001) and higher heart rates (80.73±17.0 bpm vs 72.7±12.5 bpm, p<0.0001) than the European cohort. Use of antihypertensive agents per patient was lower in the African population (0.96±0.05 vs 1.22±0.05, p<0.001) and there was lower usage of renin-angiotensin-aldosterone-system modifying therapies. Reported smoking rates were lower in the African cohort (3% vs 16%, p<0.0001). Only 78 of the African cohort had lipids evaluated compared with all the European cohort and in this subset, while total cholesterol was lower (4.4±1.2, vs. 4.6±0.5 mmol/L, p<0.01), it was due to lower HDL (0.99±0.5 vs 1.3±0.2 mmol/L, p<0.001) as LDL cholesterol was similar (2.6±1.0, vs 2.5±0.5 mmol/L, p=ns). Statin usage was lower in the African cohort (1.6% vs 61.5%, p<0.0001). Surprisingly, the average body mass index did not differ between the populations (28.9±0.3 vs 29.2±1.5 kg/m2, p=NS) and there were similar proportions of obesity (31.1% vs 33.7%). Plasma glucose was higher in the African population (10.3±0.4 vs. 7.4±0.1 mmol/L, p<0.0001) despite similar usage of antidiabetic therapies. Average ejection fraction was significantly lower in the African cohort (49.8±8.6% vs 66.5±3.5%, p<0.0001). Left ventricular systolic dysfunction (<40%) was significantly more prevalent in the African cohort (21% vs 0.4%, p<0.0001). Conclusions The profile of cardiovascular risk factors, medications and cardiac dysfunction is different in community dwelling African and European patients with chronic cardiovascular disease. One in 5 African patients in our study has undiagnosed left ventricular systolic dysfunction reflecting the need for increased focus on non-communicable diseases and cardiovascular prevention. Further work on the pathophysiology of the high rate of LVSD noted and prevention strategies are required

Enlightenment of the United Nations high-level summit on non-communicable disease prevention and control on the development of public health system in China

The Third UN High-level Meeting on Non-Communicable Diseases was held on September 2018. The conference carried out a series of activities on the theme of "Time To Deliver", and adopted the 2018 Political Declaration on Non-Communicable Diseases. The new "5×5" strategy for non-communicable diseases prevention and control was clearly put forward, slow progress of non-communicable diseases prevention and control was criticized and the seven major challenges hindering the progress of non-communicable diseases prevention and control was analyzed, the main role and responsibility of governments at all levels in coping with the challenges of non-communicable diseases was reiterated, and put forward clear requirements. The declaration also reiterates the importance of strengthening public health measures. The meeting and declaration aroused strong repercussions and were regarded as a milestone to promote the global prevention and control of non-communicable diseases, and also brought a series of important inspirations for the development of public health in China in the new era. In order to cope with the heavy burden of non-communicable diseases in China, we must give full play to our institutional advantages, mobilization advantages and organizational advantages, adhere to prevention-oriented, emphasize the role of professional public health institutions, and consolidate and strengthen the disease control system and capacity building.

The increasing prevalence of non-communicable diseases in low-middle income countries: the view from Malawi.

Non-communicable diseases (NCDs) are the leading cause of death globally, the majority of these being due to cardiovascular disease, cancer, chronic respiratory diseases, or diabetes. Mortality from many NCDs continues to increase worldwide, with a disproportionately larger impact in low-middle income countries (LMIs), where almost 75% of global deaths occur from these causes. As a low-income African country that consistently ranks amongst the world’s poorest nations, Malawi as a case study demonstrates how transition due to societal change and increasing urbanization is often accompanied by a rise in the rate of NCDs. Other factors apart from changing lifestyle factors can explain at least some of this increase, such as the complex relationship between communicable and NCD and growing environmental, occupational, and cultural pressures. Malawi and other LMIs are struggling to manage the increasing challenge of NCDs, in addition to an already high communicable disease burden. However, health care policy implementation, specific health promotion campaigns, and further epidemiological research may be key to attenuating this impending health crisis, both in Malawi and elsewhere. This review aims to examine the effects of the major NCDs in Malawi to help inform future public health care policy in the region.

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries

Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available.Objectives: This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC.Methods: Data were collected during a workshop at the WONCA East Mediterranean Regional Conference in 2017. Academic family physicians (FP) presented their country, using the WONCA framework of 11 PowerPoint slides with queries of the country demographics, main health challenges, and the position of PHC in the health system.Results: All six countries have improved the health of their populations, but currently face challenges of non-communicable diseases, aging populations and increasing costs. Main concerns were a lack of trained FPs in community settings, underuse of prevention and of equitable access to care. Countries differed in the extent to which this had resulted in coherent policy.Conclusion: Priorities were (i) advocacy for community-based PHC to policymakers, including the importance of coordination of healthcare at the community level, and UHC to respond to the needs of populations; (ii) collaboration with universities to include PHC as a core component of every medical curriculum; (iii) collaboration with communities to improve public understanding of PHC; (iv) engagement with the private sector to focus on PHC and UHC.

Prevalence of non-communicable diseases and use of health services in the Gaza Strip: an analysis of a household survey

BackgroundThere is a growing need for and interest in targeting non-communicable diseases (NCDs) in Gaza Strip. However, little is known about their distribution among different population groups and about the use of health services by patients with NCDs. We aimed to identify the differences in prevalence of NCDs and use of health-care services among different groups of patients with NCDs in the Gaza Strip. MethodsWe interviewed 760 households in the Gaza Strip in July, 2013, about the characteristics of household members, including occurrence of NCDs, and their use of and expenditures on health services. We analysed data according to the frequency distribution of variables and used χ2 testing to assess the statistical difference between grouped variables. Findings661 (12·7%) of the 5192 individuals had at least one NCD. Prevalence of NCDs was higher among refugees than non-refugees (485 [13.4%] of 3618 vs 176 [10·5%] of 1574; odds ratio [OR] 1·23, 95% CI 1·023–1·477; p=0·027) and was associated with increasing age (Cramer's V=0·545): at least one NCD was reported in 78 (2·9%) of 2699 individuals aged less than 20 years, 110 (7·5%) of 1470 aged 20–39 years (OR 4·237, 95% CI 3·19–5·628), 248 (35·4%) of 701 aged 40–59 years (28·679, 21·091–38·995), and 225 (69·9%) of 322 aged 60 years or older (77·944, 56·165–108·169; p<0·0001). 545 (82·5%) of the 661 patients with NCDs regularly accessed health services at least once every 3 months. The choice of health provider for regular care for NCDs differed by refugee status; 327 (85·8%) of 381 refugee patients compared with 121 (73·8%) of 164 non-refugee patients chose public providers for the regular care of their NCDs (OR 2·152, 95% CI 1·37–3·38; p=0·001). InterpretationThe prevalence of NCDs is positively associated with increasing age. Entitlement to health care in the Gaza Strip through refugee status contributed to increasing the detection of NCDs and refugee status influenced the choice of health-care provider for NCDs. There is a need to expand entitlement to health services to achieve universal access to health care in order to respond to the increasing challenge of NCDs in the Gaza Strip. FundingWHO 2013 special grant for Priority Areas in Public Health in the Eastern Mediterranean Region.

Fighting the Challenges of Non Communicable Diseases (Ncds)

Fighting the Challenges of Non Communicable Diseases (Ncds)

S12-3 - Health governance and strategy and the challenge of non-communicable diseases: Viewpoints from lifestyle intervention in diabetes prevention

S12-3 - Health governance and strategy and the challenge of non-communicable diseases: Viewpoints from lifestyle intervention in diabetes prevention

A comprehensive capacity assessment tool for non-communicable diseases in low- to middle-income countries: development and results of pilot testing

Non-communicable diseases (NCDs) are the leading causes of death worldwide, with higher rates of premature mortality in low- and middle-income countries (LMICs). This places a high economic burden on these countries, which usually have limited capacity to address this public health problem. We developed a guided self-assessment tool for describing national capacity for NCD prevention and control. The purpose of this tool was to assist countries in identifying key opportunities and gaps in NCD capacity. It was piloted in three countries between 2012 and 2013: Mozambique, Colombia, and the Dominican Republic. The tool includes details about NCD burden; health system infrastructure and primary care services; workforce capacity; surveillance; planning, policy, and program management; and partnerships. In the three pilot countries, the tool helped to identify differences in capacity needs pertaining to staff, training, and surveillance, but similarities were also found related to NCD challenges and opportunities. The NCD tool increased our understanding of needs and critical capacity elements for addressing NCDs in the three pilot countries. This tool can be used by other LMICs to map their efforts toward addressing NCD goals and defining priorities.

State humanitarian verticalism versus universal health coverage: a century of French international health assistance revisited.

The French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal and free public health care to the colonies, and French State imperial humanitarianism crystallised in vertical programmes inspired by Louis Pasteur, while vying with early private humanitarian activism in health represented by Albert Schweitzer. From decolonisation to the end of the Cold War (1960-99), French assistance to newly independent states was affected by sans frontièrisme, Health for All, and the AIDS pandemic. Since 2000, France has had an active role in development of global health initiatives and favoured multilateral action for health assistance. Today, with adoption of the 2030 Sustainable Development Goals and the challenges of non-communicable diseases, economic inequality, and climate change, French international health assistance needs new direction. In the context of current debate over global health as a universal goal, understanding and acknowledging France's history could help strengthen advocacy in favour of universal health coverage and contribute to advancing global equity through income redistribution, from healthy populations to people who are sick and from wealthy individuals to those who are poor.

Wearable Sensors and Healthcare Informatics Solutions in Non- Communicable Diseases (Ncds) Prevention and Management in Africa

Safe and cost-effective wearable sensors and healthcare informatics solutions hold great promises and opportunities in tackling non-communicable diseases (NCDs) burden. This paper highlights the future opportunities of wearable sensors and healthcare informatics consolidation platforms implementation, uptake capabilities and needs in non-communicable diseases (NCDs) prevention and management in Africa. Establishing digital wearable technology policy and frameworks requires robust political commitment and financial investment in research and development towards real time, safe and effective prevention and management programs and tools. Leveraging on it added-value in strengthening health systems inefficiencies and low-cost care delivery is imperative in promoting predictive and preventive lifestyle mitigation an adaptation solutions to millions at risk or suffering from chronic illnesses. Also, in promoting participatory patient- professionals-health providers’ relationship and cooperation, monitoring and tracking of medication adherence to pathophysiological disease progression. Furthermore, digital wearable sensors offer another opportunity in generating data, information and knowledge in promoting evidence- based and practical lifestyle adaptations and other health / fitness mitigation programs in revamping the rising NCDs challenges in most vulnerable populations in Afri

Economics of Non-Communicable Diseases: Case Study of South Africa and India

The burden of Non Communicable Diseases (NCDs) is one of the vital factors that is currently affecting most of the developing countries. NCDs accounted for 68% of worldwide deaths in 2012 and nearly three fourth of these deaths occurred in low and middle-income countries. The efforts of developing countries towards eradication of poverty and achievement of sustainable development is currently hindered due to significant loss in productivity caused by NCDs related premature deaths and treatment. South Africa and India are confronted with various health and developmental issues. Being a highly populated country, India faces a great challenge from NCDs as it mainly affects the most productive age group, which results in a heavy absolute economic burden. South Africa is faced with the problem of quadruple burden of diseases along with the problem of high incidence of poverty and inequality. Being resource-scarce economies, increasing expenses on health sector will adversely affect the availability of resources for other sectors in these countries. Both South Africa and India have initiated steps to combat the burden of NCDs in line with Global targets set by WHO. If appropriate actions are not initiated to prevent NCDs, it will further increase poverty and widen inequality. In view of this a holistic approach involving all the sectors of the economy, including community to work together, is essential to address the challenges of NCDs.

Redesigning primary care to tackle the global epidemic of noncommunicable disease.

Noncommunicable diseases (NCDs) have become the major contributors to death and disability worldwide. Nearly 80% of the deaths in 2010 occurred in low- and middle-income countries, which have experienced rapid population aging, urbanization, rise in smoking, and changes in diet and activity. Yet the health systems of low- and middle-income countries, historically oriented to infectious disease and often severely underfunded, are poorly prepared for the challenge of caring for people with cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We have discussed how primary care can be redesigned to tackle the challenge of NCDs in resource-constrained countries. We suggest that four changes will be required: integration of services, innovative service delivery, a focus on patients and communities, and adoption of new technologies for communication.

Health system challenges of NCDs in Tunisia.

The objective of this study was to present a qualitative 'situation analysis' of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs). Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson's framework (1994) for policy analysis was used: content, actors, context, and process. Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void. This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.

The macroeconomic impact of non-communicable diseases in China and India: Estimates, projections, and comparisons

Abstract This study provides estimates of the macroeconomic impact of non-communicable diseases (NCDs) in China and India for the period 2012–2030. Our estimates are derived using the World Health Organization’s EPIC model of economic growth, which focuses on the negative effects of NCDs on labor supply and capital accumulation. We present results for the five main NCDs (cardiovascular disease, cancer, chronic respiratory disease, diabetes, and mental health). Our undiscounted estimates indicate that the cost of the five main NCDs will total USD 23.03 trillion for China and USD 4.58 trillion for India (in 2010 USD). For both countries, the most costly domain is cardiovascular disease. Our analyses also reveal that the costs are much larger in China than in India mainly because of China’s higher and steeper income trajectory, and to a lesser extent its older population. Rough calculations also indicate that WHO’s best buys for addressing the challenge of NCDs are highly cost-beneficial.

Policies and priorities to combat NCD challenges in India

Chronic non-communicable diseases (NCDs) have replaced communicable diseases as the most common causes of morbidity and premature mortality worldwide. Since 1980, the Government of India had supported states in prevention and control of cancer as a vertical program. However, several challenges were identified, such as: lack of comprehensive approach to key NCDs including diabetes and cardiovascular diseases; limited emphasis on health promotion and preventive measures to reduce exposure to risk factors; lack of facilities and capacity for screening, early diagnosis and effective management within the public health care system was not adequately addressed. Aiming at preventing rise of NCDs, the government launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2010 and planned to expand to all districts of the country in a phased manner. The current programme has prioritised preventive and promotive services to the general population and holistic care to the people with NCDs at primary, secondary and tertiary levels of health-care with integrated management and strong monitoring system for making services universally accessible in the country. Under the mass screening initiative, nearly 60 million people aged 30 years and above were screened for diabetes and hypertension. Those identified with raised blood sugar and high blood pressure need to be referred for further investigations, treatment and periodic follow-up. It is therefore recommended that the revised National Health Policy should duly emphasize policies and strategies to prevent and control key NCDs through population-based interventions that require multi-sectoral approach. The referral system needs strengthening and secondary and tertiary levels of health care require further strengthening key NCDs and their complications. Due attention is to be given for implementation of these programs in remote rural areas and underprivileged population in the urban areas. For India, having committed to global indicators and goals to address NCDs and risk factors by the year 2025, a missionary approach is required for effective implementation of programs.