Addressing NCDs in Low and Middle Income Countries Special Interest Group

The special interest group for non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is a group for public health professionals with an interest in taking action to reduce the burden of NCDs.

NCDs are one of the major health challenges of the 21st century. Although NCDs affect all countries across the globe, the burden is rising disproportionately fast in LMICs where 47% of premature deaths from NCDs occur. The impact on health and society is especially damaging in those countries whose healthcare systems are already weakened by conflict, natural disasters, epidemics and chronic under-resourcing.

Our work focuses on:

  • Advocating for action to address the rising burden of NCDs in LMICs

  • Supporting other global health SIGs with work related to NCDs

  • Acting as a resource to FPH and its members on knowledge related to NCDs and LMICs

We are keen to welcome new members to the group. If you are interested please do get in touch with one of the co-chairs: Katy Scammell (kscam@hotmail.com), or David McConologue (dmcconalogue@yahoo.com).

NCDs are chronic, long-term diseases and health conditions that are not communicable, whether through interpersonal contact or vector transmission. Globally, they are the leading cause of premature mortality and disability. The range of health conditions captured under the heading of NCDs can be large since it potentially includes (for example) mental health problems, nutritional disorders, injuries and trauma, and gender-based violence. The four leading NCDs are cardiovascular disease, respiratory disease, diabetes and cancer, which together account for around 70% of all NCDs and were these are the main focus of the World Health Organization’s work on NCDs.

NCD incidence and prevalence can be reduced through proven interventions that influence behavioural and metabolic/physiological risk factors. In fact, WHO estimates that at least 80% of all heart disease, stroke and diabetes and 40% of cancer could be prevented by tackling major risk factors. Managing these risk factors can avert onset and reverse disease progression. For individuals, outcomes will be highly variable, and may be affected by social, metabolic, behavioural and other factors including co-morbidities, compliance, and quality of health care available.

The behavioural risk factors include tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol. These can be reduced by societal interventions such as legislation and taxation, as well as changes to individual behaviour.

The metabolic risks include raised blood pressure, overweight/obesity, hyperglycaemia (high blood glucose levels) and hyperlipidaemia (high levels of fat in the blood). These can be addressed through screening and treatment.

The social context in which these risk factors occur is also crucial. Therefore, effective responses to NCDs must also consider the ‘causes of the causes’ or the ‘social determinants of health’ and the huge inequalities which exist in these both within and between countries.

NCDs have complex inter-relationships with other disease groups and health outcomes:

  • Some infectious diseases can led to the development of NCDs. For example, Human Papilloma Virus, a sexually transmitted infection, can lead to cervical cancer and HIV, a transmissible disease, has effectively become a chronic disease through improved treatment options;

  • Mental illness, including depression and other short and long term mental health conditions can make individuals more vulnerable to risk factors for NCDs, while the experience of suffering from an NCD can have effects on individual mental health;

  • Alcohol and drug abuse is frequently linked to injuries, accidents and gender-based violence.

Preventing, diagnosing and successfully controlling NCDs requires a whole of government approach in order that necessary actions beyond the health service can be identified and implemented.

Global best buys

Working with partners, the WHO has analysed a range of interventions to prevent and control NCDs at the population level in order to identify how governments can use their available resources in the most cost-effective way. These ‘best buys’ can help guide policy priorities by enabling national authorities to get the best value for money from their limited resources.

  • Increase excise taxes and prices on tobacco products and alcoholic beverages

  • Implement plain/standardized packaging and/or large graphic health warnings on all tobacco packages

  • Enact and enforce comprehensive bans on tobacco advertising, promotion and sponsorship and restrictions on exposure to alcohol advertising (across multiple types of media)

  • Eliminate exposure to second-hand tobacco smoke in all indoor workplaces, public places, public transport

  • Implement effective mass media campaigns that educate the public about the harms of smoking/tobacco use and second-hand smoke

  • Enact and enforce restrictions on the physical availability of retailed alcohol (via reduced hours of sale)

  • Reduce salt intake through the reformulation of food products to contain less salt and the setting of target levels for the amount of salt in foods and meals

  • Reduce salt intake through a behaviour change communication and mass media campaign

Global health and political leaders have made a number of commitments to address and control NCDs. In September 2011, heads of state and government, assembled at the United Nations, committed to address the global burden and threat of NCDs with the adoption of a wide-ranging political declaration at the opening of the General Assembly’s first United Nations High-level Meeting (HLM) on NCDs. In July 2014, during the second United Nations HLM on NCDs, ministers and representatives of states and government committed to setting national NCD targets, developing multisectoral policies and plans, accelerating the reduction of risk factors, and strengthening health systems.

The WHO published a Global Action Plan for the prevention and control of NCDs (2013–2020) which was endorsed during the Sixty-sixth WHO World Health Assembly in 2013 and is due to be updated.

In September 2018 a High Level Meeting on the NCDs was held at the UN General Assembly and agreed a 13 point plan to tackle NCDs globally.

Global Targets

The following targets for voluntary action by governments were agreed at the 2013 World Health Assembly in Resolution WHA66/10 and have formed the basis for subsequent monitoring of progress.

  1. A 25% relative reduction in the overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases.

  2. At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context.

  3. A 10% relative reduction in prevalence of insufficient physical activity.

  4. A 30% relative reduction in mean population intake of salt/sodium.

  5. A 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years.

  6. A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances.

  7. Halt the rise in diabetes and obesity.

  8. At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes.

  9. An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities.

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