Health Watch

What causes non-communicable diseases?

Manjari PEIRIS

Non-communicable diseases (NCDs) are the leading causes of death globally, killing more people each year than all other causes combined. Contrary to popular opinion, available data demonstrate that nearly 80 percent of NCD deaths occur in low and middle-income countries. Despite their rapid growth and inequitable distribution, much of the human and social impact caused each year by NCD-related deaths could be averted through well-understood, cost-effective and feasible interventions.

Of the 57 million deaths that occurred globally in 2008, 36 million – almost two thirds – were due to NCDs, comprising mainly cardiovascular diseases, cancers, diabetes and chronic lung diseases. The combined burden of these diseases is rising fastest among lower-income countries, populations and communities, where they impose large, avoidable costs in human, social and economic terms.

NCD related deaths

About one fourth of global NCD-related deaths take place before the age of 60. NCDs are caused, to a large extent, by four behavioral risk factors that are pervasive aspects

of economic transition, rapid urbanization and 21st-century life: tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol. The greatest effects of these risk factors fall increasingly on low and middle-income countries, and on poorer people within all countries, mirroring the underlying socioeconomic determinants.

Among these populations, a vicious circle may ensue: poverty exposes people to behavioural risk factors for NCDs and, in turn, the resulting NCDs may become an important driver to the downward spiral that leads families towards poverty.

As a result, unless the NCD epidemic is aggressively confronted in the most heavily affected countries and communities, the mounting impact of NCDs will continue and the global goal of reducing poverty will be undermined.

A major reduction in the burden of NCDs will come from population-wide interventions, which are cost effective and may even be revenue-generating, as is the case with tobacco and alcohol tax increases, for instance. But effective interventions, such as tobacco control measures and salt reduction, are not implemented on a wide scale because of inadequate political commitment, insufficient engagement of non-health sectors, lack of resources, vested interests of critical constituencies, and limited engagement of key stakeholders. For example, less than 10 percent of the world’s population is fully protected by any of the tobacco demand-reduction measures contained in the WHO Framework Convention on Tobacco Control.

Improved healthcare, early detection and timely treatment is another effective approach for reducing the impact of NCDs. However, appropriate care for people with NCDs is lacking in many settings, and access to essential technologies and medicines is limited, particularly in low and middle-income countries and populations.

Many NCD-related healthcare interventions are cost effective, especially compared to costly procedures that may be necessary when detection and treatment are late and the patient reaches advanced stages of disease. Health systems need to be further strengthened to deliver an effective, realistic and affordable package of interventions and services for people with NCDs.

As the magnitude of the NCD epidemic continues to accelerate, the pressing need for stronger and more focused international and country responses is increasingly recognized by Member States. Much has been learnt about the causes, prevention and treatment of NCDs over the past three decades, as important achievements have been made in reducing mortality in many high income countries; the evidence base for action is steadily mounting and global attention to the NCD epidemic is intensifying. Non-communicable diseases include: cancer, cardiovascular disease, chronic respiratory disease and diabetes. Tobacco use, unhealthy diet and physical inactivity are responsible for the vast majority of death and disability caused by NCDs. These threats have increased dramatically with recent global changes such as globalization and urbanization, and related demographic, economic and technological developments. Urbanization, employment patterns, social trends and mass communication work together to create an environment that restricts choices and shapes the behaviours that influence health, including quality of diet and level of physical activity. In extremely low income countries, many NCDs are linked to infections. These include rheumatic heart disease, cervical cancer, liver cancer and stomach cancer.

NCDs affect men, women and children of all social and economic levels. The large majority of those suffering from NCDs live in low and middle-income countries. In high-income settings, NCDs are most common among the poor. Poverty is both a cause and a consequence of NCDs. Limited access to healthcare, insurance and/or social benefits in low-income countries means that the death or disability of a breadwinner often impoverishes an extended family. The loss of productivity of workers killed or disabled by NCDs is enormous and it threatens to undermine the economic growth of many developing and emerging economies. NCDs impede progress toward the Millennium Development Goals, especially those on factors affecting health like poverty and education.

Many people still believe that NCDs primarily affect the wealthy. NCDs are seldom seen to be a health priority in low and middle-income countries. Because the behaviours that contribute so heavily to NCD risk are shaped by policy, norms and environmental factors, solutions require the commitment and collaboration of many sectors that are not accustomed to taking health needs into account.

Governments, civil society and elements of the private sector are beginning to recognize that we must invest in NCD prevention to protect socio-economic development. Policymakers, educators, healthcare providers, corporations, municipal authorities, the media and others are starting to work together to raise the priority given to non-communicable diseases, to increase resources allotted to them and to move people to action. Effective tobacco control policies, changes in food content, guidelines and policy on labelling and marketing, plus city planning that facilitates active (as opposed to motorized) transport are among the measures that will help get the NCD epidemic under control.

The UN Summit on NCDs, to be held in September 2011, will call on heads of State to fully recognize the burden imposed by NCDs and to show concrete commitment to overcoming it.

Laser treatment unit for prostate

The first Laser treatment unit for prostate gland was installed at Nawaloka Hospitals recently.

Prostate gland enlargement affects up to 43 percent of men over the age of 60, leading cause of voiding difficulties, half of all men over 50 have prostate gland enlargement symptoms the percentage growing to 80 percent of men over 80. Prostate gland is a walnut sized cone shaped organ situated just below the urinary bladder and the urine passes through it.

At young reproductive ages the gland contributes to the production of semen and provide nutrients to the sperms thus forming an essential part of male reproductive systemic. However with ageing specially after 45 the central core of the gland undergoes certain changes (benign prostatic hypertrophy-BPH) making the gland to swell in size. This newly formed tissue can block the urethra or the urine pipe causing symptoms such as difficulty in starting the stream, straining to pass urine, stopping and starting urinary flow, getting up in the night to pass urine and sometimes total blockage which is called acute urinary retention.

Although can often be handled adequately with medical treatment, patients who continue to have significant voiding problems will eventually require surgical intervention, to avoid long-term sequeale such as urinary retention, urinary track infections diverticula and bladder calculi. When surgical treatment was considered the traditional only surgical option was to open the abdomen and core out the enlarged gland which was associated with many complications such as bleeding, wound infection, pain, prolonged hospitalization and delayed return to normal daily pursuits.

Fortunately over the last few decades surgery through telescopic instruments introduced through the urinary passage and electrical cutting of the gland (Trans urethral resection of the prostate - TURP) has nearly replaced the open surgery. Alternate therapies have been developed in an attempt not only to provide a surgical treatment for prostate gland enlargement but also to minimize the risk of post operative complications and the length of hospital stay.

“Latest laser method (Holmium laser) which has overcome most of these problems has been introduced to Sri Lanka by Nawaloka Hospitals PLC by its recently acquired Versa Pulse Power Suite 100 Watts Holmium Surgical Laser for urological applications, which was launched on June 18, 2011. Holmium laser prostate surgery will be relatively more economical to the patient as many patients can be operated with a single laser fibre and this method can be used not only for evaporation but also to cutoff large glands more completely without bleeding, avoiding re-operations. Even very large prostates which will need open operations could be removed with this new Laser,” a spokesman for Nawaloka Hospitals said.

“The new laser for the prostate has cost nearly 17 million SLR in addition to the supportive endoscopic instruments which cost nearly 10 million. In spite of these heavy capital expenditure Nawaloka Hospitals PLC has made plans to maintain the services at a viable and affordable financial level.”

It will be either on par or much more economical than the available older resection methods and laser methods.

A trained Local senior Urological surgeon and a team performed the surgery following a live demonstration and instructional work shop conducted on June 18-19, 2011 by Dr Anil Varshney from India, who is a regional expert on this new Holmium laser prostate surgery, in collaboration with the Sri Lanka association of urological Surgeons,” he added.

Art of Clinical Medicine

Title: Art of clinical medicine

Author: Dr S D K Perera, MD, FRCP (Consultant Physician and Gastroenterologist)

This short text book provides a practical account of Clinical Medicine. It focuses on the interpretation of history, physical examination and relevant investigations that are required to make a correct diagnosis.

This is a 264 page book with 277 colour photos.

CD is provided.

This book is suitable for undergraduates, postgraduates and also for those who are preparing for ERPM examination.

Distributors - Samayawardana Books, Maradana.