A shared commitment to fight NCDs is the need of the hour

Lionel WIJESIRI

Non Communicable Diseases (NCDs) have become an acute global crisis these days. People from developing countries are at most vulnerable status to NCDs. When Health Ministry Additional Secretary, Dr. Palitha Maheepala stated recently that, 71 percent of the total deaths reported from hospitals were caused by NCDs, it became obvious that NCDs have become an acute problem in our country, also.

NCDs, which include diabetes, cardio-vascular disease, chronic respiratory diseases and cancers, are largely preventable, since their main risk factors of tobacco use, unhealthy diets, harmful use of alcohol and physical inactivity can all be modified. Despite this, what made NCDs to reach such epidemic proportions across our country? It is time we sit up and begin to take stock urgently.

Managing this national challenge requires collaborative solutions, involving government, civil society and private companies.

First of all, we must be bold and ambitious in setting national targets to reduce the burden of NCDs. These targets should push comprehensive and evidence-based concrete action to address the diverse and complex drivers of this epidemic. Targets should include an overall reduction in the incidence of new cases, a reduction in the prevalence of major NCDs.

Sound leadership across government to work with the full range of relevant National and International agencies will then be required to promote and implement cross-sector action to meet these targets. This will ensure a coordinated, cross-border response to NCDs. All future infrastructure development policies should be subject to health impact assessments and cross-sector food policy should address the full spectrum of nutrition-related issues both under-nutrition and over-nutrition.

Whilst specific targets to reduce deaths from NCDs may not have been achieved in the past decade, there is much to be learned from our experiences. More dedicated work is now needed to commit to reducing avoidable deaths from NCDs by 25 percent by 2025 - a target that the World Health Organization (WHO) believes is achievable.

Children

Children are especially vulnerable and powerless. They often have no voice to advocate for their own needs, and yet they face unique challenges and have special needs. The period of rapid growth and development that occurs in childhood has a profound impact on future health and quality of life enjoyed in adulthood, and represents a 'golden window' of opportunity in terms of improving the overall lifetime health of populations and promoting rights to health for all.

It is, therefore, imperative that children’s issues are an integral part of our national NCD discourse. A predominant focus on adults will systematically neglect important opportunities to reduce NCD risk factors from the earliest possible stages. By contrast, a focus on children promotes generational and population-based change, and empowers a pro-active approach to the primary, secondary and tertiary prevention of NCDs.

Unfortunately, there is a common misconception that NCDs do not affect children, but are diseases of adulthood only. This is patently false. NCDs and their risk factors have an enormous impact on the health of children. Cancer, diabetes (both Type 1 and Type 2), chronic respiratory diseases (such as asthma), obesity, congenital and acquired heart disease and many endemic NCDs all affect children and/or start in childhood. Children and young people are often targeted by companies advertising fast food, tobacco or alcohol, and many grow up today in environments that are not conducive to them adopting healthy lifestyles (e.g. participating in sport).

Prevention

A large percentage of NCDs are preventable through the reduction of their four main behavioural risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet.

The influences of these behavioural risk factors, and other underlying metabolic and physiological causes, on the NCD epidemic include:

Tobacco: Our current smoking prevalence is 39 percent among males and 2.6 percent among females. Chewing tobacco is more common than smoking among women. NCDs have become the leading cause of morbidity and mortality with tobacco use being the second biggest cause of all deaths and disabilities from NCDs. Over 20, 000 people die per year due to tobacco-related illnesses annually in Sri Lanka.

Insufficient physical activity: People who are insufficiently physically active have a 20 percent to 30 percent increased risk of all-cause mortality. Regular physical activity reduces the risk of cardiovascular disease including high blood pressure, diabetes, breast and colon cancer and depression. Few decades ago, insufficient physical activity is highest only in high-income countries, but very high levels are now also seen in some middle-income countries, like Sri Lanka, especially among women.

Most of our urbanites have higher Body Mass Index (BMI) value than the required value. Many do not exercise. A healthy person needs to exercise 600 metabolic minutes per week. Around 30 percent of women and 19 percent of men do not get the required amount of exercise.

Harmful use of alcohol: Our current alcohol consumption is over 75 million of litres in hard liquor and about 52 litres of beer per year. It’s also notable that the statistics are skewed because more people drink illicit liquor, which isn’t counted. It has been estimated that there are over 200,000 illicit brew retailers, compared to the 3,200 licensed retail shops ('wine stores') in the country.

Surveys have found that 67 percent of the families had at least one member consuming alcohol heavily. It is seen as a major cause for the eroding human values in the modern society of Sri Lanka. The number of liver cirrhosis patients is increasing, among oral cancer patients 68 percent were alcohol users.

Unhealthy diet: Medical experts say that a normal adult requires less than five grams of salt per day. An average Sri Lankan consumes 10 to 15 grams of salt per day. A person needs to consume less than 10 grams of sugar per day but a Sri Lankan consumes 60 to 75 grams of sugar per day. This leads to increased diabetics, blood pressure and related diseases.

Adequate consumption of fruit and vegetables reduces the risk for cardiovascular diseases, stomach cancer and colorectal cancer. Around 82 percent of adults over the age of 40 do not consume the required amount of fruits and vegetables per day, according to surveys.

High consumption of saturated fats and trans-fatty acids is linked to heart disease. Unhealthy diet is rising quickly in lower-resource settings. Available data suggest that fat intake has been rising rapidly in lower-middle-income groups since the 1980s.

Cancer-associated infections: Cancer is a malignant disease. Around 12,000 patients are yearly affected by it in Sri Lanka. The types of cancer very common locally are oral, breast, cervical, oesophageal, and the lung cancers. Medical experts explain that, smoking, alcoholism and pollution have become the causative factors while chemicals, preservatives and radiation have aggregated the situation.

The rapidly growing burden of NCDs in Sri Lanka is accelerated by the negative effects of globalization, speedy urbanization and increasingly sedentary lives. People are more and more eating foods with higher levels of total energy and are being targeted by marketing for tobacco, alcohol and junk food, while availability of these products increases.

People of lower social and economic positions fare far worse. Vulnerable and socially disadvantaged people get sicker and die sooner as a result of NCDs than people of higher social positions; the factors determining social positions are education, occupation, income, gender and ethnicity. There is strong evidence for the correlation between a host of social determinants, especially education, and prevalent levels of NCDs and risk factors.

Overwhelmed by the gravity of the issue, the present government is attempting to keep pace with ever-expanding needs for policies, legislation, services and infrastructure that could help protect their citizens from NCDs.

The Health Ministry is formulating a National Policy on Non Communicable Diseases. The ministry has appointed a committee to handle NCDs at district level. Special NCD units are to be set up at Divisional Secretariats next year. The government has allocated Rs. 900 million to control NCDs in the next three years in addition to the annual budgetary allocation for the health sector.

Interventions to prevent NCDs on a population-wide basis are not only achievable but also cost effective. And the income level of a country or population is not a barrier to success. Low-cost solutions can work anywhere to reduce the major risk factors for NCDs.