A shared commitment to fight NCDs is the need of the hour
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
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 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 childrenís 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
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).
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
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.
Itís also notable that the statistics are skewed because more people
drink illicit liquor, which isnít 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.