Multi-pronged approach needed to fight :NCDs in children

Lionel Wijesiri

The Health Ministry recently warned that around 90 per cent of our schoolchildren are vulnerable to non-communicable diseases (NCDs) due to unhealthy food patterns and lack of physical exercises. Meanwhile, the Ayurveda Department of the Colombo Municipal Council (CMC) also reported that over 80 percent of schoolchildren who seek Ayurveda treatments from the CMC health units have high blood pressure, diabetes, arthritis, kidney troubles and high cholesterol levels. CMC Chief Medical Officer said that in addition to environmental pollution, excessive stress and consumption of fast food by children are also the reasons for children suffering from such NCDs.

Worldwide, NCDs currently represent 63 percent of global deaths, and 80 percent of these are in low and middle-income countries. Left unchecked, it is estimated that NCDs will be responsible for 73 percent of all deaths by 2020. Most of this increase will be accounted for by emerging NCD epidemics in developing countries.

In late 2010 concerns were raised that children risked being systematically excluded from the global NCD discourse. The terminology in common use at the time maintained a focus on adults, neglecting the fact that children are not only affected by all key NCDs, but moreover are the cornerstone to a life course approach to primary prevention and risk factor management.

In September 2011, the United Nations held its second-ever health-related Summit on the prevention and control of NCDs. It focused on the four most prominent NCDs, namely cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, and the common risk factors of tobacco use, alcohol abuse, unhealthy diet and physical inactivity. However, the agenda did not stress much on children.

Reasons

There are four important reasons why children require special attention and, therefore, integrated within NCD policies.

* NCDs impact the health of children (directly and indirectly) just as much as they do the health of adults. Children suffer from a wide range of NCDs: some are triggered in childhood by a complex interaction between the child’s body, surrounding environment, living conditions, infectious agents, nutritional and/or other factors, with consequent scope for preventive action. Some conditions are congenital. NCDs are a major cause of preventable mortality, morbidity and disability among children. Many of these children die prematurely because of late diagnosis and/or lack of access to appropriate treatment; those fortunate to survive often experience significant hardship and disability as a result of living with a chronic health condition that is not optimally managed.

* Children’s right to health requires special attention. Children are especially vulnerable and powerless, with 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. It represents an opportunity in terms of improving the overall lifetime health of population and promoting rights to health for all.

Approach

* There is now strong evidence for the importance of good maternal health, healthy birth weights and breast-feeding to reduce the future risk of children developing ‘lifestyle’ NCDs as adults. The rates of some ‘lifestyle’ NCDs among children is already on the rise nationally (eg: obesity and Type 2 Diabetes), so reducing exposure to these risk factors earlier in life will have a substantial impact on the future health of entire populations.

* The needs of children with chronic health conditions are complex. They extend beyond the traditional ‘acute’ health context and involve families, schools and the broader community. Increased capacity of primary, secondary and tertiary health care is required at local and national levels to develop comprehensive chronic care platforms that address the entire lifecycle of humans rather than simplistic approaches to change that risk ‘forgetting’ children.

To lessen the impact of NCDs on children, a comprehensive approach is needed that requires all sectors, including health, finance, education, agriculture, planning and others, to work together to reduce the risks associated with NCDs.

An important way to reduce NCDs in children is to focus on lessening the risk factors associated with these diseases. Experiences in other countries tell us that low-cost solutions exist to reduce the common modifiable risk factors and map the epidemic of NCDs and their risk factors. Other ways to reduce NCDs in children are high impact NCD interventions that can be delivered through a primary health-care approach to strengthen early detection and timely treatment. Evidence shows that such interventions are excellent economic investments because, if applied to patients early, can reduce the need for more expensive treatment.

These measures can be implemented in various resource levels. The greatest impact can be achieved by creating child-friendly public policies that promote NCD prevention and control and re-orienting health systems to address the needs of children with such diseases.

Data

We are fortunate to have in our country an efficient public health system. Our sanitation, infection and vector control systems, nutrition, vaccinations, and maternal and child health programmes have been commended by international health bodies. Tragically, however, there are few local or national data concerning the incidence of non-communicable diseases. The limited monitoring is based on information on death certificates, but this has value for control programmes as the occupational, environmental, and genetic factors that precede death are not documented. Moreover, death is just ‘the tip of the iceberg,’ the most severe form of disease but a delayed and infrequent manifestation.

Disciplines

Considerable national assets have been spent to prevent non-communicable diseases - for example, with major investments to improve the environment. However, as there has been no simultaneous monitoring of incidence, it is extremely difficult to determine the effects of these expensive actions to human health and well being.

To reduce NCDs in children, the writer believes that the need to work across disciplines, and avoiding working in ‘silos’, is important in three areas in particular:

1. Combining the work of maternal health, development and NCD organization’s;

2. Working to bring together programmes on communicable and non-communicable diseases; and

3. Tackling the risk factors for NCDs in children by looking outside the health sector to the education, urban development, finance and other sectors, and identifying ways of working that are more creative by taking an ‘all-of-systems’ approach. In this context, the strengthening of health systems, and identifying points at which existing programmes can be bolstered to address NCDs in children, are very important. Taking this approach will avoid the problems becoming ‘vertical’, in which obvious win-win situations are missed because each programme is too focused on its own specific area.

Empowering children

There is a pressing need to empower and enable the young to make responsible and healthy choices in a world where damaging lifestyle habits are common, increasing, encouraged and even glamorized. This should be done through the integration of education about health within schools and youth groups in which young people can choose alternative ways of spending their money and leisure time. It is imperative that decisions made at the highest levels regarding children strive to include young people themselves within decision-making processes. This will bring a better understanding as to their needs and those factors influencing their behaviour and lifestyle choices. Children must be recognized as active and responsible citizens within society, and supported to adopt healthy behaviours through the promotion of enabling environments. For children in particular, there is an imperative to broaden the reach of prevention activities to sectors beyond health (such as education and the environment) if we are to achieve wide-ranging benefits - from creating health-promoting cultures in communities and schools to the sustainable delivery of primary prevention strategies.

Legislation will likewise play a key role in protecting children and adolescents from exposure to NCD risk factors, limiting access to harmful products such as alcohol and tobacco and regulating the marketing of unhealthy foods and other products to children.

It is imperative that specific efforts be made by all policy makers and members of society if we are to protect and promote the rights of children to healthy and fulfilling lives, free from the preventable burdens associated with NCDs.