Tag Archives: noncommunicable diseases (NCDs)

In the Developing World, Diseases Defy Definition

Before last week, I thought I knew the definition of “noncommunicable disease.” Then I attended “The Long Tail of Global Health Equity: Tackling the Endemic Non-Communicable Diseases of the Bottom Billion.”

 Held on the campus of Harvard Medical School in Boston March 2nd and 3rd, the 2-day conference was sponsored by Partners In Health, an international nonprofit organization that conducts research, does advocacy, and provides direct health care services for people living in poverty around the world. The “Bottom Billion” of the meeting’s title refers to the world’s poorest people living on less than $1 per day.

 In a 2008-2013 action plan, the World Health Organization refers to “the four noncommunicable diseases – cardiovascular diseases, diabetes, cancers and chronic respiratory diseases and the four shared risk factors – tobacco use, physical inactivity, unhealthy diets and the harmful use of alcohol.” Together, these conditions account for approximately 60% of all global deaths, of which 80% occur in low- and middle-income countries. 

A cancer patient in Rwanda receives chemotherapy as her husband and physician discuss her treatment / Photo courtesy of Partners In Health

But as I learned at the conference, among the Bottom Billion, rheumatic heart disease is often the result of an untreated streptococcal infection early in life, diabetes is frequently associated with malnutrition rather than over-nourishment, and cervical cancer due to human papillomavirus is far more common than in the developed world, where women routinely receive PAP screenings and a vaccine can now also prevent the infection.   

And most startling to me: Among the world’s poorest, smoking is not the most common cause of chronic obstructive pulmonary disease. Cooking with biomass fuels is.   

Individually, these and other so-called “endemic NCDs” including Burkitt’s lymphoma, sickle cell disease, and tropical diseases are far less common than those within the WHO’s “four-by-four” definition. But together, that “long tail” of chronic conditions contributes to a great deal of suffering. 

In May 2010, the United Nations announced that it would hold a high-level meeting on NCDs in 2011, now set for September 19-20. It will be only the 29th such meeting that the UN has ever held (formerly called “special sessions“), and just the second pertaining specifically to a health issue. The first one, the 2001 Summit on HIV/AIDS, is credited with focusing global attention and obtaining public and private funding for that cause. 

Speakers at the Partners In Health meeting stressed that the NCD movement should not be undertaken as an “us against them” competition with infectious disease for scarce resources. In a statement that will be presented to the heads of government at the UN summit, the group called instead for “strengthening and adjusting health systems to address the prevention, treatment, and care of NCDs, particularly at the primary health care level.”

—Miriam E. Tucker (@MiriamETucker on Twitter)

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Filed under Alternative and Complementary Medicine, Cardiovascular Medicine, Dermatology, Endocrinology, Diabetes, and Metabolism, Family Medicine, Gastroenterology, Health Policy, Hematology, IMNG, Infectious Diseases, Internal Medicine, Neurology and Neurological Surgery, Obstetrics and Gynecology, Oncology, Pediatrics, Primary care, Pulmonary Diseases and Sleep Medicine, Uncategorized

Diabetes Doesn’t Spare Sub-Saharan Africa

Contrary to widespread belief, diabetes is not rare in sub-Saharan Africa. In an article included in the June 26th special diabetes issue of the Lancet, Dr. Jean Claude Mbanya and his associates outlined what is currently known about diabetes in that region. The statistics may surprise those who are unfamiliar with modern life there.

Just as in the developed world, lifestyle change brought on by rapid urbanization—decreased physical activity and increased consumption of energy-dense and high-fat diets—is believed to be a major contributor to the rising burden of obesity, diabetes, and cardiovascular disease now being seen even in many historically impoverished nations, wrote Dr. Mbanya, president of the International Diabetes Federation (IDF), and his colleagues.

Blood sugar testing in the Democratic Republic of the Congo / Photo courtesy of the International Diabetes Federation

According to the IDF’s Diabetes Atlas, there are now about 12.1 million adults with diabetes in sub-Saharan Africa. That number is projected to nearly double, to 23.9 million, by 2030. Currently, more than a third of the population of sub-Saharan Africa live in urban areas. That is expected to increase to 45% by 2025. And by 2035, more people are expected to live in urban than rural areas.

While diabetes rates of less than 3% have been reported in rural and some urban communities, frequencies of 3%-10% have been noted in urban populations, comparable with rates in developed countries. In urban parts of Dr. Mbanya’s native Cameroon, for example, the diabetes rate rose from 1.5% in the 1990s to 6.6% in 2003.

In most of sub-Saharan Africa, existing health care systems are typically devoted to “the unfinished agenda” of communicable disease, not to chronic noninfectious conditions. There is no medical insurance or free national health care available in most countries, so patients themselves have to pay. “Thus, when an individual with diabetes cannot afford the cost of drugs, the situation could be fatal,” the authors wrote, also noting that mortality rates attributable to diabetes in sub-Saharan Africa are highest in working-age adults aged 20-39 years.

“Agents such as generic glucose-lowering drugs and antihypertensive treatments should be funded just as drugs for HIV/AIDS are, along with support for delivery mechanisms and chronic disease education and care models,” they recommended.  In addition, “A multidisciplinary, politically driven, and coordinated approach in areas of health, finance, education, sports, and agriculture can contribute to a reversal of the underlying cause of this epidemic.” Indeed, that’s a good prescription for the entire world.

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Filed under Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, Health Policy, IMNG, Infectious Diseases, Internal Medicine, Primary care, Uncategorized

A Global Health Agenda

Jean-Claude Mbanya, M.D., Ph.D.

Dr. Jean Claude Mbanya, photo taken by Miriam E. Tucker

From the World Diabetes Congress, Montreal

“Improving the quality of life for people with diabetes at all levels,” Dr. Jean Claude Mbanya replied when I asked him what his primary goal would be over the next 3 years of his term as president of the International Diabetes Federation.

The steps to achieving that goal, which he outlined in a speech at the World Diabetes Congress, actually target something even broader: A restructuring of the world’s health care priorities to focus more attention on noncommunicable diseases (NCDs).

With sedentary lifestyles and unhealthful diets proliferating everywhere, chronic conditions now pose a greater threat to health than do infectious diseases in many parts of the developing world, said Dr. Mbanya, professor of medicine and endocrinology at the University of Yaounde, Cameroon, and chief of the endocrinology and metabolic diseases unit at Hospital Central in Yaounde.

According to the IDF’s newly released Diabetes Atlas, there are now 285 million people in the world with diabetes, nearly double the 151 million reported in 2000.

Contrary to common belief, most people with diabetes live in low- and middle-income countries rather than the wealthy ones, although the latter is where the vast majority of health care funds are spent. India has the highest number of people with diabetes (51 million), followed by China (42 million), and the United States (27 million). “No country is immune to diabetes,” Dr. Mbanya said.

In 2006, a United Nations Resolution on Diabetes recognized the disease as a threat to global health and economic development. That document is IDF’s mandate, he said.

Next steps include furthering an established alliance with the World Heart Federation and the International Union Against Cancer, which have jointly called for the UN to convene a special session on NCDs. The three health organizations also are urging the UN to incorporate NCD indicators in the 2015 Millennium Development Goals, which currently specify only HIV/AIDS and malaria as diseases that need to be addressed in the name of improving world development.

Indeed, Dr. Mbanya believes that the disproportionate focus on infectious diseases at the expense of NCDs has distorted health funding: The World Health Organization budget for infectious diseases is 10 times more than the amount earmarked for NCDs, mental health, and injuries combined. Money shouldn’t be taken away from infectious disease, he said, but instead health systems should be restructured to “treat the whole person and not compartmentalize treatment by disease.”

By the same token, IDF and other NCD organizations also are calling for essential medicines to treat NCDs—including low-cost, generic drugs that reduce glucose, blood pressure, and lipids—to be made available to poorer countries, just as HIV and malaria drugs are now.

“We have to act today to ensure that accidents of geography and history do not determine who should live and who should die,” the new IDF president said.

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Infectious Diseases