Todays risk factors – tomorrow’s diseases

DR COUILLARD, our regular Health Watch contributor,  has been attending a World Health Organization (WHO) Stakeholder’s conference in South Africa .This column was sent from Johannesburg.

Globally we face a rapidly increasing burden of NCDs (Non Communicable Diseases) alongside the continuing threat of communicable diseases. 

The main NCDs include diabetes, cardiovascular diseases, chronic respiratory diseases, cancer, sickle-cell anaemia and the consequences of violence and road traffic accidents.
Tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity are fuelling the NCD epidemic. These factors act alone or in combination to adversely affect people's health.
A staggering 50 per cent of diabetics do not know that they are diabetic. The nearly silent disease is a leading cause of heart disease, stroke, kidney failure, blindness and amputation. Diabetes is responsible for 1 death every 7 seconds and accounts for more than 4.6 million deaths per year.
The rate of developing diabetes has increased by 700 per cent in the last five decades and can be traced to personal habits.

A proactive lifestyle that includes a healthy diet, regular physical exercise, avoidance of tobacco and maintaining a normal body weight can prevent, delay and even treat the effects of the most common causes of diabetes.
One of the best ways to reduce diabetes and other NCDs is to eat more of the foods you’ve always known are good for you. Eat a colourful variety of fruits and vegetables. Fruits and vegetables are low fat and are loaded with essential vitamins and minerals.
To help keep your blood pressure under control, and therefore lower your risk of heart disease, limit the amount of salt you consume. Up to 75% of the salt in the diet comes from processed foods—everything from soups to salad dressings.
As many as one in six deaths can be linked to physical inactivity, according to Dr I-Min Lee, the lead researcher from Harvard Medical School said, “Only about one quarter of the world’s population smokes, but about two-thirds are inactive.”

Tackling big tobacco
Tobacco use is a global epidemic that brings disability, disease, lost productivity and death to entire countries and regions throughout the world. Tobacco continues to be the leading cause of preventable death despite aggressive national educational campaigns.
Nearly 6 million tobacco users die every year via cancer, heart disease, lung disease and other chronic, long-term health conditions. The tobacco epidemic is one of the biggest public health disasters as it kills up to half of its users. Over the course of the 21st century, tobacco use could kill up to a billion people unless urgent action is taken.
“The tobacco epidemic is entirely man-made, and it can be turned around through the concerted efforts of governments and civil society says Dr Margaret Chan, Director General, WHO.
Nicotine, the addictive component in tobacco is known to accelerate the heart rate and raises blood pressure. Nicotine can damage the lining of the blood vessels, increase fatty deposits in the arteries, increase blood clotting, raise bad cholesterol, reduce good cholesterol and promote coronary artery spasm according to the World Heart Federation.

Combating risky alcohol practices
The harmful use of alcohol is a global problem that claims at least 2.5 million lives per year. The sad reality is that many of the lives lost are caused by an intoxicated person’s poor choices that ultimately resulted in the harm of others. Alcohol use is very similar to the concept of second-hand smoke; it impacts everyone around you.
The seemingly innocent drink is a staple in social gatherings but its effects often spills over into society as a whole. Alcohol’s intoxicating, toxic and dependence-producing properties play a role in violence, child neglect and abuse, shattered relationships and poor job performance.
Nearly everyone knows someone that has been harmed intentionally or unintentionally by risky alcohol practices. Fatal accidents resulting from traffic accidents, violence and suicides tend to occur in younger age groups but are not limited to youth or any gender group.
“320,000 young people between the age of 15 and 29 die from alcohol-related causes, resulting in 9% of all deaths in that age group”, according to the World Health Organization.

Coordinating action
To curb the escalating burden of NCDs, the World Health Organization's Regional Director for Africa, Dr Luis Sambo has organized the multi-national, Multi-Stakeholder’s Dialogue on Addressing Risk Factors for Noncommunicable Diseases.
Around 200 delegates are taking part, including public health experts on NCDs and risks factors, researchers and practitioners, senior officials representing relevant government ministries, consumer organizations, the food industry, intergovernmental organisations and other health stakeholders.
“Sound health policy and preventive actions on the risk factors and their determinants taken at government, community and individual levels have the potential to halt or reverse the rising trend of NCDs”, explains Dr Sambo.
He observed that about a third of NCD deaths occur prematurely during the most productive years of life, and this negatively impacts economic growth and development. Most of the risk factors associated with these diseases are behavioural and lifestyle related and therefore amenable to change.
“Governments and parliamentarians together with representatives of civil society organizations and consumer associations to develop policies, set norms and pass and enact legislation that protect public health and give individuals reliable facts to make informed choices”, he added.

Dr Sambo emphasised strengthening the capacity of health services to tackle the clinical aspects of chronic diseases using the primary health care approach including ensuring qualified staff, and making medicines and technologies accessible.
Together we can reduce the impact of future disease burdens by tackling daily risk factors and find common grounds culturally, socially and economically. Education may be initially needed, but action and follow through is required to make a true difference.
NCD prevention and cure needs sustainable financing under the objective of universal health coverage. Limited resources in countries of the African Region, universal health coverage will become even more difficult unless more attention is given to prevention of illness and promotion of health according to Dr Aaron Motsoaledi.
“This means seriously tackling the known social determinants of health and the specific risk factors for NCDs. If we fail to do this, with the growing numbers of ill people, our health services will become even more overwhelmed than they already are. We have no option; we must put more effort into prevention of diseases and promotion of health and healthy lifestyles”, he said.
Dr Motsoaledi outlined some of the breakthrough initiatives and regulations he has implemented in South Africa to address NCDs. These include : regulation of salt in processed foods, regulation on the use of trans fat in food production processes and proposed regulations to further reduce tobacco use.
It’s understood that these are not the only risk factors in the development of NCDs but the risk factors identified are good starting points to reduce the global NCD burdens. Systematic implementation will allow government ministries, consumer organizations, intergovernmental organisations and other health stakeholders to monitor and track outcomes and disease trends.

Dr Cory Couillard is an international healthcare speaker and columnist.. He works in collaboration with the World Health Organization's goals of disease prevention and global healthcare education.