"As global health landscapes evolve, traditional approaches to disease management are under scrutiny. Today's healthcare leaders navigate a shifting paradigm, investing in innovative strategies to confront and adapt to the dynamic challenges of a worldwide disease shift."
For those who are unaware, the term "disease shift" refers to a significant change in the patterns of diseases affecting a population over time. This often involves a transition from communicable diseases, which are easily transmitted from person to person (like infectious diseases), to non-communicable diseases (NCDs), which are chronic, complex conditions not directly contagious.
Think of it as a journey of disease dominance. Historically, infectious diseases like malaria, tuberculosis, and diarrhea might have held sway, causing the majority of illness and death in a population. However, through public health interventions like vaccination, sanitation improvements, and better access to healthcare, these diseases have begun to decline, but unfortunately enough, others have risen. This article explores the dynamics of the global disease shift that has taken place.
Key facts according to WHO
- Noncommunicable diseases (NCDs) account for 41 million annual deaths worldwide, or 74% of all fatalities.
- 17 million individuals die from NCDs before they become 70 years old every year; low- and middle-income nations account for 86% of these premature fatalities.
- 77% of NCD-related deaths occur in low- and middle-income nations.
- The majority of NCD deaths—17.9 million annually—are caused by cardiovascular illnesses, which are followed in death by cancer (9.3 million), chronic respiratory diseases (4.1 million), and diabetes (2.0 million including deaths from renal disease induced by diabetes).
- More than 80% of all early NCD fatalities are caused by these four categories of diseases.
- The chance of dying from an NCD is increased by smoking, air pollution, poor diets, hazardous alcohol use, and physical inactivity.
- The approach to NCDs includes palliative care in addition to NCD detection, screening, and treatment.
- People with low- and middle-income countries are disproportionately affected by NCDs; in these countries, 31.4 million NCD deaths worldwide take place.
Drivers of NCD
1. Aging Populations: Life expectancy across the world is increasing, with the global average reaching 72.6 years in 2019. As people age, the risk of developing chronic diseases like cardiovascular diseases, diabetes, and cancers naturally increases. This is due to cellular changes, accumulated risk factors, and slower metabolisms. In 2019, NCDs were responsible for 74% of all deaths globally, with over half of these deaths occurring among individuals aged 70 and above.
2. Unhealthy Lifestyles: According to IHME, almost 8 million deaths worldwide are related to tobacco use (including those caused by secondhand smoking). Excessive consumption of salt and potassium has been linked to 1.8 million fatalities per year. Cancer and other NCDs account for more than half of the 3 million alcohol-related deaths that occur each year. It is estimated that 830,000 fatalities per year are caused by insufficient physical activity.
3. Urbanization: According to UN, Urban populations worldwide are projected to reach 68% by 2050, driven by economic and social factors. Urbanization is often accompanied by heavy industrialization and hence pollution.
Water pollution: Water pollution from industrial waste dumping and chemical runoff, contaminating water sources and affecting aquatic life.Contaminated water can lead to gastrointestinal diseases, waterborne bacterial infections, and even cancers in the long term. A 2017 study linked exposure to arsenic-contaminated water in Bangladesh to an increased risk of skin cancer and bladder cancer.
Soil contamination: Exposure to heavy metals and other toxins from contaminated soil can lead to developmental problems, neurological disorders, and even cancers.
Air pollution: Studies have established a clear link between air pollution and respiratory diseases like chronic obstructive pulmonary disease (COPD), asthma, and lung cancer. Air pollution damages lung tissue through various mechanisms, including Inflammation (pollutants trigger inflammatory responses in the lungs, leading to damage and scarring), Oxidative stress (Free radicals generated by pollutants can damage lung cells and DNA), Impaired lung function (Pollutants can directly interfere with the lungs' ability to exchange oxygen and carbon dioxide).
According to the World Health Organization (WHO), NCDs are influenced by a number of environmental risk factors. The greatest of them is air pollution, which is responsible for 6.7 million fatalities worldwide, of which 5.7 million are attributable to NCDs, such as lung cancer, ischemic heart disease, stroke, and chronic obstructive pulmonary disease. A significant contributing element to COPD, a progressive lung condition that impairs breathing, is air pollution. Research indicates that being exposed to fine particulate matter (PM2.5) can hasten the advancement of COPD and raise the possibility of COPD-related fatalities. It is estimated that air pollution causes more than 170,000 deaths in Bangladesh each year. The World Health Organization (WHO) estimates that air pollution significantly increased the burden of non-communicable diseases (NCDs) in Bangladesh in 2019 and was responsible for 7% of all deaths in the country.
IMPACTS
Economic Impact:
i. Impact on GDP: According to PAHO, NCDs will push millions of people below the poverty line and cost the world economy more than US$ 30 trillion between 2011 and 2030. In 2010, NCDs accounted for 48% of the global GDP.
ii. Increased Healthcare Expenditure: According to estimates, smoking-related disorders' direct treatment costs accounted for 5.7% of worldwide health expenditures in 2012, while the associated total economic cost, which includes productivity losses as well as medical expenses, was 1.8% of global GDP. According to a recent OECD analysis, drinking more than one drink per day for women and 1.5 drinks per day for males might result in diseases that shorten life expectancy by 0.9 years and cost 2.4% of all healthcare costs in OECD nations. Macroeconomically speaking, illnesses brought on by excessive alcohol consumption have a 1.6% negative GDP impact on OECD nations.
Social Impact:
i. Reduced quality of life: NCDs can significantly reduce quality of life, causing physical limitations, pain, and emotional distress. Women and low-income communities are disproportionately affected by NCDs due to social and economic factors that limit access to preventive care and quality treatment.
ii. Social stigma: NCDs can be associated with stigma and discrimination, leading to social isolation and decreased access to opportunities.
iii. Increased burden on caregivers: Caring for individuals with NCDs can place a significant burden on families and communities, affecting their time and resources.
iv. Intergenerational impact: NCDs can have a ripple effect, impacting future generations through lost income and educational opportunities.
Pressure on Healthcare
i. Increased Demand for Services:The burgeoning NCD burden directly translates to higher demand for healthcare services. This includes diagnostic tests, specialized consultations, long-term treatment plans, and rehabilitation therapy. The significant resource demands of NCDs can strain healthcare systems. This can lead to longer waiting times, limited access to specialist care, and increased pressure on healthcare personnel.The challenge lies in balancing resource allocation between NCDs and other healthcare needs, particularly in resource-constrained settings.
ii. Shifting Treatment Paradigms: Traditionally, medical care emphasized acute interventions and cures. However, NCDs require a chronic care approach, focusing on long-term management, lifestyle modifications, and prevention of complications.This shift necessitates a move towards integrated care models, involving collaboration between different specialists, nurses, nutritionists, and mental health professionals.The NCD surge is stimulating innovations in medical technology. Telemedicine, remote monitoring technologies, and AI-powered diagnostic tools are emerging to improve access to care, manage chronic conditions remotely, and optimize resource utilization.
iii. Focus on NCD Prevention: Recognizing the economic and social burden of NCDs, the medical sector is increasingly emphasizing prevention and early detection. Public health initiatives, community engagement programs, and educational campaigns are gaining traction.
Challenges and Opportunities
Bridging the healthcare workforce gap: NCDs require a specialized workforce, necessitating training and upskilling of healthcare professionals to address the growing demand.
Addressing social determinants of health: Healthcare systems need to collaborate with other sectors to tackle factors like poverty, education, and social inequalities that contribute to NCD risk while promoting healthy economic choices
Conclusion
The rise of NCDs presents a significant challenge for the medical sector, but it also holds opportunities for innovation, improved preventive care, and personalized medical approaches. By adapting to the changing landscape, embracing technological advancements, and prioritizing both treatment and prevention, the medical sector can play a vital role in mitigating the impact of NCDs and building a healthier future for all.
