The Heart Of All Our Problems: Non-Communicable Diseases
Hello Readers, In this post I would like to discuss with you what I have learnt about non-communicable diseases (NCDs). WHO defines NCDs as those diseases that are NOT transmitted from person to person, are of long duration, and progress slowly. The 4 main types of NCDs are cardiovascular disease (e.g. heart attacks & stroke), cancers, chronic respiratory disease (e.g. asthma) and diabetes. NCDs kill 38 MILLION PEOPLE ANNUALLY and almost 3/4 of NCD deaths (28 million) occur in low and middle income countries. In fact, NCD related deaths in these countries are even surpassing those of infectious diseases (e.g. malaria and HIV). Even just these introductory statistics alone highlight the severity and global burden of NCDs and the dire need for us to be able to control and prevent NCDs on a global scale. Our guest lecturer on this topic was Dr. Joshua Manolakos, the 2013 McMaster Resident Research Prize Recipient and an aspiring cardiologist, who specifically focused on the global burden of cardiovascular disease (CVD). Why the specific focus on CVD? Well, CVD is actually the NCD that causes the most deaths annually - 17.5 million deaths/year! In addition, CVD is a multifactorial process meaning that it is caused by a wide range of factors that can be either individual biological factors, lifestyle factors or environmental factors. Traditional factors, as published in the JAMA report of 2003, include hypertension, cigarette smoking, obesity, diabetes, dyslipedimia, physicial inactivity, microalbuminuria, family history of CVD, and age of >55 for men and >65 for women. The factors published in this report were as a result of the analysis of those who develop the disease in the "Western World" since it was historically most prevalent in high-income countries. However, with time it has become more and more prevalent within middle and low income countries causing them to now surpass high-income countries. As a result, it is an absolute necessity to research the underlying causes and risk factors for CVD in different ethnic populations to ensure that effective treatments and strategies are being implemented for them. Dr. Salim Yusuf, one of the most influential health care professionals within this field, decided to investigate the differences in risk factors based on ethnicity in his famous INTERHEART study. His colloborative efforts with the work of 600 other investigators around the globe enabled this study to obtain data from 52 countries. It was found that 9 modifiable risk factors account for over 90% of the risk of an initial heart attack across all ethnic groups, with smoking and high level of lipids being the most important. Another important finding were protective factors that can reduce the risk of heart attacks which included fruit and vegetable intake, not smoking, exercise and moderate alcohol intake. For more details of INTERHEART you can access it at this link: http://www.sciencedirect.com/science/article/pii/S0140673604170189 These findings are GOOD news! It implies that we can actually change some habits in our life to lower our risk. However, despite the fact that all these factors are well known, there is a big discrepancy in the policies that exist to ensure that the public actually makes the necessary lifestyle changes. I will reflect on my own experiences with regards to nutritional policies but I would love if you could share your experiences too with any policies/strategies, positive or negative, for any of the risk factors in INTERHEART. So, for the past year I've tried to adopt a healthy lifestyle by doing regular exercise and trying to incorporate a more well balanced diet. I thought my biggest hurdle would be keeping my motivated myself to go to the gym. However, it turned out that the most difficult task for me was finding healthy, affordable nutritional options on campus. Why is is that a tiny salad that I wouldn't even pass as an appetizer is for $9 while a calorie-loaded beef burger is only $3? Realistically, which option would most of the general public choose? Similarly, when I visited my native country, Pakistan, I also noticed a similar trend in prices. Remember that CVD is increasing in low and middle income countries where many struggle to afford even just bread. So if someone like me who doesn't have as much financial restrictions but still thinks twice before buying an extremely over-priced salad, how do we expect poorer populations to eat better? I've heard of policies where people have proposed to increase the prices of fast food by putting tax on them but what about making healthy options cheaper? I've always been intrigued by the lack of solid nutritional policies to combat not only CVD but also obesity and diabetes. I am hoping to explore this further this upcoming summer in order to understand what the difficulties are in coming up with an effective strategy to combat these risk factors and how to tailor these strategies according to the local population. I hope this post was able to shed some light about the severity of the global burden of NCDs. Stay tuned for my next post on water, sanitation and health. Iqra Effendi M.Sc. Global Health McMaster University