non communicable disease

1. Non communicable disease
Cultural and religious diversity in
healthcare. Spiritual health, elements
of care.
Nino Buadze
NCDC
Lecture 7

2. Non-Communicable Disease (NCD): Definition
(WHO, 2011)
.
Noncommunicable diseases (NCDs), also known as chronic diseases, are
not passed from person to person. They are of long duration and
generally slow progression.

3. Non-Communicable Disease (NCD): Definition
Chronic conditions are characterized by the
following:
– Do not result from an (acute) infectious process
– Are “not communicable”
– Cause premature morbidity, dysfunction, and
reduced quality of life
– Usually develop and progress over long periods
– Often initially insidious
– Once manifested there is usually a protracted period
of impaired health

4. Non-Communicable Disease (NCD): Extended Definition
In some definitions, NCDs also include:
• Chronic mental illness
• Injuries, which have an acute onset, but may be
followed by prolonged convalescence and
impaired function

5. Types of NCDs
Cardiovascular disease (Coronary heart
disease, Stroke)
• Cancer
• Chronic lung disease
• Diabetes
• Chronic neurologic disorders (Alzheimer’s,
dementias)
• Arthritis/Musculoskeletal diseases

6. Characteristics of NCDs
• Complex etiology (causes)
• Multiple risk factors
• Long latency period
• Non-contagious origin (non-communicable)
• Prolonged course of illness
• Functional impairment or disability
• Incurability
• Insidious onset

7. Risk Factor
An aspect of personal behavior or lifestyle, an environmental exposure,
or a hereditary characteristic that is associated with an increase in the
occurrence of a particular disease, injury, orother health condition.”

8. Risk Factor
An aspect of personal behavior or lifestyle, an environmental exposure,
or a hereditary characteristic that is associated with an increase in the
occurrence of a particular disease, injury, orother health condition.”

9. Modifiable Risk Factor
A risk factor that can be reduced or controlled by
intervention, thereby reducing the probability of
disease.
The WHO has prioritized the following four:
• Physical inactivity
• Tobacco use
• Alcohol use
• Unhealthy diets

10. Non-Modifiable Risk Factor
A risk factor that cannot be reduced or controlled
by intervention, for example:
• Age
• Gender
• Race
• Family history (genetics)

11. Common Risk Factors

12. What are noncommunicable diseases?
Noncommunicable diseases – a group of conditions that includes
cardiovascular diseases, cancer, mental health problems, diabetes
mellitus, chronic respiratory disease and musculoskeletal conditions –
cause 86% of deaths and 77% of the disease burden in the WHO
European Region. These disorders are largely preventable and are
linked by common risk factors, underlying determinants and
opportunities for intervention. A more equitable share of the benefits
from effective interventions would bring significant health and
economic gain to all Member States.

13. WHO/Europe noncommunicable diseases
WHO/Europe promotes a comprehensive approach to tackling noncommunicable
diseases that simultaneously:
promotes population-level health promotion and disease prevention programmes;
actively targets groups and individuals at high risk, and maximizes population
coverage of effective treatment and care; and
systematically integrates policy and action to reduce inequalities in health.
This approach requires integrated action on risk factors and their underlying
determinants across sectors, combined with strengthening health systems to
improve prevention and control.

14. Noncommunicable diseases/Key facts
Noncommunicable diseases (NCDs) kill 41 million people each year, equivalent to 71%
of all deaths globally.
Each year, more than 15 million people die from a NCD between the ages of 30 and 69
years; 85% of these "premature" deaths occur in low- and middle-income countries.
77% of all NCD deaths are in low- and middle-income countries.
Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually,
followed by cancers (9.3 million), respiratory diseases (4.1 million), and diabetes (1.5
million).
These four groups of diseases account for over 80% of all premature NCD deaths.
Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all
increase the risk of dying from a NCD.
Detection, screening and treatment of NCDs, as well as palliative care, are key
components of the response to NCDs.

15. Noncommunicable diseases
Noncommunicable diseases (NCDs), also known as chronic diseases,
tend to be of long duration and are the result of a combination of
genetic, physiological, environmental and behavioural factors.
The main types of NCD are cardiovascular diseases (such as heart
attacks and stroke), cancers, chronic respiratory diseases (such as
chronic obstructive pulmonary disease and asthma) and diabetes.
NCDs disproportionately affect people in low- and middle-income
countries where more than three quarters of global NCD deaths – 31.4
million – occur.

16. People at risk of NCDs
People of all age groups, regions and countries are affected
by NCDs. These conditions are often associated with older
age groups, but evidence shows that more than 15 million of
all deaths attributed to NCDs occur between the ages of 30
and 69 years. Of these "premature" deaths, 85% are
estimated to occur in low- and middle-income countries.
Children, adults and the elderly are all vulnerable to the risk
factors contributing to NCDs, whether from unhealthy diets,
physical inactivity, exposure to tobacco smoke or the harmful
use of alcohol.

17. Risk of Non communicable disease
These diseases are driven by forces that include rapid
unplanned urbanization, globalization of unhealthy lifestyles
and population ageing. Unhealthy diets and a lack of physical
activity may show up in people as raised blood pressure,
increased blood glucose, elevated blood lipids and obesity.
These are called metabolic risk factors that can lead to
cardiovascular disease, the leading NCD in terms of
premature deaths.

18. Risk factors
Modifiable behavioural risk factors
Modifiable behaviours, such as tobacco use, physical inactivity, unhealthy
diet and the harmful use of alcohol, all increase the risk of NCDs.
Tobacco accounts for over 7.2 million deaths every year (including from
the effects of exposure to second-hand smoke), and is projected to
increase markedly over the coming years .
4.1 million annual deaths have been attributed to excess salt/sodium
intake .
More than half of the 3.3 million annual deaths attributable to alcohol
use are from NCDs, including cancer .
1.6 million deaths annually can be attributed to insufficient physical
activity .

19. Metabolic risk factors of NCDs
Metabolic risk factors contribute to four key metabolic changes that increase the
risk of NCDs:
• raised blood pressure;
• overweight/obesity;
• hyperglycemia (high blood glucose levels); and
• hyperlipidemia (high levels of fat in the blood).
In terms of attributable deaths, the leading metabolic risk factor globally is
elevated blood pressure (to which 19% of global deaths are attributed)(1),
followed by overweight and obesity and raised blood glucose.

20. The socioeconomic impact of NCDs
NCDs threaten progress towards the 2030 Agenda for Sustainable Development,
which includes a target of reducing premature deaths from NCDs by one-third by
2030.
Poverty is closely linked with NCDs. The rapid rise in NCDs is predicted to impede
poverty reduction initiatives in low-income countries, particularly by increasing
household costs associated with health care. Vulnerable and socially disadvantaged
people get sicker and die sooner than people of higher social positions, especially
because they are at greater risk of being exposed to harmful products, such as
tobacco, or unhealthy dietary practices, and have limited access to health services.
In low-resource settings, health-care costs for NCDs quickly drain household
resources. The exorbitant costs of NCDs, including treatment which is often lengthy
and expensive, combined with loss of income, force millions of people into poverty
annually and stifle development.

21. Prevention and control of NCDs
An important way to control NCDs is to focus on reducing the risk
factors associated with these diseases. Low-cost solutions exist for
governments and other stakeholders to reduce the common
modifiable risk factors. Monitoring progress and trends of NCDs and
their risk is important for guiding policy and priorities.
To lessen the impact of NCDs on individuals and society, a
comprehensive approach is needed requiring all sectors, including
health, finance, transport, education, agriculture, planning and
others, to collaborate to reduce the risks associated with NCDs, and to
promote interventions to prevent and control them.

22. Prevention and control of NCDs
Investing in better management of NCDs is critical. Management of NCDs
includes detecting, screening and treating these diseases, and providing
access to palliative care for people in need. High impact essential NCD
interventions can be delivered through a primary health care approach to
strengthen early detection and timely treatment. Evidence shows such
interventions are excellent economic investments because, if provided early
to patients, they can reduce the need for more expensive treatment.
Countries with inadequate health insurance coverage are unlikely to provide
universal access to essential NCD interventions. NCD management
interventions are essential for achieving the global target of a 25% relative
reduction in the risk of premature mortality from NCDs by 2025, and the SDG
target of a one-third reduction in premature deaths from NCDs by 2030.

23. What Is the Burden of Noncommunicable Disease?
Noncommunicable disease represents a wide range of
diseases, from cardiovascular disease, cancers, and
depression, to Alzheimer’s and chronic arthritis. Together,
they represent the majority of causes of death and disability
in most developed countries.
Today, ardiovascular diseases and cancer alone each
represent nearly 25% of the causes of death as reflected on
death certificates in the United States.

24. The impact of noncommunicable diseases on
death
The impact of noncommunicable diseases on death only reflects part of the influence of
these diseases on people’s lives.
Chronic disabilities, largely due to noncommunicable diseases, are now the most rapidly
growing component of morbidity in most developing as well as developed countries.
As populations age, noncommunicable diseases increase in frequency. The presence of
two or more chronic diseases makes progressive disability particularly likely. The
consequences of the rapidly growing pattern of disability due to noncommunicable
diseases have enormous economic implications. The great increase in direct costs for
health care is in part due to the increased burden of noncommunicable diseases.
The impact extends beyond healthcare costs, as it affects the quality of life and may limit
the ability of those who wish to work to continue to do so.

25. approaches to noncommunicable
diseases
There are a wide range of preventive, curative, and rehabilitative
approaches to noncommunicable diseases. However, there are a limited
number of basic strategies being used that are part of the population
health approach, including:
■ Screening for early detection and treatment of
disease
■ Multiple risk factor interventions
■ Identification of cost-effective treatments
■ Genetics counseling and intervention
■ Research

26. How Can Screening for Disease Address the Burden of
Noncommunicable Diseases?
Screening for disease implies the use of tests on individuals
who do not have symptoms of a specific disease. These
individuals are asymptomatic. This implies that they do not
have symptoms related to the disease being investigated.
They may have symptoms of other diseases. Screening for
disease can result in detection of disease at an early stage
under the assumption that early detection will allow for
treatment that will improve outcome.

27. Culture
Culture, in a broad sense, helps people make judgments about the world and decisions about behavior.
Culture defines what is good or bad, and what is healthy or unhealthy. This may relate to lifestyle
patterns, beliefs about risk, and beliefs about body type—for example, a large body type in some
cultures symbolizes health and well-being, not overweight or other negative conditions.
Culture directly affects the daily habits of life.
Food - choice and methods of food preparation and preservation are all affected by culture, as well as
socioeconomic status. The Mediterranean diet, which includes olive oil, seafood, vegetables, nuts, and
fruits, has been shown to have benefits for the heart even when used in countries far removed from the
Mediterranean.
There are often clear-cut negative and/or positive impacts on disability related to cultural traditions as
diverse as feet binding in China and female genital mutilation in some parts of Africa. Some societies
reject strenuous physical activity for those who have the status and wealth to be served by others.

28. Ways that culture may affect health
Culture is related to behavior—social practices may put individuals and groups
at increased or reduced risk
Examples- Food preferences— vegetarian, Mediterranean diet Cooking methods
History of binding of feet in China Female genital mutilation Role of exercise
Culture is related to response to symptoms, such as the level of urgency to
recognize symptoms, seek care, and communicate
symptoms
examlples - Cultural differences in seeking care and self-medication
Social, family, and work structures provide varying degree of social
support—low degree of social support may be associated with reduced health-
related quality of life

29. Culture is related to the types of interventions that are
acceptable
Examples - Variations in degree of acceptance of traditional
Western medicine, including reliance on self-help and
traditional healers.
Culture is related to the response to disease and to
interventions
Examples - Cultural differences in follow-up, adherence to
treatment, and acceptance of adverse outcome

30. Religion
Social factors affecting health include religion along with culture. Religion can have a
major impact on health, particularly for specific practices that are encouraged or
condemned by a particular religious group.
For instance,
we now know that male circumcision reduces susceptibility to HIV/AIDS. Religious
attitudes that condone or condemn the use of condoms, alcohol, and tobacco have
direct and indirect impacts on health as well.
Some religions prohibit specific healing practices, such as blood transfusions or
abortion, or totally reject medical interventions altogether, as is practiced by Christian
Scientists.
Religious individuals may see medical and public health interventions as complementary
to religious practice or may substitute prayer for medical interventions in response to
symptoms of disease.

31. Ways that religion affects health
Religion may affect social practices that put individuals at increased or
reduced risk
Examples- Sexual: circumcision, use of contraceptives Food: avoidance of
seafood, pork, beef Alcohol use: part of religion versus prohibited Tobacco
use: actively discouraged by Mormons and Seventh Day Adventists as part
of their religion.
Religion may affect the response to symptoms.
Examples- Christian Scientists reject medical care as a response to
symptoms
Religion may affect the types of interventions that are acceptable
Examples- Prohibition against blood transfusions Attitudes toward stem cell research
Attitudes toward abortion End-of-life treatments
Religion may affect the response to disease and to interventions
Examples- Role of prayer as an intervention to alter outcome

32. Summary
We have examined a number of ways that the broad social
influences of socioeconomic status, culture, and religion may
affect health and the response to disease.

33. wish you health
thank you for your
attention 