Prevention of Disease-related Mortality from Chronic Non-communicable Diseases

Abstract

The disease-related mortality from chronic non-communicable diseases is an emerging issue of global health in middle to high income countries. Cardiovascular and cerebrovascular diseases, chronic obstructive pulmonary disease, dementia and diabetes mellitus are of special concern. Over time, the major risks undergone transition from the traditional to the modern ones. Although the major health risks are considered global, their geographic variations must be taken seriously into account when planning preventive strategies for specific countries or regions. Original Article Original Articles 29 Clinical Social Work and Health Intervention Vol. 11 No. 2 2020 Introduction: The disease-related mortality accountable to chronic non-communicable diseases (NCD) constitutes an increasing burden for public health, social and financing systems worldwide. If looking at the WHO ranking (2018) of leading 10 death causes (see Figure 1), it is striking that 6 of them belong to non-communicable diseases (ischaemic heart disease, stroke, chronic obstructive pulmonary disease, Alzheimer disease and other dementias, respiratory cancers and diabetes mellitus). Moreover, the top 2 NCD (ischemic heart disease and stroke) are permanent unbeatable leaders of the chart since decades (1-16). Alone cardiovascular diseases killed 17.65 million people in 2015 according to the WHO statistics. The time dynamic of some other NCD over last 15 years shows a remarkable progression however. For instance, deaths from diabetes increased from 1.0 million to 1.6 million and deaths from dementia doubled. The financial impact of NCD is permanently growing on one side and unmasking insufficiency, inefficacy and inequity of most financial schemes on the other side. According to the estimations of World Bank (2019) 20% to 40% of health spending is wasted, whereas the healhtcare spending pushes people into extreme poverty at the same time. (17-25) Chronic Non Communicable diseases All chronic NCD are truly global: they have impact around the entire world and affect countries from high, middle and low income groups. On the same instance they all have known health risks which can be defined as factors that raise the probability of adverse health outcomes. The top 5 worldwide leading health risks are currently high blood pressure, tobacco use, high blood glucose, physical inactivity, overweight and obesity according to the WHO Global Health Risk Report (2009). Considerably enough all of them belong to the so called „modern risks“ as compared to the traditional ones (Figure 2). Apart from inherited genetic/biological constitution there are 4 important sets of determinant conditions (health behavior, clinical care, social and economic factors, physical environment) that influence individual and public health (Figure 3). Each of these four cardinal sets consists of manyfold specific entities which may be addressed by health policies, programs and interventions aimed to improve major health outcomes (length of life and quality of life). Consequently, most of the NCD may be prevented by appropriate prevention methods (5-10). Figure 1. Top 10 diseases attributable to worldwide mortality. 30 Clinical Social Work and Health Intervention Clinical Social Work and Health Intervention Vol. 11 No. 2 2020 Figure 2. The risk transition Figure 3. Sets of preventable health determinants. Original Articles 31 Clinical Social Work and Health Intervention Vol. 11 No. 2 2020 Prevention strategies When it comes to prevention strategies, there is a lot of evidence on their effectiviteness, whether they are striving for lifestyle changes, identifying issues and removing barriers to care or just increasing awareness. The impact level of individual preventive tools may however differ depending on their characteristics. Typically, the global impacts are managed and assessed by renowned international agencies such as WHO, World Bank or CDC. Campaigns at a national level are funded and executed by dedicated state agencies. Table 1 presents an authors overview of internationally proven prevention strategies and their risk influences. Although displaying common global characteristics, there are certain specific differences in NCD resulting from socio-geographic variations of various communities and countries. The most developed countries such as Australia, Germany or United States tend to show higher prevalence of substance abuse with consequent obesity, diabetes, cardiac diseases, cancer and mental health problems, whereas the emerging/developing countries like Mexico, Romania or Brazil suffer from environmental pollutions (unsafe water, indoor smoke, malaria, air pollution, road traffic, lead exposure and others) and low average education level. The underdeveloped countries such as Afghanistan, Chad or Nepal are devastated by health inequality, as well as deficit of knowledge and services (Brown 1966, Orach 2009). Improved sanitation may serve as a demonstration of progress in some developing countries (Gutiérrez 2015) over last 25 years (Figure 4). An example of structurally elaborated preventive actions against cardiovascular recurrence and mortality is shown on Figure 5 As clearly depicted, the means of primordial prevention are complemented by targeted interventions within realms of primary and secondary prevention.