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The convergence of non-communicable diseases (NCDs) and infectious diseases (IDs) in low- and middle-income countries presents major challenges to the world’s poorest and most neglected groups of people. NCDs continue to escalate and cause hundreds of billions of dollars of loss annually despite aggressive lifestyle campaigns.
A NCD is a medical condition or disease that is non-infectious and non-transmissible amongst people. NCDs may be chronic diseases of long duration and slow progression, or they may result in more rapid death such as some types stroke and heart attacks. Unknowingly to most, NCDs also include autoimmune diseases, many cancers, asthma, diabetes, chronic kidney disease and many more.
Most Low- to middle income countries has dual disease burdens of NCDs and IDs including tuberculosis, HIV/AIDS and parasitic diseases. Unfortunately, experts, institutions and policies that support prevention and control of these two overarching disease categories have very limited interaction and alignment of strategies.
NCDs and IDs share many common features, such as long-term care needs as well as evidence of increased susceptibility to IDs in individuals with NCDs.
The attention to the NCDs driven by tobacco, alcohol, overweight and lack of physical activity is limited and should be expanded to include those risk factors and diseases that disproportionately affect the poorest populations in the world.
The four lifestyle risk factors and their associated diseases largely ignore the most vulnerable victims of NCDs: the very poor, children and pregnant women.
If we do not address endemic NCDs and their risk factors, children and young adults will continue to suffer from conditions such as rheumatic heart disease. They will likely suffer from conditions such as Burkitt’s lymphoma, breast cancer, treatable leukemias and lymphomas, sick-cell anemia, Type 1 diabetes, asthma, epilepsy and schizophrenia.
Similarly, pregnant women will continue to suffer from heart disease and maternal diabetes that can lead to death during or after pregnancy. The health of the mother often creates long-term health risks for the child as well.
Taken together, these endemic NCDs account for around 20 percent of the disease burden among the world’s poorest billion. We cannot ignore the problems of this vulnerable population according to Harvard Medical School and Partners In Health.
“Efforts to develop a common understanding of NCDs and their risk factors have not focused sufficiently on the extreme poor," says Dr. Gene Bukhman, Director of Program in Global NCD’s and Social Change.
The greatest risk factors for dying of NCDs are complications with infectious diseases such as HIV, TB, Malaria, Streptococcus, HPV, HBV and Rubella. Significant concerns continue to rise in regard to pollution and a toxic environment in the household air, food insecurity, clean water and the adverse effects of rapid urbanization and population overcrowding.
Investments in health systems should not be limited to a few endemic NCDs, but rather should build upon integrated platforms of care that addresses clusters of related conditions whenever possible.
We must focus on vulnerable populations where IDs and NCDs are endemic by strengthening social protections and improving access to NCD and ID health services, screening, treatment programmes and the overall assessment of their impact.
Dr Cory Couillard is an international health columnist that works in collaboration with the World Health Organization's goals of disease prevention and global health care education. Views do not necessarily reflect endorsement.
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