The Drum Beat 170: Non-communicable Diseases - Risk Factors and Communication
***
NON-COMMUNICABLE DISEASES
The search for effective responses to health issues has predominantly focused on medical interventions. Increasingly, as issues of social norms, individual behaviours, societal and cultural environments are linked to health status across the spectrum of health issues, communication strategies and action are required as core components of any effective health initiative. This clearly applies to non-communicable diseases. The World Health Report 2002 (WHR 2002), discusses the latest evidence on risks to public health, how these risks are perceived, measured and communicated and explores solutions available to governments and others to reduce and prevent these risks. It highlights the growing recognition for greater international cooperation in the design of comparable indicators and in standardizing the measurement and assessment of risk factors.
This Drum Beat, based on the WHR 2002, examines which risk factors are the most prevalent in the world today as concerns Non-communicable Diseases, how people understand these risks to their health and how the public health community approaches concepts of risk and works to reduce and prevent them.
RISK
Risk, as discussed in the WHR 2002, is a probability of an adverse outcome, or a factor that raises this probability. The WHR 2002 focuses on the 10 risks that cause the most damage to health, in terms of death and disability. They are: undernutrition, unsafe sex, high blood pressure, tobacco consumption, alcohol consumption, unsafe water, sanitation and hygiene, iron deficiency, indoor smoke from solid fuels, high cholesterol, and overweight and obesity.
Levels of risk for NCDs involve people's patterns of behaviour, determined by the interplay between personal characteristics, social interactions and many environmental factors. Individual behaviour is only part of the problem. The WHR 2002 points out that poverty, violence, rapid social and economic changes, lack of education, inadequate or total absence of health services contribute as much to the increasing cases of NCDs as they do to AIDS, malaria and tuberculosis. This shift reflects a significant change in diet habits, physical activity levels, and tobacco consumption worldwide as a result of industrialisation, urbanisation, economic development and food market globalisation. Click here for further details.
All of the following risk factors - blood pressure, cholesterol, tobacco, alcohol, obesity and the diseases linked to them - are well known to wealthy societies. The real drama is that they now also dominate in low mortality developing countries where they create a double burden on top of infectious diseases that have always afflicted poorer countries.
Click here for further details.
While a list that outlines the top 10 risk factors may seem straightforward, the fact is that the risk story is very complicated.... [these risks] rarely manifest themselves individually. Their effects are compounded and become even more lethal...when an individual or a community is exposed to several risks together. Click here for further details.
Another issue that must be taken into consideration is how the public perceives risks. Social, cultural and economic factors are central to how individuals perceive every aspect of their world-including the risks to their health. By the same token, it would be irresponsible to presume that the countless diverse groups that make up a given community or population might understand the risks that surround them in the same way, or more importantly, that they might share the same views about risk with health practitioners or public health professionals.
A number of contemporary trends greatly influence the existence of risks to health in the modern world, and how they are perceived. Global debates sparked by the power and influence of special interest groups associated with corporate, often multinational, business interests and the juxtaposed efforts of many advocacy coalitions and public health groups to educate and promote policies that prioritise the public good have become central to any serious consideration of public health policy. Parallel to this phenomenon, the ever-growing power and reach of mass media and new forms of communication have created a platform for messages of all types to be transmitted in a way rarely witnessed before.
Click here for further details.
The impact of these risks can be reversed quickly, and most benefits will accrue within a decade.... Even modest changes in risk factor levels could bring about large benefits, if they are population-wide, and clusters of related major risks are addressed simultaneously. Among some developing countries, a healthy life expectancy of 10 years could be gained by tackling leading risks to health.
Click here for further details.
The WHR 2002 explains that in constructing health policies for the prevention of well-known risks, choices need to be made between different strategies. For instance, will preventing small risks in large populations avoid more adverse health outcomes than avoiding large risks in a smaller number of high risk individuals? What priority should be given to cost-effective interventions for primary rather than secondary prevention, such as lowering blood pressure distribution by reducing salt intake compared to treatment of people with high blood pressure? For example, policy-makers might need to analyse cost-effectiveness of lowering the blood pressure distribution of the whole population through reducing salt intake versus pharmacological treatment of high risk individuals only. Or the value of lowering cardiovascular risk by promoting healthy diets and physical activity through policy interventions compared to expensive bypass surgery....
Decisions also have to be made with regard to comprehensive risk factor approaches that address tobacco use, diet, physical inactivity, high blood pressure, and high blood cholesterol together; as opposed to single risk factor interventions (treating blood pressure or cholesterol alone) as the latter is much less effective both in terms of costs and outcomes.
Click here for further details.
Advocacy for healthy public policy frames the issues and creates public support for action. Patients need knowledge, motivation, and skills to stop using tobacco products, to eat a proper diet, and to engage in regular physical activity. Prevention and health promotion should be part of every visit to health care service providers.
Beyond interventions and policies, the WHR 2002 underscores the need for trust in order to reduce risks - trust in sources of information, and trust in the information itself. Governments and public agencies are often tempted to present simplified explanations. Political credibility and public trust are rapidly lost if the public believes it has not been given the full information on the risks that affect them.
Click here for further details.
UNDERNUTRITION
Underweight and malnutrition is one of the 10 highest risk factors for death in both high and low mortality developing countries. Click here for further details.
- Women's Health, Child Health and Nutrition Clinic - South Africa
- Programa de Comunicación en Salud Infantil (COMSAIN) - Honduras
HIGH BLOOD PRESSURE & CHOLESTEROL
There are about 600 million people with high blood pressure in the world. Most of them are unaware and undiagnosed. High blood pressure and cholesterol are major risk factors of cardiovascular disease (CVD). Click here for further details.
TOBACCO CONSUMPTION
Tobacco use kills 4.2 million people every year. This figure has nearly doubled in the last ten years and it is estimated to reach 8.4 million by 2020 if action is not taken now to curb the tobacco epidemic. 479 deaths per hour, or one every 7.5 seconds, are from cardiovascular disease, chronic respiratory disease, cancer and other diseases caused by tobacco consumption. Click here for further details.
- Tobacco on Trial - A BBC Project - Global
- Asian and Pacific Islander Tobacco Education Network - Oceania and South East Asia
- Smoking Prevention Campaign - Egypt
ALCOHOL CONSUMPTION
Alcohol causes 1.7 million deaths and 56 million disability-adjusted life years lost a year. It is estimated that alcohol causes 20-30% of oesophageal cancer, liver cancer, cirrhosis of the liver, homicide, epilepsy, motor vehicle accidents.... Click here for further details.
- Project HOPE and Substance Abuse - Moscow
- Impact Data - A Case Study of the Self Employed Women's Association - Gujarat, India
UNSAFE WATER, SANITATION, AND HYGIENE
About 1.7 million deaths a year worldwide are attributed to unsafe water, sanitation and hygiene, mainly through infectious diarrhoea. 9 out of 10 such deaths are in children, and virtually all of the deaths are in developing countries. WHR 2002 Overview [PDF] - pg 8.
IRON DEFICIENCY
Iron deficiency affects an estimated 2 billion people, and causes almost a million deaths a year. Young children and their mothers are the most commonly and severely affected. WHR 2002 Overview [PDF] - pg 8.
INDOOR SMOKE FROM SOLID FUELS
Half the world?s population is exposed to indoor air pollution, mainly the result of burning solid fuels for cooking and heating. Globally, it is estimated to cause 36% of all lower respiratory infections and 22% of chronic obstructive pulmonary disease. WHR 2002 Overview [PDF] - pg 8.
OBESITY/OVERWEIGHT
Overweight and obesity raise the risk of Cardiovascular Disease, as well as diabetes and many cancers. Obesity has also been associated with asthma and impaired lower lung function. Click here for further details.
***
Click here for The World Health Report 2002.
***
The Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.
Please send material for The Drum Beat to the Editor - Deborah Heimann dheimann@comminit.com
To reproduce any portion of The Drum Beat, see our policy.
To subscribe, click here.
Comments
- Log in to post comments