Noncommunicable diseases


Key facts

  • Noncommunicable diseases (NCDs) kill 40 million people each year, equivalent to 70% of all deaths globally.
  • Each year, 15 million people die from a NCD between the ages of 30 and 69 years; over 80% of these “premature” deaths occur in low- and middle-income countries.
  • Cardiovascular diseases account for most NCD deaths, or 17.7 million people annually, followed by cancers (8.8 million), respiratory diseases (3.9million), and diabetes (1.6 million).
  • These 4 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.

Overview

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 behaviours factors.

The main types of NCDs are cardiovascular diseases (like 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 million – occur.

Who is at risk of such diseases?

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 15 million of all deaths attributed to NCDs occur between the ages of 30 and 69 years. Of these “premature” deaths, over 80% 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.

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.

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 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. (1)
  • 4.1 million annual deaths have been attributed to excess salt/sodium intake. (1)
  • More than half of the 3.3 million annual deaths attributable to alcohol use are from NCDs, including cancer. (2)
  • 1.6 million deaths annually can be attributed to insufficient physical activity. (1)

Metabolic risk factors

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.

What are the socioeconomic impacts 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 often lengthy and expensive treatment and loss of breadwinners, force millions of people into poverty annually and stifle development.

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 promote interventions to prevent and control them.

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.

WHO response

WHO’s leadership and coordination role

The 2030 Agenda for Sustainable Development recognizes NCDs as a major challenge for sustainable development. As part of the Agenda, Heads of State and Government committed to develop ambitious national responses, by 2030, to reduce by one-third premature mortality from NCDs through prevention and treatment (SDG target 3.4). This target comes from the High-level Meetings of the UN General Assembly on NCDs in 2011 and 2014, which reaffirmed WHO’s leadership and coordination role in promoting and monitoring global action against NCDs. The UN General Assembly will convene a third High-level Meeting on NCDs in 2018 to review progress and forge consensus on the road ahead covering the period 2018-2030.

To support countries in their national efforts, WHO developed a Global action plan for the prevention and control of NCDs 2013-2020, which includes nine global targets that have the greatest impact on global NCD mortality. These targets address prevention and management of NCDs.


References

(1) GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016; 388(10053):1659-1724

 

MIT Team Develops Urine Test for Cancer.


  • Scientists at MIT say they have developed a simple, cheap paper test that could be used to improve cancerdiagnosis rates and help people get treated earlier. The diagnostic, which works much like a pregnancy test, reportedly could reveal within minutes, based on a urine sample, whether a person has cancer. This approach has helped detect infectious diseases, and the new technology allows noncommunicable diseases to be detected using the same strategy.

    MIT Team Develops Urine Test for Cancer

    The technique, developed by MIT professor and Howard Hughes Medical Institute investigator Sangeeta Bhatia, Ph.D., relies on nanoparticles that interact with tumor proteases, each of which can trigger release of hundreds of biomarkers that are then detectable in a patient’s urine.

    “When we invented this new class of synthetic biomarker, we used a highly specialized instrument to do the analysis,” said Dr. Bhatia. “For the developing world, we thought it would be exciting to adapt it instead to a paper test that could be performed on unprocessed samples in a rural setting, without the need for any specialized equipment. The simple readout could even be transmitted to a remote caregiver by a picture on a mobile phone.”

    Dr. Bhatia, who is also a member of MIT’s Koch Institute for Integrative Cancer Research and Institute for Medical Engineering and Science, is the senior author of a paper (“Point-of-care diagnostics for noncommunicable diseases using synthetic urinary biomarkers and paper microfluidics”) describing the particles in Proceedings of the National Academy of Sciences.

    In 2012, Dr. Bhatia and colleagues introduced the concept of a synthetic biomarker technology to amplify signals from tumor proteins that would be hard to detect on their own. These proteins, known as matrix metalloproteinases (MMPs), help cancer cells escape their original locations by cutting through proteins of the extracellular matrix, which normally holds cells in place.

    The MIT nanoparticles are coated with peptides targeted by different MMPs. These particles congregate at tumor sites, where MMPs cleave hundreds of peptides, which accumulate in the kidneys and are excreted in the urine.

    In the original version of the technology, these peptides were detected using a mass spectrometer. However, these instruments are not readily available in the developing world, so the researchers adapted the particles so they could be analyzed on paper, using a lateral flow assay.

    “We describe the design of exogenous agents that serve as synthetic biomarkers for NCDs [noncommunicable diseases] by producing urinary signals that can be quantified by a companion paper test. These synthetic biomarkers are composed of nanoparticles conjugated to ligand-encoded reporters via protease-sensitive peptide substrates,” wrote the investigators. “Upon delivery, the nanoparticles passively target diseased sites…where up-regulated proteases cleave the peptide substrates and release reporters that are cleared into urine. The reporters are engineered for detection by sandwich immunoassays, and we demonstrate their quantification directly from unmodified urine.”

    In tests in mice, the researchers were able to accurately identify colon tumors as well as blood clots. Dr. Bhatia says these tests represent the first step toward a diagnostic device that could someday be useful in human patients.