Noncommunicable Disease Risk Factors in Developing Countries: Policy Perspectives

Following advances in infectious disease control, noncommunicable diseases (NCDs) have overtaken other conditions as causes of premature death and disability in lower-income nations.The largest portion of the NCD burden in low-and middle-income countries (LMICs) is represented by cardiovascular diseases (CVD), followed by cancer, diabetes and chronic respiratory disease (World Health Organization, 2016).Although NCDs are often considered to be diseases of ageing, the NCD crisis in developing countries does not appear to be explained solely by longer life spans; the growth in NCD deaths and disability in these countries has occurred at a faster rate than the contemporaneous decline in communicable diseases (Stuckler, 2008).Specific circumstances that worsen NCD outcomes in LMICs relative to high-income countries are the timing of disease onset and the level of treatment after onset.NCDs in LMICs tend to occur earlier in life (WHO, 2016; (Institute for Health Metrics and Evaluation, 2013)), and may not receive adequate treatment once they occur (Cameron et al., 2011).Health systems in LMICs may not be equipped to address the needs of the chronically ill, and long-term treatment may not be accessible.This adverse combination of factors results in NCD outcomes that have broad societal, economic, and health security consequences in developing countries.Recognizing the role of NCDs as an impediment to international development, the 2030 Agenda for Sustainable Development has identified the reduction in premature NCD mortality among its primary targets (United Nations, 2015).It is not merely NCD mortality but the disproportionate prematurity of NCDs that has come to define NCD-related disparities in LMICs.In contrast to high-income countries, the majority of NCD deaths in developing countries occur before age 70 (WHO, 2016).The proportion of NCD mortality presenting in persons younger than 60 is 44% in low-income countriesnearly quadruple the rate of 12% in high-income countries (WHO, 2016).The prematurity of NCD complications in developing countries may contribute to perpetuating the cycle of poverty at the individual level, and to impeding economic development at the macro level (Bloom et al., 2011).Inadequate attention to NCDs in LMICs may further compound the negative effects of communicable illnesses, in clinical as well as economic ways.From a clinical perspective, NCDs and NCD risk factors have been shown to interfere with infectious disease control by increasing susceptibility to certain infections (Bagaitkar et al., 2008); (Remais et al., 2013); (Crevel et al., 2017).From an economic perspective, the added strain on health systems from rising and poorly controlled chronic illnesses (Heymann et al., 2015) can crowd out resources for dealing with existing and/or emerging infections.The worldwide epidemiological shift from infectious diseases to NCDs has increased the relevance of NCD initiatives to global health security.As the provision of NCD services becomes a foundational component of health delivery systems, global health security elements such as emergency outbreak response can be contingent on NCD-based health infrastructure.Efforts to control communicable diseases and NCDs in developing countries intersect by sharing health systems, risk factors, and target populations; recognizing the significance of these overlaps can increase the efficiency of efforts to improve health security globally (Kostova et al., 2017).A critical approach for addressing NCDs, particularly in LMICs with limited clinical capacity, is NCD prevention through policies that reduce unhealthy behaviors and risk factors such as tobacco use and obesity.Since tobacco use is implicated in all leading NCDs including CVD, cancer, and pulmonary disease, population-level strategies to discourage this behavior are top priorities for public health policy.Such strategies include tobacco taxes high enough to increase prices, regulatory measures including smoke-free public places, compelling anti-tobacco messaging, and marketing restrictions.Increasing the prices of tobacco products through taxation is the least costly and most cost-effective tobacco use intervention in LMICs (Asaria et al., 2007); (U.S. National Cancer Institute and World Health Organization, 2016).The demonstrated success of tobacco taxes in reducing consumption across multiple geographies has helped tobacco tax policy become a key approach to NCD risk prevention.