Noncommunicable diseases and disability case study

Noncommunicable diseases (NCDs) are a group of conditions characterized by the fact that they cannot be transmitted from person to person. In this step Antony Duttine from LSHTM and Pan American Health Organization/World Health Organization looks at how the rising trend of NCDs is impacting global health and disability, and the implications for the health sector in responding to those people living with NCDs.

Overview

Noncommunicable diseases (NCDs) include health conditions such as diabetes, heart disease, depression, arthritis, skin disorders such as psoriasis, dementia, cancer and asthma. Together they are easily the most common health conditions that occur globally and they are responsible for almost three quarters of all deaths (72%) worldwide.

Given NCDs tend to affect and kill people later in life, they have received less attention within the global health agenda than those health conditions that affect people earlier, such as HIV, malaria and maternal health.

Using GBD data, we can see below that while NCDs are responsible for 72% of all deaths, they only account for just over half of all year lives lost (YLLs), a measure used to factor in the age of death by calculated by subtracting the age at death from the longest possible life expectancy for a person at that age.

However, when we look at the Years Lived with Disability (YLDs), a measure that takes into account the impact that living with a health condition has, NCDs are responsible for over 80%.

In essence, we are seeing a growing trend in health across the world so that people are living longer lives but experiencing a wider range of health conditions that impact on function and quality of life, in other words, causing disabilities. This trend is also true in countries with the lowest socio-demographic indexes (SDI). The GBD measures show that whilst communicable, nutritional, neonatal and perinatal disorders still dominate deaths and YLLs, there is a growth in NCDs and even in these countries, 68% of years lived with disability are NCD related.

Since 2011 NCDs have become more and more recognized as a global challenge within the health sector. However, the global response has been largely focused on the four conditions that cause the most deaths – heart disease, cancer, diabetes and respiratory illness – and the four main risk factors associated with these conditions – tobacco, alcohol, diet and physical inactivity. Therefore, the strategy for tackling NCDs has been almost completely concentrated on prevention.

The health sector response

The reality facing health systems is that people are already experiencing NCDs and many cannot be fully prevented. As such, services like rehabilitation, which focusses on optimising functioning and reducing disability, are becoming more and more needed.

Rehabilitation can be defined as a set of interventions designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment. Rehabilitation services may support people with both short and long term NCDs and may be preventative, curative or palliative. For example, someone with a sudden episode of lower back pain, may benefit from a short course of rehabilitation, such as physiotherapy, which helps to achieve a full recovery and prevention of future episodes. Additional short and long term examples of rehabilitation support for NCDs include:

• Foot management and care for people living with diabetes who can experience neuropathy and peripheral vascular disease.
• Psychosocial rehabilitation for a person experiencing depression.
• Provision of assistive devices such as for a person who has mobility and cognitive difficulties following a stroke.
• Communication support for a person who has age related hearing loss.

NCDs amongst people with disabilities

So far, we have considered how NCDs may cause disability and how rehabilitation plays an important role in optimizing function for those who have an NCD. However, it is also important to consider the prevalence of people with disabilities who experience an NCD. Several studies indicate that people with disabilities may have a higher prevalence of NCD related risk factors compared to those without disabilities. According to the Center for Disease Control in the US, the obesity prevalence for adults with disabilities in the US is 36% compared to 23% for those without disabilities; the smoking prevalence is 25% compared to 17% and the percentage of women with disabilities receiving a mammogram over the past two years is 61% compared to 75%.

If targets for reducing NCD risk factors across a population are going to be achieved, it is vital to ensure that health promotion initiatives and campaigns can be accessed by persons with disabilities. This may mean giving consideration to accessibility, educational materials, language and other factors to ensure the inclusion of people with disabilities in NCD health programming.