INFECTIOUS diseases have been a scourge for a long time. That is why so many resources have been devoted to malaria, TB, AIDS and other infectious-disease-

control programmes. This approach yielded positive results, but now, the burden is shifting from infectious to non-communicable diseases, a new scourge in public health. NCDs covering heart disease, chronic respiratory illnesses, cancers, diabetes and mental health conditions are now a major cause of mortality in the developing world.

While in 1990, infectious diseases accounted for more than 50 per cent of the deaths in the developing world, in 2000 it was NCDs that were responsible for 57pc of deaths. According to current trends, deaths from NCDs are set to rise to 70pc by the year 2020.

Deaths from non-infectious diseases are set to rise.

Non-communicable disease is a long-term condition of gradual onset, exacting a huge toll in terms of deteriorating body functions and disability and fatalities. Because of the long-term nature of NCDs and the associated treatment cost, both patients and healthcare systems face enormous financial pressure. In the EU, healthcare costs associated with chronic disease have been calculated at €700 billion. Not surprisingly, the 2017 European public health conference organised in Stockholm devoted a considerable portion of its deliberations to the growing burden of NCD in Europe and beyond.

Pakistan is no exception. Like other developing countries, it faces the double burden of both transmissible diseases and NCDs according to the WHO 2014 country profile. The profile estimates 25.3pc individuals with high blood pressure, 19pc suffering from cardiovascular disease, 3pc with diabetes, 6pc with chronic respiratory disease, and 8pc with cancers. In addition, every fourth adult is either obese or overweight. The projected number of premature deaths from NCDs between 2010 and 2025 was put at some 3.87 million lives between the ages of 30 and 69 years. The same study calculates the NCD-associated economic burden rising from $152m in 2010 to $296m in 2025.

However, despite the worrying growth in NCDs, the official response has been fitful and slow. Pakistan began well in 2004 with the formulation of a national action plan on NCDs. Yet not much progress seems to have been made since then. WHO has issued guidelines and activated member states to commit to national action plans and targets on NCDs.

In 2017, the WHO progress report has found Pakistan wanting in the setting of national NCD targets, the collection of mortality data, the formulation of an integrated NCD strategy, coherent policy formulation on tobacco taxation, advertising and promotion, and unhealthy salt- and sugar-reduction measures alongside the lack of promotion of physical activity. The progress report also notes another 25pc of the population at an increased risk of premature death due to NCDs.

Clearly, Pakistan can ill afford to ignore the NCD scourge and its societal and economic costs to health systems and the population. NCD prevention and control measures should start with prevention, detection, and treatment. The key to NCD prevention and control is a well-functioning primary healthcare system. This calls for sustained effort at improving the quality and delivery of primary healthcare systems to prevent or detect NCDs at an early stage. Prevention strategies need to focus on larger health policies that focus on physical activity, salt and sugar restriction, and mental health and wellness.

On the treatment front, the cost of medicines is a huge barrier. In Kenya, the government, in partnership with the pharmaceutical industry, has been engaged in making sure medicines are provided to patients at a cost as low as one dollar a month. Punjab has also signed a similar MoU with a pharmaceutical company to replicate this model. Many such partnerships with other provincial governments are reportedly in the works.

In terms of policy, the focus must shift from curative to primary care and prevention which are key to tackling the NCD epidemic. In Western countries, the shift of focus to health and wellbeing strategies has not only helped prevent but also delay the onset of NCDs. Physical activity and childhood obesity are being tackled through health promotion and education strategies. Other interventions instituted are legally enforceable salt and sugar restriction measures. In China, a national salt-reduction programme has proved helpful in reducing the burden of NCDs.

Similarly, the sugar tax imposed on sweet beverages in Mexico is being billed as a successful NCD-control measure. Tobacco taxation has been a known policy instrument to control smoking. And diabetes prevention and control should be a key plank of policy. One paper has advocated the formation of the provincial commission for the prevention and control of NCDs which is a positive and integrated way forward.

The writer is a public health and development consultant.
drarifazad@gmail.com
Twitter@arifazad5

Published in Dawn, December 11th, 2017