How to deal with the global spread of chronic disease

As delegates gather for the World Health Summit in Berlin, attention is rightly focused on an accelerating global challenge that some experts see as a slow-motion pandemic: the spread of non-communicable diseases (NCDs) across low- and middle-income countries.

On a recent trip to Vietnam I was confronted by numerous people who personify the scale of the challenge. Take Gian Cho De. A routine check may well have saved this 77-year-old Vietnamese pensioner. He recently trekked six miles to a community clinic for treatment of a minor ailment. While he was there, a standard test revealed dangerously high blood pressure and a significant risk of a heart attack or stroke.

Gian now benefits from regular check-ups and medical advice to help him improve his diet and lifestyle so he can control his blood pressure. In rural north-west Vietnam, the rudimentary healthcare system is fighting to address a big increase in patients like Gian who suffer from NCDs.

The problem goes beyond Vietnam, of course. Once the preserve of wealthy countries, doctors throughout Latin America, Africa and South-East Asia are now seeing greater numbers of people with hypertension, diabetes, cancer and other chronic diseases.

Chronic diseases account for almost two-thirds of all deaths worldwide – and 80% of these now occur in low- and middle-income countries, according to a World Health Organization (WHO) report. By 2030, more people in these countries will die from heart attacks and strokes than from infectious diseases, the organization predicts. For countries still struggling to control infectious diseases such as malaria, tuberculosis and HIV/AIDS, the rise of chronic diseases represents a double burden.

The rise of chronic diseases also has economic implications. Chronic illnesses cause billions of dollars of lost national income, and push millions of people below the poverty line every year as their health problems affect their ability to work and add new costs to already tight household budgets. Although some governments and international organizations are aware of the scale of the problem, it is still below the radar in many emerging economies because they have other pressing problems.

The rise of chronic diseases is linked to some positive trends in society: better nutrition, improved hygiene and progress in tackling communicable diseases means people are living longer and therefore developing diseases of older age. Other reasons are less positive. Rapid urbanization, for example, following economic growth leads to changing diets and more sedentary lifestyles. Many people in low- and middle-income countries face difficulties gaining access to diagnosis and high-quality treatment.

One obstacle to access is the lack of qualified doctors and nurses, who play a vital role in bringing basic care to patients at the community level, especially in rural areas. Even where healthcare workers are present, they often lack the know-how to diagnose or treat complex diseases and specialists are few and far between. Ethiopia, for instance, has a population of about 97 million, but just six endocrinologists and four oncologists.

Social factors can also play a role. In remote areas people often rely first on traditional medicine until illnesses become acute. Ignorance, embarrassment and the stigma attached to diseases such as cancer can also keep people from seeking medical help. And cost is also a big factor because a doctor’s visit means time off work. Long-term treatment, even when it is available, is also expensive.

A 2014 Economist Intelligence Unit report on Non-communicable disease in sub-Saharan Africa found the cost of treating a chronic medical problem amounted to 29% of the average annual income.

Some countries are finding creative, pragmatic ways to address these challenges. Efforts to address chronic disease early are beginning to have an impact; policies targeted at improving access to primary care are making progress. This includes training more community healthcare workers. Hundreds of thousands have fanned out into rural areas in Zambia, Kenya, Ethiopia and elsewhere.

In Rwanda alone, more than 45,000 trained health workers offer basic treatments and refer patients to doctors as part of a dramatic expansion of healthcare provision. The biggest gains in reducing deaths will likely come from prevention and by educating people about the importance of healthier lifestyles and eating habits. The government is campaigning about the risks of poor diet, physical inactivity, excessive alcohol and tobacco consumption.

This systematic approach works. Lawmakers in Rwanda recognize that making progress in tackling chronic disease is fast becoming as important a challenge as it was to combat communicable disease.

In Vietnam too, efforts at the community level extol the virtues of healthy living and better health awareness. Widespread monitoring includes identifying patients at risk of developing diabetes or hypertension and treatment for those with symptoms. Recruitment of more doctors, training of healthcare workers and the creation of better healthcare infrastructure all helps to expand the availability and quality of screening and diagnostic services. Other measures will help build more effective distribution systems and in time widen patient access to high quality medicines.

These and other experiences can serve as examples for lawmakers, healthcare providers and others looking at how to counter the spread of chronic disease.

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Author: Dr. Harald Nusser, Global Head Novartis Access

Image: Client Julius Wayne Dudley (L) reacts as volunteer Jeffrey Pierre-Paul picks his finger for a cholesterol test in the Family Van in Boston, Massachusetts August 9, 2010. REUTERS/Brian Snyder