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Our view

Trapped in a vicious cycle

by Hans Dembowski


Fast food vendor in Nicaragua.

Fast food vendor in Nicaragua.

For a long time, non-communicable diseases (NCDs), the most important of which are chronic, were considered to be diseases of the better off. The poor were not much affected by hypertension, diabetes and cancer. To put it crudely, they died too early to worry much about NCDs. Their problem was that they did not get enough food, not that they were eating unhealthy products.

That was then. Life expectancy has risen in most places. Internationally, the number of people who are overweight is now twice as high as the number of those with insufficient calorie intake. Development has resulted in people living longer lives, and one implication is that chronic NCDs have become more common. Humans are mortal. If infectious diseases, violence or accidents do not kill us, an NCD will eventually cause our death. Blood pressure and blood-sugar levels tend to increase with age, and accordingly strokes, heart attacks, kidney failures and other terminal crises become more likely. Cancer becomes more likely with age as well. (Some kinds of cancer are infectious, but it often becomes chronic and requires long-term management.)

Unfortunately, masses of people get ill far too early in life. Ageing is not the only cause of NCDs spreading. Another one is that major food corporations are promoting unhealthy products. Moreover, air pollution makes respiratory illnesses more likely.  NCDs are complex conditions. Over-simplification must be avoided, but it is true that the main drivers of the NCD plague include:

  • food that contains too much fat, sugar and/or salt,
  • the consumption of tobacco, alcohol and other stimulants,
  • lack of physical exercise and
  • stress, time pressure and lack of rest.

If an NCD is managed well, patients normally do not suffer devastating consequences for a long time. Even most kinds of cancer can be kept in check. The problem is that the majority of people living with an NCD today belong to low-income groups. Most are not in a position to manage their health issues well for the rest of their lives. All too many lack access to professional health care. And even if they are diagnosed, they probably cannot afford all relevant medications and treatments. Families are overburdened, especially as an unchecked NCD reduces a patient’s ability to work and earn money.

Health has socio-economic aspects, and poor patients get stuck in vicious cycles of deprivation. They lack information, services and resources. Knowing they are unlikely to get the support they need, many do not even want to be diagnosed, so their health deteriorates faster than it has to. Steps to contain the problem early on are much cheaper than interventions at later stages. For good reason, the NCDs are on the agenda of the Sustainable Development Goals. Relevant targets include reducing premature mortality from NCDs by one third by 2030, making relevant NCD medication affordable and accessible and achieving universal health coverage. These things are indeed vital issues for fighting poverty and making societies more inclusive.

Personal behaviour matters too, however. NCD patients should exercise regularly and adopt healthy diets. However, sensible lifestyle is not only an issue of personal discipline, but of money too. Gym memberships are expensive. In urban settings, traffic and air pollutions keep people from exercising outside. Many hard-working and time-stressed urban people, moreover, find fast food is affordable – but not restaurants that serve healthy food.

Hans Dembowski is editor in chief of D+C Development and Cooperation / E+Z Entwicklung und Zusammenarbeit.
[email protected]

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