THE Philippines should act with agility and sense of urgency to address the onslaught of noncommunicable diseases , now at epidemic proportions.

Cardiovascular diseases have remained the primary cause of death in the Philippines and globally, according to the Philippine Statistics Authority data in 2023.

Overview

Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors.

The main types of NCD are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.

NCDs disproportionately affect people in low- and middle-income countries, where more than three quarters of global NCD deaths (31.4 million) occur.

World Health Organization Data on NCDs

Noncommunicable diseases (NCDs) kill 41 million people each year, equivalent to 74% of all deaths globally.

Each year, 17 million people die from a NCD before age 70; 86% of these premature deaths occur in low- and middle-income countries.

Of all NCD deaths, 77% are in low- and middle-income countries.

Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.3 million), chronic respiratory diseases (4.1 million), and diabetes (2.0 million including kidney disease deaths caused by diabetes).

These four groups of diseases account for over 80% of all premature NCD deaths.

Tobacco use, physical inactivity, the harmful use of alcohol, unhealthy diets and air pollution all increase the risk of dying from an NCD.

Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs.

Philippine Heart Association Report

The PHA also underscored “living a stress-free life and healthy lifestyle” as well as adhering to the PHA lifestyle code of 52100 or five servings of vegetables/fruits daily; not more than two grams of sodium daily; one hour of physical activity daily; zero sugared beverage; and zero smoking.

It also stressed that CVD is preventable “as long as you stick to 52100,” avoiding too much stress, and avoiding alcohol abuse.

“Early detection is also important along with counselling, management, and proper medication,” the PHA added.

What are CVDs?

A group of disorders of the heart and blood vessels, CVDs include coronary heart disease, a disease of the blood vessels supplying the heart muscle; cerebrovascular disease, a disease of the blood vessels supplying the brain; peripheral arterial disease, a disease of blood vessels supplying the arms and legs; rheumatic heart disease, damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria; congenital heart disease – birth defects that affect the normal development and functioning of the heart caused by malformations of the heart structure from birth; and deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Heart attacks and strokes, meanwhile, are usually acute events that are mainly caused by a blockage that prevents blood from flowing to the heart or brain.

The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain.

“Strokes can be caused by bleeding from a blood vessel in the brain or from blood clots,” it added.

Detecting CVDs

Chest pain is one of the most common reasons people visit the emergency rooms or consult their physicians, the PHA noted.

Pain may feel like a sharp, stabbing pain or dull ache.

“More often than not, people seek medical help only because of physical pain, such as chest pain. Still, some dismiss it as simple pain that may be caused by lifting heavy weights, anxiety, trauma to the chest, flatulence, and heartburn,” the PHA said.

However, the PHA noted, that not all CVDs exhibit physical symptoms and even chest pain.

“That’s why it is important that a healthcare provider, the cardiologist, could test, treat, or help every individual prevent a number of cardiovascular problems,” the PHA stressed.

“After all, a cardiologist is a physician who’s an expert in the care of your heart and blood vessels. They can also specialize in specific areas, such as abnormal heart rhythms, heart failure or heart problems you’ve had since birth,” it added.

People at risk

People of all age groups, regions and countries are affected by NCDs. These conditions are often associated with older age groups, but evidence shows that 17 million NCD deaths occur before the age of 70 years.

Of these premature deaths, 86% are estimated to occur in low- and middle-income countries. Children, adults and the elderly are all vulnerable to the risk factors contributing to NCDs, whether from unhealthy diets, physical inactivity, exposure to tobacco smoke or the harmful use of alcohol or air pollution.

These diseases are driven by forces that include rapid unplanned urbanization, globalization of unhealthy lifestyles and population ageing.

Unhealthy diets and a lack of physical activity may show up in people as raised blood pressure, increased blood glucose, elevated blood lipids and obesity. These are called metabolic risk factors and can lead to cardiovascular disease, the leading NCD in terms of premature deaths.

Risk factors

Modifiable behavioural risk factors

Modifiable behaviours, such as tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol, all increase the risk of NCDs.

Tobacco accounts for over 8 million deaths every year (including from the effects of exposure to second-hand smoke)

1.8 million annual deaths have been attributed to excess salt/sodium intake

More than half of the 3 million annual deaths attributable to alcohol use are from NCDs, including cancer.

830 000 deaths annually can be attributed to insufficient physical activity

Metabolic risk factors

Metabolic risk factors contribute to four key metabolic changes that increase the risk of NCDs:

raised blood pressure;
overweight/obesity;
hyperglycemia (high blood glucose levels); and
hyperlipidemia (high levels of fat in the blood).
In terms of attributable deaths, the leading metabolic risk factor globally is elevated blood pressure (to which 19% of global deaths are attributed) followed by raised blood glucose and overweight and obesity.

Environmental risk factors

Several environmental risk factors contribute to NCDs. Air pollution is the largest of these, accounting for 6.7 million deaths globally, of which about 5.7 million are due to NCDs, including stroke, ischaemic heart disease, chronic obstructive pulmonary disease, and lung cancer.

Socioeconomic impact

NCDs threaten progress towards the 2030 Agenda for Sustainable Development, which includes a target of reducing the probability of death from any of the four main NCDs between ages 30 and 70 years by one third by 2030.

Poverty is closely linked with NCDs. The rapid rise in NCDs is predicted to impede poverty reduction initiatives in low-income countries, particularly by increasing household costs associated with health care.

Vulnerable and socially disadvantaged people get sicker and die sooner than people of higher social positions, especially because they are at greater risk of being exposed to harmful products, such as tobacco, or unhealthy dietary practices, and have limited access to health services.

In low-resource settings, health-care costs for NCDs quickly drain household resources. The exorbitant costs of NCDs, including treatment, which is often lengthy and expensive, combined with loss of income, force millions of people into poverty annually and stifle development.

Prevention and control

An important way to control NCDs is to focus on reducing the risk factors associated with these diseases. Low-cost solutions exist for governments and other stakeholders to reduce the common modifiable risk factors. Monitoring progress and trends of NCDs and their risk is important for guiding policy and priorities.

To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed requiring all sectors, including health, finance, transport, education, agriculture, planning and others, to collaborate to reduce the risks associated with NCDs, and to promote interventions to prevent and control them.

Investing in better management of NCDs is critical. Management of NCDs includes detecting, screening and treating these diseases, and providing access to palliative care for people in need. High impact essential NCD interventions can be delivered through a primary health care approach to strengthen early detection and timely treatment. Evidence shows such interventions are excellent economic investments because, if provided early to patients, they can reduce the need for more expensive treatment. Countries with inadequate health care coverage are unlikely to provide universal access to essential NCD interventions. NCD management interventions are essential for achieving the SDG target on NCDs.

Less talk. More action.

1. Reduce smoking rates among the youth

2. Amend vape law. This is urgent.

3. Calorie counter

4. More walk ways and bike lanes

5. National program to curb obesity

6. Insert preventive health education program in schools , workplace , and community

7. Innovative ways to use Philhealth on out patient basis

8. Raise salaries of health care workers to prevent brain drain

9. More hospitals in countryside

10. Solve medical corruption to save more patients

References :

Global Burden of Disease Collaborative Network, Global Burden of Disease Study 2019 (GBD 2019) Results (2020, Institute for Health Metrics and Evaluation – IHME)

Philippine Heart Association

World Health Organization

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Anthony C. Leachon, M. D.

Independent Health Reform Advocate

Past President ,
Philippine College of Physicians

Department of Internal Medicine
Manila Doctors Hospital

Email address : [email protected]
[email protected]