Non-communicable
diseases, communicable diseases and trauma are emerging as a triple burden for
healthcare system of developing countries like Nepal thus hindering our efforts
to increase life expectancy, spur economic growth and halting the global strategy
for obtaining good health for all.
Only prompt and appropriate measures can
prevent the nation from the triple burden that, otherwise, might lead us to the
vicious cycle of increased death toll, disability and devastating healthcare
system among others.
Non-communicable diseases account for 50
percent of deaths in the developing countries. According to World Health
Organization (WHO), every year, an estimated 14 million people die prematurely
in developing countries from preventable heart disease, stroke, diabetes,
cancers and asthma, with major negative consequences for socioeconomic
development. By 2020, these diseases are expected to account for seven out of
every ten deaths.
Similarly, the number of diabetes in the world
is expected to increase from 194 million in 2003 to 330 in 2030 with three in
four living in developing countries. This burden of diseases is the result of
complex constellation of social, economic, and behavioral factors like
increased exposure to tobacco use, unhealthy diets, sedentary lifestyle and
harmful use of alcohol. The problems are going to be severely exacerbated by
aging population, urbanization and community planning, unhealthy diets and
lifestyles, climate change and rapidly increasing cost of medical technologies
in developing countries.
It is predicted that the burden of
non-communicable diseases will cost $84 billion by 2015 straining the capacity
of the afflicted countries to provide adequate healthcare services if measures
are not taken to stabilize and slow this growth.
Similarly, communicable diseases account for
one in two deaths in the developing countries where the victims are usually
children and young adults. In WHO’s estimation, communicable diseases claim 13
billion deaths a year, making it the cause of 32 percent of total deaths.
Almost 90 percent of these deaths are caused by pneumonia, tuberculosis (TB),
diarrheal diseases, malaria, measles, and the human immunodeficiency virus
(HIV). The increasing spread of communicable diseases has to do with low living
standard, urbanization, migration, illiteracy, unavailability of pure drinking
water and inadequate sanitation facilities.
An estimated 2.62 million deaths are caused by
these infectious diseases in the countries of South East Asia Region where
poverty rate is high. In the same way, the poor underlying nutritional status
and inadequate immunization coverage are the main predisposing factors for
measles which cost 250 000 children’s’ lives in these counties. The curse of
the diseases does not end here. New epidemics of SARS, avian influenza and
Nipah virus are also severely damaging the exhausted healthcare system in developing
countries by sharply increasing the health expenses and thus halting the
economic growth.
Unlike the two diseases discussed above,
trauma has a significant impact on physical, mental and social well being of
the afflicted people. WHO has estimated that trauma and injury account for
around nine percent of the global mortality and 12 percent of the global
disease burden. More than 90 percent of injury deaths occur and millions more
are disabled, temporarily or permanently, in low and middle income countries
from road traffic accidents, burns, falls, other types of unintentional injury,
violence and suicide.
Sadly in those countries, preventive efforts
are often nonexistent; treatment and rehabilitation resources are woefully
inadequate; and health-care systems are least prepared to meet the challenge.
Alarmingly, road traffic accidents are second only to AIDS in killing young
adults. Evidently, this will significantly magnify economic loss from injuries
through treatment and rehabilitation costs, not to mention lost wages and
wasted productivity. Therefore, trauma is a big curse for healthcare system in
developing countries that contributes to rising poverty of an individual and
the community.
However, it is possible to come out of this
catastrophic impact of triple burden with efficient actions and strategies such
as promoting healthy life style, strengthening the healthcare infrastructure
and advocating for the effective policies and regulations. Prominent causes for
heart disease, diabetes, cancer and pulmonary diseases can simply be reduced by
just altering the life style. It is proven that up to 80 percent of cases of
coronary heart disease, and up to 90 percent of diabetes, could potentially be
avoided by changing lifestyle.
Therefore, emphasis should be given on public
health education and awareness programs to persuade the people to quit smoking
and reduce the amount of alcohol intake. A healthy diet in place of an
unhealthy and obesogenic poor nutrient diet and physical activities like aerobics
and yoga in place of sedentary life style can substantially reduce the risk of
obesity and chronic diseases.
Similarly, safe water supply and sewage
disposal, advances in food hygiene, improvement in housing and general civic
environments and adequate immunization can considerably reduce the burden of
infectious disease. In case of trauma, though the preventing measures like
increasing infrastructure, improving road and vehicular safety and traffic
management, tackling the inappropriately high speeds and alcohol impaired
driving by implementation of traffic laws may interfere the incidents and lower
the death and disability, the victims are in dire need of post-injury treatment
and rehabilitation services.
Therefore, the combination of preventive as
well as curative methods like providing safe and timely medical care, easy
access to essential surgical services can yield better result while coping with
the injuries. Moreover, this requires a greater investment in infrastructure,
physical resources and supplies, and trained health workers to tackle trauma
burden.
The triple burden is a major healthcare
problem in developing countries that is claiming millions of lives and
thousands of disabilities. This, in turn, is exerting extra pressure on healthcare
expense and leading the victims into abysmal poverty. Only by adopting
preventive, curative and supportive measures, strengthening healthcare
infrastructures, public health promotion and broadening international
coalition, we can fight this burden.
DR RAJA RAM DHUNGANA
Republica
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