MPH Assignment: Epidemiologic Transition and NCD Spread Analysis

This report provides a comprehensive overview of the epidemiologic transition and the spread of non-communicable diseases (NCDs), also known as chronic diseases. It explores various aspects, including risk factors like tobacco use, unhealthy diets, and lack of physical activity, as well as non-modifiable factors such as age, gender, and family history. The report delves into the social and environmental determinants influencing NCDs, including social inequalities, pollution, and workplace exposures. It also examines specific NCDs like obesity, cardiovascular disease, and diabetes, discussing their prevalence, management strategies, and prevention approaches. The report highlights the challenges faced by developing countries in managing NCDs, including poverty, malnutrition, and limited access to healthcare. The report also discusses the importance of lifestyle modifications, dietary interventions, and pharmacological treatments in managing and preventing these diseases.

Master of Public Health
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Epidemiologic transition and spread of non-communicable disease: Noncommunicable
disease (NCD) is also termed as chronic disease which persist for the longer duration. NCDs
mainly occurs due to multiple factors like genetic, physiological, environmental and
behavioural factors. NCDs mainly occur in the low and middle socio-economic countries and
globally approximately 70 % deaths occur due to NCDs. Approximately, 85 % deaths of
NCDs occur in low and middle socio-economic countries. NCDs are categorised into
different types like cardiovascular, cancers, diabetes and respiratory diseases. Cardiovascular
disease includes heart attack and stroke. Respiratory diseases include chronic obstructive
pulmonary disease and asthma. Most of deaths of NCDs occur due to cardiovascular diseases
with approximately 18 million people annually die due to cardiovascular disease followed by
cancers, respiratory disease and diabetes deaths occur in 9, 3.9 and 1.6 million people
respectively. Population of developing countries are misfortunate due to multiple factors like
poverty, malnutrition, infectious diseases and diseases related to pregnancy and childbirth
(Rodriguez-Fernandez et al., 2016). In developing countries, in the last of 12 years;
traditional diseases reduced from 49 to 38 % and NSDs increased from 40 to 51 %. This
burden of disease estimated in terms of disability-adjusted life years relative to all causes of
disease. In developing countries, number of deaths are proportional to the burden of disease.
Number of deaths due to the traditional diseases reduced from 37 to 27 % and number of
deaths due to NCDs increased from 53 to 63 %. In developing countries, disease burden is
3.5 times higher and deaths are 2.5 % higher for NCDs as compared to the western countries.
Rapid rise in NCDs occur in developing countries; however, it remains stable in the western
countries (Min et al., 2018; Siegel et al., 2016).
Increase in the global burden and diverse pattern of NCDs in the different geographical
regions are helpful in demonstrating epidemiologic transition. During the past two centuries,
it has been observed that there is dramatic shift in the death due to infectious disease and
malnutrition to the cardiovascular disease and cancer in the both developed and developing
countries. However, rate of shift is at faster rate in the developing countries as compared
developed countries. Between 1999 to 2020; there was increase in the prevalence of
cardiovascular diseases by 120 and 137 % in women and men respectively (Rodriguez-
Fernandez et al., 2016; Min et al., 2018).
Risk factors: Tobacco is one of the major factors for the occurrence of NCDs in developing
countries. Modifiable risk factors can be controlled through intervention and probability of
disease occurrence can be effectively reduced. WHO recommended four modifiable risk
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factors for NCDs like physical activity, tobacco use, alcohol use and unhealthy diet in the
form of high fat and sodium intake with low fruit and vegetable intake. Non-modifiable risk
factors can not be controlled through intervention. These risk factors include age, gender,
race and family history (Esmailnasab, Moradi, and Delaveri, 2012). Tobacco use is
responsible for the prevalence of cardiovascular disease, diabetes, cancer and chronic
respiratory disease in countries like India. Unhealthy diet, physical activity and harmful use
of alcohol are mainly responsible for the occurrence of cardiovascular disease, diabetes and
cancer. Modifiable risk factors lead to metabolic risk factors which are the biochemical
processes responsible for the body’s normal functioning. WHO prioritised four metabolic risk
factors for NCDs which include increased blood pressure, increased total cholesterol level,
raised glucose level and overweight and obesity (Nethan, Sinha, and Mehrotra, 2017).
Environmental risk factors are the major cause of NCDs in the developing world. Household
and outdoor pollution are the major environmental risk factors responsible for the occurrence
of NCDs. Environmental risk factors can be of different types like physical, chemical,
biological and work related. These environmental factors can be modifiable; however, natural
environmental factors can not be modifiable. Approximately 90 % population of the
developing countries are exposed to harmful pollution levels in the ambient air and 40 %
population in developing countries exposed to harmful smoke due to cooking with inefficient
technology and fuel combinations. Stroke, ischaemic heart disease, lung cancer and chronic
obstructive respiratory disease occur in 24, 25, 28 and 43 % respectively population of
developing countries like Republic of Korea, Cubatao and Brazil due to exposure to ambient
and household air pollution. Workplace related exposure of chemicals and chemical mixtures
are responsible for approximately 1.3 million deaths annually in the form of cardiovascular
diseases, chronic obstructive pulmonary disease, and cancers. Chemical exposure also leads
to neurological and mental disorders (Nelson, Nyarko, and Binka 2015; Norman et al., 2015).
Determinants: Social determinants are responsible for the distribution of risk factors of
NCDs. Social inequalities before birth and in the early life are responsible for the lifetime
NCDs. Child development is associated with social gradients in terms of physical, cognitive
and emotional/behavioural aspects. Disadvantaged socioeconomic status is mainly
responsible for the improper brain development which contribute to the improper regulation
and control of behaviour and thought process which produces risk factors of NCDs. These
risk factors include loss of cognitive control over diet and physical activity. Family
environment is mainly responsible for the occurrence of obesity and overweight. Low and
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middle socio-economic class people are responsible for the development of both underweight
and overweight condition. Underweight condition might develop due to insufficient food
consumption and overweight condition might occur due to consumption of unhealthy food
habits like consumption of food with high fat level and high sugar content (Aryal et al.,
2018). Lack of physical activity is also responsible for the NCDs like cardiovascular diseases
and diabetes. In developing countries, less attention is being given to the physical activity due
to insufficient knowledge about the importance of physical activity and lack of open
playgrounds for physical activity due to continuously increase in the population in the
developing countries. Poor people in the developing countries are not able to afford healthy
food like fruits and vegetable which are proved beneficial in the control of NCDs like
cardiovascular diseases and diabetes (Low, Lee, and Samy, 2015). It has been reported that
people in the low socio-economic countries consume more amount of alcohol as compared to
the people in the high socio-economic countries which is one of the major risk factors for
NCDs. People in the low socio-economic countries like Taiwan, Afghanistan and Zimbabwe
experience psychological stress and risk behaviours due to environmental, living, working,
and social conditions. People in the low socioeconomic countries are less educated; hence,
they are not aware of the healthy living and risk factors associated with NCDs (Feng et al.,
2018).
Obesity: Recent data indicated that approximately 35.5 % and 35.8 % men and women are
obese respectively. Moreover, 63 % and 73 % men and women are overweight. Augmented
prevalence of obesity are the alarming signals for the endocrinologists mainly due to obesity
is linked to diabetes and adipose tissue related diseases. In clinical practice, overweight
condition and obesity are diagnosed through body mass index (BMI). Increase in BMI is
associated with health risks like diabetes, coronary heart disease, degenerative joint disease,
and certain cancers. BMI alone can not be potential diagnostic parameter for obesity; hence,
waist circumference should be added along with BMI for the accurate diagnosis of
overweight and obese condition (Ford, Patel, and Narayan, 2017). Recently, it has been
demonstrated that it is advisable to administer high risk medicines to the patients with higher
severity. Basic foundation of the obesity treatment is reducing energy consumption and
increasing energy expenditure. However, in most of the obese patients; it is not possible to
implement exercise intervention. Hence, recently researchers indicated to consume optimal
diet composition for the management of obesity. Different diet compositions were studied
comprising of low fat, moderate fat, low carbohydrate, low glycaemic and high protein for
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the optimization of optimum diet. Different compositions of these diets were studied in
different clinical trials. However, not a single diet emerged as distinctive diet for the
management of obesity. However, it has been established that adherence to the optimised diet
as compared to the regular diet proved beneficial in weight loss in obese and overweight
patient. Research indicated that duration of consumption of optimised diet is important factor
as compared to the type of food for the management of obesity. In recent studies, it has been
established that increase in insulin is associated with reduction in weight. Hence, low
glycaemic load diet should be incorporated in the management of the obesity (Afshin,
Reitsma, and Murray, 2017).
It has been demonstrated that maintaining adherence to the optimised diet for the longer
duration is difficult in obese patients. Hence, there might be weight gain in the patients after
stopping of the consumption of optimised diet food. Moreover, weight loss is associated with
decreased leptin, increased ghrelin and reduced peptide YY and cholecystokinin. Weight
regain after stopping of consumption of optimised food might be due to hormonal alterations.
Hence, recent research indicated that along with optimised diet; it is necessary to administer
medications which can alter physiology and hormonal level. In the past decade, researchers
were aiming for optimisation of physical activity for weight loss. Studies indicated that
physical activity is not beneficial in reducing weight as compared to the diet; however,
physical activity proved to be beneficial in preventing weight gain. In the initial phase, diet is
useful for weight loss and adherence to diet fade over time. Hence, research indicated that
physical activity is more beneficial over the time to prevent weight gain after fading
adherence to the optimised diet. Research studies indicated that bariatric surgery is useful in
obese patients with diabetes because it is useful in controlling diabetes which would be
difficult to control through traditional medication treatment. Roux-en-Y gastric bypass
(RYGB) and sleeve gastrectomy along with medications proved beneficial in obese patients
with diabetes (Dinsa et al., 2012).
Cardiovascular disease : Recently, it has been demonstrated that quit smoking in addition to
the pharmacological treatment are more effective in the management of cardiovascular
condition as compared to the only quit smoking intervention. People in the developing
countries are associated with poor financial assistance; hence, heavy taxation on the tobacco
products proved beneficial in reducing consumption of tobacco and related products.
Scheduled quit plan along with dedicated follow-up proved beneficial in quitting smoking
more effectively in the cardiovascular patients. In the studies, it has been established that only
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diet control is not useful in the effective management of cardiovascular conditions; however,
diet control in addition to the lifestyle changes proved more beneficial in the management of
cardiovascular diseases. Patient self-management and sustainable behavioural change would
be helpful in the effective management of the cardiovascular disease. Research has
established that physical activity needs to be altered with different time points and physical
activity need to be performed for the fixed duration of time (Celermajer et al., 2012; Uthman
et al., 2015).
Prevention strategies for the cardiovascular diseases should target its risk factors like tobacco
consumption, hypertension, cholesterol abnormalities, obesity, physical inactivity, and
diabetes mellitus. Both individual based and population based preventive strategies should be
implemented for the prevention of cardiovascular diseases. Individual based strategies should
be comprising of assessment of risk factors and providing intervention to fix risk factors to
certain threshold like blood pressure 140/90 mmHg. Guidelines were developed for the
threshold value of risk factor for each of the risk factors. Population based strategies include
reducing risk factors of the entire population. Effective diagnosis should be implemented for
the accurate diagnosis of the cardiovascular diseases; hence, effective intervention can be
implemented. Cost-effectiveness ration need to be fixed for the drug-regimens in the
developing countries; hence, these drug regimens would be affordable for the low and middle
economical class people in the developing countries (Shroufi et al., 2013).
Diabetes: Diabetes is mainly caused due to different factors like overweight, obesity, physical
inactivity, insulin resistance, genes and family history. It has been demonstrated that cases of
diabetes are going to be doubled in next decade. WHO predicted 280 million cases of
diabetes by 2030. In developing countries, majority of the diabetes patients are in the age
group 45-64 years in comparison to the people above 65 years age. Prevalence of diabetes in
the younger age and in females predisposes intrauterine fetal exposure to diabetes in the
developing exposure. Prevalence of intrauterine diabetes is mainly responsible for the
development of future generation with diabetes in the developing countries. High preventive
costs and manifold socioeconomic gaps are mainly responsible for the diminished outcome of
diabetes in the developing countries. Gaps in the health and social infrastructure in addition
to the lack of health literacy are mainly responsible for the poor outcome in the diabetes
management. In studies, it has been established that non-medication strategies like increased
physical activity, reduced calorie intake and modest body weight reduction proved beneficial
in the management of type 2 diabetes (Ashwal, Hadar, and Hod, 2015).
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Mental health: Mental illness is often associated with the NCDs and share multiple risk
factors with NCDs. Mental health and well-being are central to the management of NCDs.
NCDs are often associated with the mental disorders like depression, anxiety disorders,
schizophrenia and bipolar disorders. Risk factors of NCDs like tobacco consumption,
physical inactivity, unhealthy diet and alcohol consumption are being usually being evident
in the patients with mental disorders. Stigma associated with people in the low
socioeconomic class are also responsible for the co-occurrence of NCDs and mental
disorders. Mental disorder produces more disability as compared to physical disability
because mental disorder patients receive less treatment due to stigmatisation (Stein et al.,
2019).
Infectious disease and NCDs : In the recent past, it has been reported that there is synergism
among NCDs and infectious diseases. Both NCDs and infectious diseases either influence or
exaggerate each other. TB and HIV/AIDS are most common infectious diseases in the
developing countries like Africa. TB and HIV/AIDS are not only co-existing with each other;
however, their interaction is also a major concern. This interaction is more annoying in the
migratory population due to increased susceptibility of spread of infection and speedy
augmentation of risk of NCDs. With the introduction of the anti-retroviral therapy (ART),
there is increased lifespan of the HIV infected patients; hence, infection turns into the chronic
infection. At the same time, these HIV infected patients are associated with the traditional
risk factors of cardiovascular diseases. Chronic HIV infection lead to activation of
immunological and inflammatory mechanisms which results in the metabolic and
inflammatory alterations in the patient. Ultimately, it results in the increased risk of
cardiovascular diseases in the HIV infected patients. HIV itself promotes atherosclerosis,
endothelial dysfunction, and thrombosis (McCrary et al., 2017). Moreover, ART potentiate
insulin resistance and reduced insulin secretion which lead to development of diabetes and
metabolic syndrome. There is association between TB and diabetes in countries like India,
Indonesia, Pakistan and Brazil; however, it is less appreciated. Diabetes impairs immune
system which is essential for the control infection in TB. It has been reported that diabetes
patients are at higher risk of TB infection (Zheng, Hu, and Gao, 2017).
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