Our non-communicable diseases challenge

Pakistan confronts a longstanding, largely unaddressed public health crisis

Pakistan confronts a longstanding public health crisis which is still largely unaddressed due to inadequate funding, ineffective policy-making, and implementation. Besides struggling to overcome easily treatable communicable diseases such as malaria or tuberculosis, along with maternal, perinatal and nutritional related health problems, the country is now facing the growing challenge of contending with non-communicable diseases (NCDs).

NCDs are better known as chronic diseases, which are not passed from person to person. Such diseases are of a long duration, they are of slow progression and more difficult to treat. Cancer, cardiovascular disease, chronic respiratory disease and diabetes are examples of common NCDs.

In 2016, over 70 per cent of worldwide deaths were from NCDs. NCDs are still considered diseases of affluence, and there is little evidence of NCDs getting due attention in many low and even middle-income countries. Yet, NCD trends have steadily decreased in wealthier countries, while they continue increasing in poorer countries like our own.

NCDs in Pakistan are rising at an alarming rate compared to many other neighbouring countries, especially amongst people who are not very old. The World Health Organisation (WHO) estimates in 2014 indicated that over 52% males and 53% females die of NCDs in Pakistan before the age of 70. Pakistan is ranked high on the list of countries where diabetes is a major problem. We also have the highest rate of breast cancer in South Asia.

It is important to question why NCDs are rising across the developing world. Globalisation is one major part of the problem. While we have seen developed countries increasingly curb tobacco use, and promote healthier lifestyles, markets in developing countries are where major tobacco companies, unhealthy fast food, hazardous pesticides, are experiencing rapid sales growth.

The prevalence of NCDs is also growing due to unchecked pollution, sedentary lifestyles, high levels of stress and low levels of physical activity within less developed countries. The burden of NCDs is likely to increase tremendously over the coming decades unless there is appropriate action taken to address these contributing risk factors.

Thus far, negligible efforts are being made to prevent and treat such diseases in Pakistan. While allocation for the health sector has significantly risen over the past several years, most of these resources go towards curative care and our health system does not focus enough on prevention and control of NCDs. Not much priority is being given to early detection and early management of NCDs. We need to invest more resources in detecting the subtler initial signs of major communicable diseases. Being unable to do so increases the cost of hospitalisation and treatment. The sale of spurious medicines is unabated, which further complicates treatment of people suffering from these diseases.

Pakistan is amongst the first developing nations to have devised a National Action Plan to address NCDs, but then this plan has languished due to lack of implementation on the ground.

Increased taxation on tobacco, sweetened drinks, and fast food is one easy way to raise needed resources to focus on preventative measures such as promotion of healthier lifestyles and eating habits. However, taxation alone will not be enough. There is also an urgent need to put in place regulations to curb pollution. Our toxic air quality is directly linked to acute respiratory and cardiovascular complications, and it is probably going to increase existing cancer rates too.

Compelling our policy-makers to tax and regulate powerful vested interests to minimise health risks is a tall order. Yet, contending with the added public health burden and human suffering that our rising NCD rates will invariably imply will be even harder.

Published in The Express Tribune, October 26^th, 2018.

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