Curated by Filomena Pietrantonio, Professor at UniCamillus
“A fat giraffe”, it may seem a paradox, but it really is the symbol of the change currently taking place in the whole world, Developing Countries included; it is the symbol of the main risk factors, and so of the causes of illness and death at a global level. In fact, if it is true that, as stated by the influential New England Journal of Medicine, due to the epidemiological transition the two leading causes of death in the Developed Countries are cardiovascular diseases and tumors, it is more and more obvious that the trend of chronic diseases (Non Communicable Diseases NCD) is rising in the whole world and mostly, unexpectedly, in the Developing Countries.
This is where the fat giraffe comes into play: what are the common risk factors that are causing the epidemiological transition in the Developing Countries too? Surprisingly the same ones of the Developed Countries: obesity, lack of physical activity, inadequate diet, rich in fats and lacking of vitamins, and waste, smoking, et cetera.
It is just as if globalization enabled the hastening of information, the use of technologies in remote places, the improvement of life conditions, access to health services, the higher life expectancy, but also the “debatable” changes in lifestyle typical of rich countries.
In fact, by analyzing the list of the main causes of disease and death in Zambia we can find, unexpectedly, that, even though HIV remains the main cause, the Diabetes Mellitus moved to the sixth place, and the Stroke is the second cause of death. Just think that, given the fact that Counselling and Testing centers for screening and diagnosing HIV are extensively widespread throughout the territory, it is being devised to associate preventive activities for HIV and information regarding chronic diseases, in particular hypertension and diabetes, so as to raise awareness among the population about the correct lifestyles in order to reduce the risk of incurring in these diseases through the prevention activities network already operational.
The World Health Organization (WHO) estimates that the 4 main causes of NCDs (cardiovascular diseases, diabetes, tumors, and chronic respiratory diseases) are responsible for two third of the 57 million deaths occurring yearly in the world, with an 80% of deaths occurring in high- and medium-income Countries. It is expected a growth of deaths by NCDs from 36 millions in 2008 to 52 millions in 2030. In response to this new epidemic, the WHO indicated a series of objectives to reduce by 25% within 2025 the deaths for these 4 main NCDs in people within a range of age from 30 and 70. Among the objectives there are prevention activities and counselling to modify the lifestyles and introduce new pharmacological formulas in order to facilitate polytherapy in patients suffering from chronic diseases. The Indian Policaps Study (TIPS) look very interesting, as it evaluates the use of a “Polycap”, a single pill containing aspirin, beta-blockers, ACE inhibitors, and statin, a “generic” and low-cost medication. The first evidence show that the Polycap formula may be a simple and practical solution to contribute towards reducing the multiple risk factors, in particular the cardiovascular ones.
Consequences of the progressive increase of the impact of chronic diseases, in Developing Countries bring a worrisome scenario: the cost of NCD treatment is consistent and elevated due to frequent hospitalizations, laboratory monitorings, and continued therapies, which cannot be sustained by Countries highly dependent from foreign help as are the Developing Countries. As for all the other countries, however, the cost for inaction is far higher than the cost for acting on chronic diseases as suggested by the WHO in the 66th World Health Assembly (May 6th 2013) in their Plan of Action 2013-2020 against NCDs. The loss of production caused by the 4 main NCDs along with mental health issues is estimated to be around 47 trillion of Dollars and it represents 75% of the world GDP in 2010.
Action against chronic diseases, in particular in Developing Countries, should therefore be seen as an investment, because it gives an opportunity to safeguard the population’s health and productivity, it creates win-win situations that influence choices regarding diet, media, information and communication technologies, sport, and health insurance, and it is potentially capable of identifying innovations that can be applied globally with the aim of reducing the uncontrolled growth of health expenditure.
…Only then, maybe, the giraffe may be able to run, slim, agile, and healthy, in the meadows of its Land.
Filomena Pietrantonio is a Professor of Internal Medicine in the Degree Courses in Physiotherapy and Nursing at UniCamillus. She also teaches in the Online First level Master in Management for Coordination Functions of Health Professions.
In particular, the Online Masters are part of an innovative educational offer of our University that, through an online platform available 24/7, is able to balance work, study and personal life of students.
For more information, click HERE
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Bibliography
Jones DS, Podolsky SH, Greene, JA. The Burden of Disease and the Changing Task of Medicine.2012; 366:2333-38
Lim SS, Vos T, Flaxman AD et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990—2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet vol 380, 9859: 224.60, 2012.