Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda

ObjectivesPhysical inactivity is a risk factor for premature mortality and several non-communicable diseases. The purpose of this study was to estimate the global burden associated with physical inactivity, and to examine differences by country income and region.MethodsPopulation-level, prevalence-based population attributable risks (PAR) were calculated for 168 countries to estimate how much disease could be averted if physical inactivity were eliminated. We calculated PARs (percentage of cases attributable to inactivity) for all-cause mortality, cardiovascular disease mortality and non-communicable diseases including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers of the bladder, breast, colon, endometrium, oesophagus, stomach and kidney.ResultsGlobally, 7.2% and 7.6% of all-cause and cardiovascular disease deaths, respectively, are attributable to physical inactivity. The proportions of non-communicable diseases attributable to physical inactivity range from 1.6% for hypertension to 8.1% for dementia. There was an increasing gradient across income groups; PARs were more than double in high-income compared with low-income countries. However, 69% of total deaths and 74% of cardiovascular disease deaths associated with physical inactivity are occurring in middle-income countries, given their population size. Regional differences were also observed, with the PARs occurring in Latin America/Caribbean and high-income Western and Asia-Pacific countries, and the lowest burden occurring in Oceania and East/Southeast Asia.ConclusionThe global burden associated with physical inactivity is substantial. The relative burden is greatest in high-income countries; however, the greatest number of people (absolute burden) affected by physical inactivity are living in middle-income countries given the size of their populations.

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The household economic burden of non-communicable diseases in 18 countries

BMJ Global Health ◽

10.1136/bmjgh-2019-002040 ◽

2020 ◽

Vol 5 (2) ◽

pp. e002040 ◽

Cited By ~ 5

Author(s):

Adrianna Murphy ◽

Benjamin Palafox ◽

Marjan Walli-Attaei ◽

Timothy Powell-Jackson ◽

Sumathy Rangarajan ◽

...

Keyword(s):

Low Income ◽

Healthcare Costs ◽

Health Expenditure ◽

Communicable Diseases ◽

The Philippines ◽

Low Income Countries ◽

Middle Income ◽

Non Communicable Diseases ◽

Middle Income Countries ◽

Catastrophic Spending

BackgroundNon-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries.MethodsUsing data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China.ResultsThe prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs.ConclusionsOur findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs.

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Improved control of non-communicable diseases (NCDs) requires an additional advanced concept for public health – a perspective from a middle-income country

F1000Research ◽

10.12688/f1000research.18423.1 ◽

2019 ◽

Vol 8 ◽

pp. 286

Author(s):

Benja Muktabhant ◽

Frank Peter Schelp ◽

Ratthaphol Kraiklang ◽

Pornpimon Chupanit ◽

Pattara Sanchaisuriya

Keyword(s):

Public Health ◽

Communicable Diseases ◽

Human Metabolism ◽

Middle Income ◽

Non Communicable Diseases ◽

The Sustainable Development ◽

Middle Income Countries ◽

Healthy Nutrition ◽

Recent Developments ◽

Low And Middle Income

A major consequence of all elements of the ‘epidemiological transition’ is the rapid emergence of non-communicable diseases (NCDs) in low- and middle-income countries. In contrast to the outcomes of the ‘Alma Ata Conference for Primary Health Care’, it has not yet been possible to introduce an equally powerful health policy for the prevention and control of NCDs. Major strategies so far are to advise individuals not to smoke and drink alcohol in excess. Additionally, ‘healthy’ nutrition and increased physical activity are also advocated. Policy for preventing and working against NCDs is now part of the Sustainable Development Goals, specifically target 3.4. So far, attempts to soften the influence of NCDs on the health of the people in low- and middle-income countries have been unsuccessful. It is argued here that additional concepts on how public health could operate against NCDs are needed. Major risk factors for NCDs interfere with and alter complex steps within the human metabolism. This paper explores how human metabolism works by assessing advances in molecular biology and research in genetics, epigenetics and gerontology. Recent developments in these scientific disciplines shed light on the complexity of how human health is maintained and diseases are invoked. Public health bodies should be aware, interested and possibly contribute to the aforementioned areas of interest, as far as NCDs are concerned, and translate major developments in a way, that could be useful in improving population health.

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Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era: a scoping review

BMJ Global Health ◽

10.1136/bmjgh-2019-002259 ◽

2020 ◽

Vol 5 (6) ◽

pp. e002259

Author(s):

Naomi Gibbs ◽

Joseph Kwon ◽

Julie Balen ◽

Peter J Dodd

Keyword(s):

Sustainable Development ◽

Low Income ◽

Operational Research ◽

Communicable Disease ◽

Health Coverage ◽

Differential Impact ◽

Middle Income ◽

The Sustainable Development ◽

Middle Income Countries ◽

Disadvantaged Groups

IntroductionNon-communicable diseases (NCDs) represent a growing health burden in low-income and middle-income countries (LMICs). Operational research (OR) has been used globally to support the design of effective and efficient public policies. Equity is emphasised in the Sustainable Development Goal (SDG) framework introduced in 2015 and can be analysed within OR studies.MethodsWe systematically searched MEDLINE, Embase, Scopus and Web of Science for studies published between 2015 and 2018 at the intersection of five domains (OR, LMICs, NCDs, health and decision-making and/or policy-making). We categorised the type of policy intervention and described any concern for equity, which we defined as either analysis of differential impact by subgroups or, policy focus on disadvantaged groups or promoting universal health coverage (UHC).ResultsA total of 149 papers met the inclusion criteria. The papers covered a number of policy types and a broad range of NCDs, although not in proportion to their relative disease burden. A concern for equity was demonstrated by 88 of the 149 papers (59%), with 8 (5%) demonstrating differential impact, 47 (32%) targeting disadvantaged groups, and 68 (46%) promoting UHC.ConclusionOverall, OR for NCD health policy in the SDG era is being applied to a diverse set of interventions and conditions across LMICs and researchers appear to be concerned with equity. However, the current focus of published research does not fully reflect population needs and the analysis of differential impact within populations is rare.

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The global non-communicable diseases epidemic and association between dietary factors and non-communicable diseases by income levels

Proceedings of The Nutrition Society ◽

10.1017/s0029665120005558 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Hyunjung Lim ◽

Do-Yeon Kim ◽

Ju Hyun Park ◽

Hyunjung Lim

Keyword(s):

Risk Factors ◽

Blood Glucose ◽

Low Income ◽

Fasting Blood Glucose ◽

Communicable Diseases ◽

Dietary Factors ◽

Middle Income ◽

Non Communicable Diseases ◽

Income Levels ◽

Middle Income Countries

AbstractNon-communicable diseases (NCDs) share common risk factors as poor dietary intakes, especially among low-income populations worldwide. However, the diet-related health burden by country income levels remains unclear. We assessed the current prevalence of NCDs and the association between selected dietary factors and NCDs by income levels. Data were obtained from the World Health Organization, Food and Agriculture Organization, and World Bank, and 151 countries were included in the analysis weighted by the total population size. Linear regression was used to find the association between metabolic risk factors and health-related behaviors by income levels. The prevalence of raised fasting blood glucose and total cholesterol, overweight, and obesity were lowest in lower and middle income countries, but prevalence of raised blood pressure and NCD deaths under age 70 were highest in lower and middle income countries (p for trend < 0.001). The proportion of carbohydrates and alcohol consumer were highest, and vegetable, milk supply, insufficient activity were lowest in lower and middle income countries. In high income countries, raised fasting blood glucose level were negatively associated with vegetable consumption (β = -0⋅05 CI [-0⋅08, -0⋅02]), and alcohol consumption, fat intake (7⋅94 [1⋅82, 14⋅06]), and sugar and sweetener supply (0⋅04 [0⋅01, 0⋅07]) were associated with overweight. In low income countries, overweight was associated with vegetable oil (0⋅03 [0⋅00, 0⋅05]),. In this study, different relationship between diets and NCDs trends were found across country income levels. Appropriate health policies for each group of countries by income are needed to solve the increasing challenges of NCDs.This work was carried out with the support of “Cooperative Research Program for Agriculture Science and Technology Development (Project No. PJ PJ01317001)” Rural Development Administration, Republic of Korea.

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Socioeconomic inequalities in risk factors for non communicable diseases in low-income and middle-income countries: results from the World Health Survey

BMC Public Health ◽

10.1186/1471-2458-12-912 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 93

Author(s):

Ahmad Reza Hosseinpoor ◽

Nicole Bergen ◽

Anton Kunst ◽

Sam Harper ◽

Regina Guthold ◽

...

Keyword(s):

Risk Factors ◽

Health Survey ◽

Low Income ◽

Communicable Diseases ◽

World Health ◽

World Health Survey ◽

Middle Income ◽

Non Communicable Diseases ◽

Middle Income Countries ◽

The World

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Are WHO “best buys” for non-communicable diseases effective in low-income and lower-middle-income countries? A systematic review

The Lancet Global Health ◽

10.1016/s2214-109x(17)30124-9 ◽

2017 ◽

Vol 5 ◽

pp. S17 ◽

Cited By ~ 6

Author(s):

Luke N Allen ◽

Jessie Pullar ◽

Kremlin Wickramasinghe ◽

Julianne Williams ◽

Charlie Foster ◽

...

Keyword(s):

Systematic Review ◽

Low Income ◽

Communicable Diseases ◽

Middle Income ◽

Non Communicable Diseases ◽

Middle Income Countries

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Global environmental health and sustainable development: the role at Rio+20

Ciência & Saúde Coletiva ◽

10.1590/s1413-81232012000600007 ◽

2012 ◽

Vol 17 (6) ◽

pp. 1427-1432 ◽

Cited By ~ 8

Author(s):

Gregg Lawrence Furie ◽

John Balbus

Keyword(s):

Sustainable Development ◽

Economic Development ◽

Environmental Health ◽

Global Climate ◽

Green Economy ◽

Middle Income ◽

The Sustainable Development ◽

Middle Income Countries ◽

Development Agenda ◽

Health Community

The Rio+20 United Nations Conference on Sustainable Development represents a crucial opportunity to place environmental health at the forefront of the sustainable development agenda. Billions of people living in low- and middle-income countries continue to be afflicted by preventable diseases due to modifiable environmental exposures, causing needless suffering and perpetuating a cycle of poverty. Current processes of economic development, while alleviating many social and health problems, are increasingly linked to environmental health threats, ranging from air pollution and physical inactivity to global climate change. Sustainable development practices attempt to reduce environmental impacts and should, in theory, reduce adverse environmental health consequences compared to traditional development. Yet these efforts could also result in unintended harm and impaired economic development if the new "Green Economy" is not carefully assessed for adverse environmental and occupational health impacts. The environmental health community has an essential role to play in underscoring these relationships as international leaders gather to craft sustainable development policies.

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