Non-communicable Diseases

(Note: This reading reflection paper was written in the second half of 2020 as part of an Introduction to Global Health course)

Non-communicable diseases (NCDs), including cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and mental health conditions, have become increasingly important in recent years. They are a significant contribution to premature deaths among persons aged 30 to 70 years old and will cost the global economy $47 trillion over the next 20 years. Also, many risk factors for NCDs (pollution, climate change, agricultural practices, deposition of persistent chemicals in the environment, and biodiversity loss) are linked to the health of the environment (Frumkin and Hanes, 2019) and end up impacting whole communities and populations living in those environments.

I agree with the view that NCDs are communicable. However, I think the process of coming up with an appropriate alternative name could become a distraction, or have an undertone of othering. While there are suggested replacements for the name NCDs. Some of these alternative names are “biosocial and development diseases” and “life-long disease.” I think these diseases should be called modernization diseases. As high income countries (HICs) aspire to become “developed” and as LMICs are sold these visions of “development,” the conditions that predispose persons to these diseases cross borders and gradually become the norm. For example, overproduction has led to the proliferation of canned foods of various sorts. Canned foods that are in many cases laden with preservatives and chemicals to preserve their color and taste. These canned foods and other genetically modified foods become a source of ill health and disease. Another example are firms from HICs who shift production to LMICs where there are lower environmental safeguards and dump wastes into water bodies. Some of these wastes, especially petrochemical wastes, are carcinogens.

While the government, food and environment regulatory bodies, and the corporate sector are implicated in the prevalence and spread of non-communicable diseases of modernization, consumers often take the blame for making poor choices responsible for their health outcomes. There are also other concerns such as to what extent does food labelling help if consumers are not sure what to look for in the food labels or if those food options are the options readily available to them. In a few cities in America, I have observed that apart from eggs, chicken, and milk, most of the other foods given out in food pantries are canned foods with high cholesterol and sodium content, and of course high corn fructose syrup. These low income individuals may not have other alternatives. Governments grapple with many considerations but they need to be more ethical as they think about the health of their population and the taxes they could recoup from companies that produce products and create by-products that make people more prone to NCDs.

I also agree that in the prevention and management of NCDs, community based interventions are beneficial than approaches that medicalize NCDs. Individuals can encourage one another to eat more fresh fruits, less processed foods, and smaller portions, and hold one another accountable. From my experience, I know of NGOs in HICs and LMICs where pre-diabetic, diabetic, and hypertensive persons come together, build friendships, and support each other so as to delay or prevent a medical crisis. A community based approach is also recommended for mental health intervention and described as cost effective, scalable, and sustainable. (Skolnick, 2020)

While taxation of alcohol, sugar, and tobacco could be helpful, most of the foods still consumed by most persons in LMICs especially in West Africa is largely carbohydrates. Just as in the US, there have been campaigns in Nigeria on the appropriate combination of vegetables, protein, and carbohydrate per plate. These campaigns are hard to follow, for example, by laborers who think or who actually need a high carbohydrate diet. These campaigns also involve a cultural shift from normal food expectations. Also, foods with low glycemic index, such as oats, are being promoted. There was a time in Nigeria during the late 1990s where wheat was being promoted as a good food for diabetics. However, this was shown to be inadequate information because the way the wheat is milled could shoot its glycemic index upwards to levels where it is no longer good for diabetic patients.

Because of the process by which diseases of modernization have spread to LMICs, I am very skeptical of opioids. I think many of those pushing for opioids in Africa have relations with manufacturers of opioids and are suspect. Except proven otherwise, they might be interested in increasing their markets than in pain management. I defer to the wisdom and motivation of the nurses at the Prince Mariama Hospital (PMH), Gaborone, Botswana, who although know opioids exist prefer to give their patients paracetamol and ibuprofen. I am sure those medical staff know how to know those cases where opioids are required.

Question

· Does it really matter the name we call these diseases? Would “diseases of modernization” be a good alternative and would the appellation (by hinting to some of the societal causes of these diseases and encouraging local and unprocessed foods) help in any way in reducing the incidence of NCDs?

· How would you characterize the motivations of those encouraging the use of opioids abroad considering that there is an opioid crisis in the US?