On Non-Communicable Diseases

June 6, 2011

In 2008, non-communicable diseases (NCDs) accounted for 63 percent of all deaths worldwide. According the World Health Organization’s (WHO) recent Global Status Report on Non-communicable Diseases, without an intervention, NCDs are “projected to kill 52 million people annually by 2030.” By informing the public about their risk, encouraging them to make healthy lifestyle changes, and improving treatment for individuals with NCDs, it may help to reduce the incidence of these diseases globally.

NCDs, which include diabetes and cancer, are defined as chronic conditions or diseases which do not result from an acute infectious process. The Centers for Disease Control and Prevention (CDC) report that half of all deaths in the U.S. each year are due to heart disease, cancer, or stroke. In addition to the incidence of NCDs in developed nations, a reported 80 percent of the 36.1 million NCD-associated deaths in 2008 occurred in developing nations. While NCDs can present a burden for any nation’s healthcare infrastructure, Dr. Margaret Chan, WHO Director General, notes that “for some countries it is no exaggeration to describe the situation as an impending disaster.”

Reports indicate that cardiovascular diseases account for the majority of NCD-related deaths, or 17 million annually, followed by cancer (7.6 million annually), respiratory disease (4.2 million annually), and diabetes (1.3 million annually). These four groups of diseases account for nearly 80 percent of all NCD deaths, and share four common risk factors:  tobacco use, inadequate physical activity, harmful alcohol use, and poor diet. Almost six million people die as a result of tobacco use each year, and 2.5 million die from alcohol-related causes. In addition, lack of exercise and poor diet contribute to obesity, increasing individual’s risk of heart disease, stroke, and diabetes.

To lessen the impact that NCDs have on global health, the WHO has suggested that a number of measures be taken, including banning smoking in public places and promoting public awareness about the importance of diet and exercise. Encouraging individuals to make healthy lifestyle choices and providing them with information about how to improve their health, it may be possible to reduce the number of NCD-related deaths worldwide.


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Tobacco Use Worldwide

December 23, 2009

Currently, approximately one third of the global population over the age of 15 – about 1.1 billion people – smoke cigarettes. Tobacco use continues to be the leading preventable cause of death worldwide, killing at least five million people each year. Trends from illness and death related to tobacco use indicate that by 2030, tobacco use will contribute to the deaths of more than 10 million people worldwide each year, 70 percent of whom live in the developing world. Though various strategies are in place, including bans on smoking in public areas, restrictions on advertisements for tobacco products, and increased taxes on cigarettes, the number of people who use tobacco has not significantly decreased. A recently released report from the World Health Organization (WHO) details cigarette and smokeless tobacco consumption and seeks to find an approach that may lessen the use of these products.

Global Tobacco Use

The WHO report indicates that though 22 of the world’s most populous 100 cities are now “smoke-free,” this only accounts for 5.4 percent of the world’s population. In 2008, the WHO established a set of guidelines aimed at helping nations to reduce smoking, which include:

  1. Monitoring tobacco use and the policies to prevent it,
  2. Protecting people from tobacco smoke,
  3. Offering people help to quit using tobacco,
  4. Warning people about the dangers of tobacco,
  5. Enforcing bans on tobacco advertising, promotion, and sponsorship, and
  6. Raising taxes on tobacco.

However, reports indicate that less than 10 percent of the world’s population is covered by any one of these measures. Additionally, only two percent of individuals live in nations that have comprehensive and widely-accepted smoke-free laws, and 94 percent are not protected by any laws against smoking.

Laws banning smoking – including the use of cigarettes, cigars, and hookahs – in public places will come into force in 2010 in many areas of the world. According the Syrian Society for Countering Cancer, 60 percent of adult men and 23 percent of women in Syria smoke, and 98 percent of Syrians are affected by second-hand smoke exposure. Other nations face similarly high rates of tobacco use and smoking-related illness and death. The high incidence of tobacco-related deaths in the Philippines (90,000 per year), Malaysia (10,000 per year), and Vietnam (40,000 per year) has caused concern in these regions, but fully effective smoking bans are not yet in place. Reports indicate that the majority of smokers in some Southeast Asian countries are men, and that as many as 75 percent of men smoke, compared to fewer than 20 percent of women who do. In Cambodia, for example, roughly half of the older women do use tobacco, but favor smokeless chewing tobacco, which many women begin during pregnancy to help lessen prenatal nausea.

Over the past four years, smoking rates have decreased in developed nations including the United States, Japan, and Western Europe as anti-smoking laws gain momentum. However, the World Lung Foundation (WLF) indicates that “More than 80 percent of those with premature deaths [from smoking] would occur in low- and middle-income countries.” Since 1960, according to the WLF, “the global production of tobacco has increased 300 percent in low- and middle-resource countries while dropping more than 50 percent in high-resource countries.” In China and India, over half a billion men consume tobacco, and other nations are facing similar problems of mass consumption of tobacco use. Tobacco is a contributing cause to heart attacks, strokes, diabetes, cancers and asthma worldwide, regardless of how it is consumed (smoked, chewed, etc.). According to Ala Alwan, the WHO non-communicable diseases expert, more than 80 percent of the WHO’s projected cancer deaths are likely to occur in the poorest regions of Africa. To increase awareness and provide education about the dangers of smoking, the WHO is planning to establish a regional hub there in 2010.

It remains to be seen how much impact the efforts of the WHO and other organizations will have with regard to decreasing the number of individuals who use tobacco. Through newly established laws, increased taxation, and outreach and education about the dangers of cigarettes and smokeless tobacco products, it may be possible to urge individuals to quit smoking or not to start at all.

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The Flu Vaccine

October 12, 2009

As new cases and concerns about seasonal flu and swine flu (H1N1) continue to spread worldwide, two vaccines have recently been made available. Both the nasal spray vaccine and injectable vaccine for seasonal flu have proven effective for specific portions of the population, however distribution is still slow. For the H1N1 (swine flu) virus, The Baltimore Sun reports, availability is still an issue and many areas have not yet received enough doses to meet the demand. While many in the developed world do not yet have access to the H1N1 vaccine, Dr. Bernadine Healy notes that the problem is even greater in the developing world. To help these nations fight the pandemic, the United States has agreed to donate 10 percent of its vaccination supply to the World Health Organization (WHO) – eight other nations will make similar donations.

Fantastic Image by Deborah Ervin

Inoculating individuals for both viruses is complicated by the time frame in which the vaccinations can occur. If one chooses nasal spray for both seasonal and swine flu, they must wait four weeks between doses, while if one is injected for one virus and uses nasal spray for the other, they can be administered together. Discovery Health reports that doctors recommend annual flu shots to lessen the chances of becoming ill. Individuals as young as six months can be inoculated, according to the Centers for Disease Control and Prevention (CDC) and side effects are reported to be minor. Because the virus used to make the seasonal flu vaccine is dead, it is not possible to contract flu from a flu shot, however one may expect a low-grade fever 8 to 24 hours following injection, a swollen or tender area around the injection site, a slight headache or chills within 24 hours.

The seasonal flu shot is an inactivated vaccine, and contains three influenza viruses – one A(H3N2) virus, one regular seasonal A(H1N1) virus (which differs from the 2009 H1N1 virus), and one B virus. The viruses used change annually based on international surveillance which track infection trends and scientists estimations about which strains will circulate during the year. In contrast to the flu shot, the nasal-spray flu vaccine contains a weakened but still living flu virus, sometimes called LAIV (live attenuated influenza vaccine). These nasal mists are approved for use in healthy individuals ages two to 49 who are not pregnant. In addition to nasal sprays, Discovery Health reports that researchers at Stanford University and the University of Alabama at Birmingham have been working with naked DNA in an effort to develop a vaccine that could be delivered via shampoo or dermal patch.

Three recent large-scale studies, including a study led by Dr. Arnold S. Monto of the University of Michigan, indicate that while the seasonal flu shot is more effective for adults and safe for women who are pregnant, the intranasal vaccine (nasal spray) is more effective at preventing flu in children. These studies showed 35 to 53 percent fewer cases of flu in children who were given the nasal spray vaccine than those who received injected vaccines. The Los Angeles Times reports that injectable vaccines prevent roughly 50 percent more seasonal flu in healthy adults than the nasal spray vaccines.

Due to the relative newness of the H1N1 vaccine, health authorities have implemented a number of tracking measures to ensure its safety. The Associated Press reports that Harvard Medical School scientists are working to link insurance databases covering 50 million people with vaccination registries to allow them to determine if people visit a doctor after being vaccination as well as the reason for the visit. Johns Hopkins University and the CDC are also working to ensure that any side effects are noted and addressed quickly. These efforts include emailing individuals who have been vaccinated recently to see how they are feeling (Johns Hopkins), and preparing take-home cards asking vaccine recipients to report any side effects to the nation’s Vaccine Adverse Event Reporting system (CDC). These measures are being undertaken as in the Internet-age, the Associated Press notes, one person updating their Facebook status to say that they got a flu shot and feel sick could cause a wave of similar reports.

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Associated Press on the Nasal Spray Flu VaccineThe New York Times on CDC Side Effect Tracking Measures