We are unhealthy
The population is in an unhealthy state. The increasing and costly burden of NCDs should be of concern to everyone.
THE first Global Burden of Disease study, carried out by the World Health Organization (WHO) in 1990, described infectious diseases, non-communicable diseases (NCDs) and injuries.
This classification reflected a predominantly infectious disease burden in low- and middle-income countries, which has since then tilted towards NCDs.
The verbose term NCDs states what this group of diseases are not. It comprises chronic diseases that are usually of long duration. Its causes are a combination of genetic, physiological, environmental and behavioural factors.
The main types of NCDs are cardiovascular diseases, e.g. heart disease and stroke; cancers; chronic respiratory diseases, e.g. chronic obstructive pulmonary disease and asthma; and diabetes.
The marked global increase in NCDs in the past two decades has not been the focus of attention of policy makers, media and the public.
What made media headlines were infectious diseases like the Nipah virus outbreak, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), Avian (bird) flu and Ebola. The health checks at entry points to countries were photo opportunities, but its contribution to control were, at best, debateable.
According to the WHO, NCDs are the leading cause of death in the world with more than 36 million deaths annually – 63% of all annual deaths. (Editor’s note: It is 73% in Malaysia.) Some 80% of all NCD deaths occur in low- and middleincome countries.
Although often associated with senior citizens, the WHO estimates that 15 million “premature” global deaths between the ages of 30 and 69 years are attributed to NCDs, with an estimate of more than 80% in low- and middle-income countries.
The factors that have driven the marked increase in NCDs globally include rapid unplanned urbanisation, globalisation of unhealthy lifestyles and population ageing.
Everyone of all ages is vulnerable to the risk factors of NCDs, which include unhealthy diets; lack of exercise; exposure to tobacco smoke; or harmful alcohol consumption.
Unhealthy diets and lack of exercise may be manifested as high blood pressure, increased blood glucose, raised blood lipids and overweight/obesity.
These “metabolic risk factors” result in bodily changes that increase the risk of NCDs.
High blood pressure, a common condition seen in primary care, can lead to heart attack, stroke, kidney failure and premature death if not detected and/or treated adequately.
About 19% of global deaths annually have been attributed to high blood pressure.
Increased blood glucose leads to diabetes which is a life-long condition that affects many parts of the body. Diabetes can lead to heart disease, stroke, kidney disease and failure, eye problems including blindness, nerve damage, foot problems, infections and premature death, if not detected and/or treated adequately.
Obesity means having too much body fat. It is different from being overweight, i.e. weighing too much.
Both terms mean that a person’s weight is greater than that considered healthy for his or her height.
Calorie intake and output varies with individuals and in the same individual, with age. The factors that affect body weight include genetics, over-eating and lack of exercise.
Obesity increases the risk of heart disease, stroke, diabetes, arthritis and some cancers.
The WHO estimates that 7.2 million deaths annually are attributed to tobacco, which include exposure to second hand smoke; 4.1 million deaths annually to excess salt/sodium intake; more than half of 3.3 million deaths annually to alcohol use; and 1.6 million deaths annually to lack of exercise.
NCDs in Malaysia
According to the Statistics Department, heart disease, stroke, cancers and chronic lower respiratory diseases accounted for 13.5%, 7.1%, 3.7% and 1.8% of all deaths respectively in 2014.
The comparative percentages for pneumonia, septicaemia and transport accidents were 12%, 6.1% and 5.6% respectively.
Data from the National Health and Morbidity Survey (NHMS) report in 2015 revealed that the prevalence in those aged more than 18 years were:
● 30.3% for high blood pressure. It was known in 13.1% and undiagnosed in 17.2%, i.e. for every two persons diagnosed with high blood pressure, three didn’t know they had it.
● 17.7% for diabetes. It was known in 8.3% and undiagnosed in 9.2%, i.e. for every one person diagnosed with diabetes, more than one didn’t know they had it.
● 47.7% for high blood lipids. It was known in 9.1% and undiagnosed in 38.6%, i.e. for every one person diagnosed with high blood lipids, four didn’t know they had it. ●
30.0% for overweight and 17.7% for obesity, based on WHO classification.
According to WHO data in 2011, Malaysia had the highest overweight/obesity prevalence in SouthEast Asia at 44.2%, compared to runners-up Thailand and Singapore at 32.2% and 30.2% respectively.
The NHMS reported that the prevalence of current smokers was 22.8% in those aged more than 15 years, with about a quarter smoking 15-24 cigarettes daily.
The exposure to secondhand smoke at home by smokers and non-smokers was 37.1%.
The Institute of Health’s Second Burden of Disease Study for Malaysia in 2012 singled out high blood pressure, smoking, diabetes, high cholesterol and overweight/ obesity as the biggest contributors to disability and death.
The high undiagnosed percentages of high blood pressure, diabetes and high blood lipids would lead to presentation at a later stage in the disease progression, with increased risks of complications or presentations with complications, resulting in difficulties in management with consequential increased cost.
In short, the population is in an unhealthy state. Not only that, our children are vulnerable to the NCD risk factors right from the time they are conceived.
The increasing and costly burden of NCDs should be of concern to everyone. Policymakers, healthcare providers and the public need to be involved in addressing the silent NCD epidemic by creating a healthy environment conducive to healthy living in which healthy choices become easy choices. Dr Milton Lum was a past president of the Federation of Private Medical Practitioners Associations, Malaysia, and the Malaysian Medical Association. The views expressed do not represent that of any organisation the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.