Why NCDs matter in the fight against poverty

As the editor-in-chief I had been contemplating a focus section on NCDs for some time, but I always felt the time was not ripe. The reason was that our core concern is lasting poverty reduction, and the poorest people on our planet tend to suffer more from other diseases. To some extent, that still is true, and yes, NCDs like hypertension, diabetes, cancer and respiratory problems are in some ways diseases of the better-off. However, they affect ever more marginalised people who lack the means to cope with their health condition.

Main drivers of the NCD spread include:

• food that contains too much fat, sugar and/or salt,
• the consumption of tobacco, alcohol and other stimulants,
• lack of physical exercise,
• stress, time pressure, lack of rest and
• plain ageing.

The last point is important. Longevity is a blessing, but ultimately, all human beings are mortal. If infectious diseases, violence or accidents do not kill us, an NCD is likely to cause our death. Blood pressure and blood-sugar levels tend to increase with age, and accordingly strokes, heart attacks, kidney failures and other terminal crises become more likely. The same is true of cancer too. (Some kinds of cancer are actually infectious, but cancer in general is considered an NCD.)

That life-expectancy has been rising in most parts of the world in the past decades is most welcome, of course. The downside is that NCDs are becoming more relevant. And it must be stressed that masses of people get ill too early.  

As societies become more urbanised, the diets of ever more people include unhealthy, pre-processed food products. People who use public transportation, minibuses or cars to move around their cities exercise their muscles less than farmers do. That is especially true if they work in an office or have a monotonous job in a small workshop. Moreover, they are exposed to more noise and more air pollution, and they typically feel more stress and time pressure in daily life.

Internationally, the number of people who are overweight is now twice the number of those who do not get enough food. Being overweight, however, does not mean getting all relevant nutrients. It is not uncommon for heavy people to lack vitamins, for example, if they do not eat enough fruit and vegetables. Obesity makes diabetes, hypertension and cancer more likely. In some ways, the NCDs are interrelated. People with diabetes are prone to get hypertension. Lack of exercise and unfavourable body-mass-indexes compound the problems.

Masses of people who are affected by these diseases are not economically well off. On the contrary, most are too poor to manage their health condition well. Many do not have access to professional health care. And even if they get the right diagnose, many cannot afford medication and other treatments. The people concerned need appropriate medication, however, and they are well-advised to exercise regularly and adopt healthy diets. Those who suffer hypertension must be careful about salt. Diabetics must reduce their consumption of sugar, including carbonhydrates.

Not everyone can afford to switch to animal proteins to still their hunger, however, and that shows that adopting a healthier lifestyle is not only an issue of personal discipline. It often is an issue of money. Gym membership is expensive, and so is organic food.  

NCD patients must manage their condition well. If they do, they are normally spared devastating consequences for a long time. Even most kinds of cancer can be kept in check, but medication and various kinds of high-tech treatment tend to be costly. Many households are overburdened, so entire families plunge into poverty because of one member’s illness. At the same time, NCDs often reduce that person’s ability to work and earn money – especially in later stages. 

Poor patients get stuck in vicious cycles of deprivation. They lack the information, services and resources they need to live in a prudent manner that keeps their condition in check. As they know that they are unlikely to get the support they need, many do not even want to be diagnosed. The result is that their health status deteriorates faster than it has to. The first steps of containing the problem are normally much cheaper than the interventions needed at later stages – but the patients do not understand these things.

For good reason, NCDs are on the agenda of the Sustainable Development Goals. Relevant targets include reducing premature mortality from NCDs by one third, making relevant NCD medication affordable and accessible and achieving universal health coverage. These things are indeed vital issues for fighting poverty.