Unreported non-communicable diseases : The impact of unreported cases of non-communicable diseases (NCDs) extends beyond individual health and mortality.

While the global health sector has traditionally concentrated on combating infectious diseases, the stealthy and widespread escalation of non-communicable diseases (NCDs) now poses a significant threat to public health, economic security, and progress, especially in low- and middle-income nations.

It is acknowledged that NCDs, including heart diseases, various cancers, chronic respiratory conditions, and diabetes, are the predominant causes of mortality and disability around the world, responsible for 71% of all deaths.

It is recognized that numerous NCD cases go unreported due to a lack of public awareness, insufficient healthcare facilities, and societal stigma, which significantly underplays the actual impact of these illnesses.

There is concern that the unreported instances of NCDs have extensive repercussions that surpass the health and lifespan of individuals, impacting families, communities, and entire countries by placing an unseen strain on healthcare systems, economies, and social frameworks.

There is a highlighted necessity for all-encompassing strategies to enhance the monitoring, documentation, and handling of NCDs to lessen their indirect effects on healthcare systems, advance equal access to health services, and support ongoing development.

The consequences of unreported NCD cases necessitate prompt focus and collaborative efforts from all involved parties, including state authorities, medical professionals, societal groups, and global entities, to incorporate NCD management into primary health care frameworks, improve public health directives, and create worldwide alliances to tackle this escalating health dilemma.

1. Healthcare Spending and National Income:
• NCDs, including coronary heart disease, stroke, type 2 diabetes mellitus, lung, colon, cervical, and breast cancer, chronic obstructive pulmonary disease, and chronic kidney disease, have significant financial consequences.
• A systematic review and meta-analysis of studies evaluated the macro-economic impact of NCD:
• Healthcare Expenditure:
• Cardiovascular disease (CVD) accounted for the highest healthcare expenditure (12–16.5%).
• Other NCDs ranged between 0.7% and 7.4% of healthcare spending.
• Costs varied across countries and regions.
• National Income:
• NCDs also affect national income.
• However, only 13 studies specifically assessed the economic impact on national income.
• The impact varies based on the type of NCD.
• In summary, NCD-related health costs vary globally, affecting both healthcare budgets and national income.
2. Primary Healthcare System Readiness:
• The readiness of primary healthcare systems to prevent and manage NCDs is crucial.
• A systematic review examined readiness/preparedness for NCDs at the primary care level²:
• Supply-Side Perspective:
• Components embedded in the WHO’s health system framework were assessed.
• However, these components are insufficiently prepared for NCDs.
• Readiness was higher for diabetes mellitus and hypertension compared to chronic respiratory diseases (asthma, chronic obstructive pulmonary disease), CVDs, and cancer.
• Demand-Side Perspective:
• Research on the demand-side perspective (essential for health systems) remains scarce.
• Addressing both supply-side and demand-side factors is essential to manage NCDs effectively.
3. Addressing the Challenge:
• To mitigate the indirect impact of unreported NCD cases, we must:
• Strengthen primary healthcare systems.
• Improve readiness for managing NCDs.
• Enhance understanding of both supply-side and demand-side components.
• By doing so, we can better prevent and manage NCDs, ultimately alleviating the burden on healthcare systems and national economies.

 

Focus on LMICs

The impact of unreported cases of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is a significant public health concern.

1. Multimorbidity and Healthcare Systems:
• A systematic review highlighted the prevalence of multimorbidity among adults in LMICs, with a pooled prevalence of 36.4%¹.
• The most common patterns included cardiometabolic and cardiorespiratory conditions¹.
• The review also found that multimorbidity increased with age and was more prevalent among women, the well-off, and urban residents¹.

Prevalence of Multimorbidity:

A systematic review and meta-analysis found a wide variation in the prevalence of multimorbidity among adults in LMICs, ranging from 0.7% to 81.3%, with a pooled prevalence of 36.4%¹.

This variation is influenced by factors such as age, gender, socioeconomic status, and urbanization.

Common Patterns of Multimorbidity:

The review identified cardiometabolic and cardiorespiratory conditions as the most common patterns of multimorbidity¹.

Cardiometabolic conditions often include combinations of diabetes, hypertension, and obesity, while cardiorespiratory conditions may involve chronic obstructive pulmonary disease (COPD) and asthma.

Factors Influencing Multimorbidity:

Age: The prevalence of multimorbidity increases with age, reflecting the cumulative effect of risk factors over time¹.

Gender: Women tend to have higher odds of developing multimorbidity compared to men¹.

Socioeconomic Status: Being well-off is associated with higher odds of NCD multimorbidity, possibly due to lifestyle factors and better access to diagnostic services¹.

Urban Residence: Urban residents have a slightly higher likelihood of multimorbidity, which may be related to urban lifestyle and environmental factors¹.

Impact on Healthcare Systems:

Multimorbidity poses a challenge to healthcare systems in LMICs, which are often not adequately equipped to manage complex, chronic conditions.

The healthcare systems face difficulties in providing integrated care for patients with multiple chronic conditions, leading to fragmented care and increased healthcare costs.

Policy Implications:

There is a need for health policies that address the unique needs of individuals with multimorbidity, focusing on integrated care models.

Policies should also consider preventive measures targeting the modifiable risk factors associated with multimorbidity.

Overall, multimorbidity is a significant and growing challenge in LMICs, with complex patterns and multiple influencing factors. Addressing it requires a comprehensive approach that includes strengthening healthcare systems, implementing integrated care models, and addressing the social determinants of health.

  Financial Burden on Households:

• The chronic nature of NCDs often leads to long-term care costs, which can result in catastrophic health expenditure for patients and their households².
• This financial burden can push families deeper into poverty and exacerbate inequality².
• The average total costs per year to a patient/household in LMICs for conditions like COPD, CVD, cancers, and diabetes were substantial, highlighting the need for social protection interventions².
2. Health System Readiness:
• Health systems in LMICs have not fully adapted to respond to the NCD threat³.
• There is a high rate of non-compliance with prescriptions for chronic diseases in LMICs, which is a major cause of treatment failure³.
• This lack of compliance underscores the need for health systems to improve their approach to managing chronic diseases.
3. Urbanisation and NCD Risk:
• Urbanisation in LMICs is associated with a higher prevalence of type 2 diabetes and increased blood pressure and cholesterol⁴.
• This suggests that urban planning and policies must consider the health implications of rapid urbanisation.

Urbanisation in low- and middle-income countries (LMICs) is a complex phenomenon with far-reaching implications for public health, particularly concerning non-communicable diseases (NCDs).

Urbanisation and Its Health Impacts:

Urbanisation is often accompanied by lifestyle changes that can increase the risk of NCDs¹.

The shift from rural to urban living can lead to decreased physical activity, unhealthy diets, and increased exposure to pollution—all risk factors for NCDs like type 2 diabetes, hypertension, and cardiovascular diseases¹.

Prevalence of NCDs in Urban Areas:

Studies have shown that urban residents in LMICs are more likely to develop type 2 diabetes, high blood pressure, and elevated cholesterol levels compared to their rural counterparts¹.

This is attributed to urban environments that promote sedentary lifestyles and access to processed foods high in sugar and fat¹.

Challenges for Urban Health Systems:

Rapid urbanisation often outpaces the development of health infrastructure, leading to inadequate healthcare services for the growing urban population².

Health systems in LMICs may struggle to cope with the dual burden of infectious diseases and rising NCDs².

Urban Planning and Policy Implications:

Effective urban planning and policies are crucial to mitigate the health risks associated with urbanisation³.

Policies need to address the determinants of NCDs, such as promoting physical activity through the creation of parks and pedestrian-friendly spaces³.

Urban policies should also aim to improve access to healthy foods and reduce the availability of unhealthy options³.

Equity and Social Determinants of Health:

Urbanisation can exacerbate health inequities, with the urban poor often facing the worst health outcomes due to substandard living conditions⁴.

Addressing social determinants of health, such as housing, education, and income, is essential to reduce NCD risk among vulnerable urban populations⁴.

In general, urbanisation in LMICs presents both challenges and opportunities for public health. While it is associated with a higher prevalence of NCDs, thoughtful urban planning and policies can play a pivotal role in creating healthier urban environments. It’s imperative that urban development considers the health implications and works towards equitable solutions that benefit all urban residents.

Overall, unreported NCD cases in LMICs have a profound indirect impact on healthcare systems, household finances, and societal inequality. Addressing these challenges requires a multifaceted approach that includes strengthening health systems, providing social protection, and considering the health impacts of urbanisation. It’s essential to improve the reporting and management of NCDs to mitigate their broader impacts.

 

Recommendations for Further Reading

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