Textbook of Chronic Noncommunicable Diseases: The Health Challenge of 21st Century Jai Prakash Narain, Rajesh Kumar
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1Textbook of Chronic Noncommunicable Diseases The Health Challenge of 21st Century2
3Textbook of Chronic Noncommunicable Diseases The Health Challenge of 21st Century
Editors Jai Prakash Narain MBBS (AIIMS) MD MPH (Harvard) MS Senior Advisor (Epidemiology and EIS) National Centre for Disease Control New Delhi, India Former Director Sustainable Development and Healthy Environments/Communicable Diseases World Health Organization Regional Office for South-East Asia Chair, ICMR Technical Working Group on NCD Surveillance New Delhi, India Rajesh Kumar MBBS MD MSc (Epi) FAMS Professor and Head School of Public Health Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh, India Foreword Vishwa Mohan Katoch
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Textbook of Chronic Noncommunicable Diseases: The Health Challenge of 21st Century
First Edition: 2016
Printed at
5Dedicated to
Our Families
During the recent years, noncommunicable diseases (NCDs), especially cardiovascular diseases, stroke, cancer, diabetes and chronic lung disease, are rising alarmingly and constitute the leading cause of death in most countries of the world. As a huge burden and considerable drain on the health resources, they not only impede national economic development but also compromise capacities of the countries to march towards achieving the cherished goal of health for all. Changes in the modern society, globalization, urbanization, etc. are contributing greatly to this health transition.
Contrary to the popular belief, NCDs are no longer diseases of affluence but they impact the poor sections of population particularly hard. The reasons are clear—the poor tend to have risky behaviors such as consumption of tobacco and unhealthy diet but are unable to cope when someone in the family gets sick with chronic diseases. High prevalence of hypertension and other NCDs in tribal and other marginalized sections of society is a matter of great concern. Given the high cost of treatment which are generally met out-of-pocket expenses, the poor get trapped in further poverty trap from which they cannot escape.
These diseases, can, however, be easily prevented to a large extent and at a low cost. The cost-effective and high-impact interventions include avoiding consumption of tobacco products, preventing harmful use of alcohol, eating healthy diet and engaging in physical activities, regulating blood sugar and cholesterol levels, and reducing obesity. There is clear and compelling evidence to show that such lifestyle changes can indeed reverse the trend of rising NCDs.
Against this backdrop, Textbook of Chronic Noncommunicable Diseases: The Health Challenge of 21st Century edited by Drs Jai P Narain and Rajesh Kumar is both timely and relevant. In this book, they undertake a thorough and comprehensive review and analysis of the health and economic consequences that the rising trends of noncommunicable diseases bring. They also underline the health system and individual behavioral changes which are required to effectively tackle the daunting challenge posed by these diseases to the health and social development in the developing countries.12
I congratulate them for spearheading this easy-to-comprehend compilation of very useful technical and programmatic information on various aspects of NCDs. The message from the book is clear that the threat of NCDs is real and can only be overcome by putting the existing knowledge into practice.
I am hopeful that the book will serve as a useful reference resource for health professionals, researchers, national program managers and other stakeholders, as well as the policy makers, contributing thereby towards reining in and even reversing the rising trend of NCDs globally in general and India in particular.
Vishwa Mohan Katoch
Textbook of Chronic Noncommunicable Diseases: The Health Challenge of 21st Century deals with various aspects of chronic noncommunicable diseases (NCDs) which now are the leading cause of death worldwide and will remain the foremost public health challenge in the 21st century. Major NCDs which include heart disease, cancers, diabetes and chronic obstructive lung diseases, not only undermine socioeconomic development at macrolevel but have a major impact at household, family and individual levels. Given the sky rocketing cost of health care and enormous out-of-pocket expenses in low and middle income countries such as India, the chronic diseases are among the most common cause why people get trapped in poverty.
To the best of our knowledge, there is presently no book available nationally or internationally which addresses NCDs in such a comprehensive manner—from disease burden, economic impact to its determinants, and to prevention, early detection and management of common noncommunicable diseases.
There is, indeed a compelling evidence that noncommunicable diseases pose a grave threat to national health and development. They not only cause premature deaths and exacerbate poverty, but also threaten national economies. The message is loud and clear that control of these diseases deserve the highest priority within the health and developmental domain.
The disease burden is high world over and in Asia, and will continue to increase well into the future. In 2014, NCDs killed more people in the South-East Asia region than communicable diseases and all other causes put together. The number of deaths is expected to increase by 21% over the next decade. Lifestyle changes due to or accompanying globalization, urbanization and aging populations are all contributing to the rapidly increasing epidemic of NCDs in the region. As a result, it is becoming increasingly apparent that the millennium development goals in these countries cannot be achieved by 2015 without effectively and urgently addressing the problem of NCDs.
Most importantly, however, these health conditions are relevant to each and every one of us, as we see the growing number of cases of hypertension, diabetes or heart disease among ourselves or among our loved ones. The good news, however is that these chronic diseases are easily preventable with lifestyle and behavioral changes—by reducing risk factors such as use of tobacco and alcohol, unhealthy diet and lack of physical exercise, supported by action from various nonhealth-related sectors. Most of these interventions cost next to nothing!
Recently, the NCDs have attracted global attention—in September 2011, the UN General Assembly discussed NCDs at its high level meeting; only the second time a health issue has been discussed by UN General Assembly. Whether that event will turn out to be game changer for NCD prevention and control, as it happened with HIV/AIDS in 2000, remains to be seen.
The first chapter in the book provides a broad overview of the problem including the evidence relating to the burden of NCDs and the associated health and developmental dimensions. The chapter describes the magnitude of the 14problem, its distribution along the social gradients, the underlying causes that are driving the NCD epidemic, and the impact on health and socioeconomic development at macro-level, and on households and family at micro-level.
The risk factors for NCDs are often linked with lifestyles and are individual behavior related, thereby modifiable or preventable as described by Manmeet Kaur and Rajesh Kumar, from the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Besides the preventable risk factors (use of tobacco, unhealthy diet, lack of physical activity, and harmful consumption of alcohol), they address also issue of social and economic determinants of health in the context of NCDs and related equity issues.
Shanthi Mendis and Oleg Chestnov, from World Health Organization (WHO), Geneva, provide the global best practices and lessons learnt on implementation of population-based cost-effective interventions including what healthy choices people can make and the package of prevention and care interventions, i.e. cost-effective, easily available and have a high impact.
The problem of NCDs in India is well described by DC Jain, et al including the burden, strategic priorities adopted and also future plans. Clearly, NCD prevention and control requires high-level political commitment and additional resources for scaling up effective approaches.
Among the various chronic diseases are big four namely cardiovascular disease, cancer, diabetes, and chronic pulmonary diseases which are responsible for 80% of all deaths. These also share common risk factors as outlined above. Each of these as well as the important problems of childhood obesity and mental illness are described in a separate chapter contributed by well-known experts as:
  • Cardiovascular diseases: Epidemiology, prevention and case management contributed by Meenakshi Sharma and Nirmal Kumar Ganguly, from Indian Council of Medical Research (ICMR) and Sir Ganga Ram Hospital, New Delhi, India.
  • Growing problem of diabetes, especially the trends and the reasons for increasing epidemic of diabetes, why early detection and containment are important by Rajendra Pradeepa, et al from Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
  • Epidemiology, prevention and case management of selected cancers by Surendra Shastri and Aditi Shastri from Tata Memorial Hospital, Mumbai, Maharashtra, India.
  • Chronic respiratory diseases, their distribution, the diagnostic techniques, and clinical management by Sajal Ajmani and SK Sharma, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
  • Childhood obesity is now taking epidemic proportions in many countries as highlighted by Priyanka Rani Garg and Narendra Kumar Arora, International Clinical Epidemiology Network (INCLEN), New Delhi, India. They describe the determinants and consequences of childhood obesity and present strategies to tackle this emerging problem.
  • In addition, Rajesh Sagar and Shrigopal Goyal from AIIMS, New Delhi, India, describe the problem of mental illness and approaches to care in health facilities and at community level.
One of the major interventions to prevent NCDs risk factors relate to health promotion and education for behavior change. Saroj S Jha has contributed a concise and to-the-point discourse on health promotion and education as 15bedrock of NCD prevention and control indicating how to plan and manage health promotion activities at country level. It is clear that the programs must be guided by the overall principles of universal access and social justice, and are addressed as an intersectoral problem in an integrated manner.
Besides changing lifestyles, medicines are a mainstay of prevention and management of NCDs and given that treatment often may have to be taken lifelong, rational use of medicines becomes a critical issue, as articulated by Ranjit Roy Chaudhury and Sangeeta Sharma in one of the chapters.
The chapter by Prashant Mathur, from Indian Council of Medical Research (ICMR), New Delhi, India, identifies the key areas for research in NCDs including basic research to focus on the development of new and effective vaccines, medicines and diagnostics, as well as on the epidemiological, clinical, social and behavioral aspects of the disease.
The link between infectious diseases and NCDs is described by Rajesh Bhatia, Director, Department of Communicable Diseases, World Health Organization (WHO), South-East Asia Region. In fact, many chronic diseases have infectious origin. Among infections, leading to cancers include viruses such as HIV to various sarcomas, human papilloma virus to cervical cancer and hepatitis B to hepatocellular carcinoma as well as some bacterial infections such as Helicobacter pylori causing gastric ulcer. Streptococcal infections in childhood leading to rheumatic heart diseases has been well established, while new evidence is emerging regarding the link between TB and diabetes. There are areas where infectious and noncommunicable disease programs need to collaborate with each other.
As NCD programs are being planned and implemented in various countries, they can benefit from many lessons from HIV and TB programs, as outlined by Tony Harries and Rony Zachariah, from the International Union Against TB and Lung Diseases, Paris in one of the chapters. These lessons encompass strategic approaches, operational aspects and monitoring and evaluation to track progress in program implementation and measuring impact. Indeed, there is much to learn from HIV/AIDS and TB programs in the advocacy area as well.
The chapter on integrating noncommunicable diseases into health system based on primary healthcare is contributed by Monir Islam from WHO highlights the urgent need to deliver efficiently evidence-based NCD prevention and control interventions using primary healthcare approach, and discusses possible solutions to address gaps in strengthening health system especially in the area of health workforce, innovative financing, service delivery and health information system.
The challenges and opportunities for multisectoral action are presented by Subarna Dhital et al from Patan Academy of Health Sciences, Nepal. They argue that a comprehensive and coordinated efforts to prevent NCDs must be supported by action from various nonhealth-related sectors such as individuals, government departments other than health, private sector, NGOs and civil society, thereby unleashing the power of prevention.
Last but not least, Jacob Kumaresan, et al from WHO articulate the role of the United Nations in NCD prevention and control and unveil future UN plans.
As outlined above, the book provides a comprehensive overview of the global and national burden of noncommunicable diseases, the interplay of behavioral and other risk factors including globalization and urbanization, link between 16poverty and disease, and the cost-effective interventions available for prevention and control including the “best buys”. It describes also the contemporary developments at the international level and global best practices, what lessons can be learnt from global experiences and most importantly, actions needed to be taken by the governments, civil society, private sector and the population at large to avert this health and developmental crisis of the 21st century.
Jai Prakash Narain
Rajesh Kumar
The idea of Textbook of Chronic Noncommunicable Diseases: The Health Challenge of 21st Century came about from the realization that materials on various noncommunicable diseases are, to the best of our knowledge, not available in a single source or in a book form. And that such a book will be of great value to the students, teachers, researchers as well as to policymakers and those working in the program at ground level such as community based organizations, NGOs as well as program managers at various levels of health care.
To have covered such enormously diverse aspects of noncommunicable diseases transcending and cutting across various departments and disciplines, we should like to thank the distinguished panel of experts for their contributions. Their commitment and assistance in bringing out the book is greatly appreciated; the range of technical expertise they have shared is the strength and hallmark of the book.
We should like also to acknowledge Dr Vishwa Mohan Katoch, Director–General, Indian Council of Medical Research and Secretary, Department of Health Research in the Government of India for his leadership and whole-hearted support for this undertaking.
We are grateful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing), M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their motivating passion. Finally, the hardwork put in by the team at M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, namely, Ms Samina Khan (PA to Director–Publishing), Mr KK Raman (Production Manager), Mr Sunil Dogra (Production Executive) and Mr Mohit Bhargava (Production Coordinator) is gratefully acknowledged. Their professionalism and efficiency has been remarkable and impressive.
We hope that the book will be of benefit to all those who have committed themselves to combat NCDs and who genuinely care for improving quality of life of the people at large.