Non-Communicable Disease
Topic outline
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Non-Communicable Diseases: Focus on Diabetes and Cardiovascular Diseases
Welcome to this course. Despite a focus on the control of communicable diseases in developing countries in the past, it is now apparent that non-communicable diseases have crept up on these populations and create a major threat. The module aims to help practitioners understand the size of this threat and its causes, and to develop policies to reduce the growing burden on developing country populations. We cannot cover all non-communicable diseases in this module, and have chosen to focus on CVD and Diabetes. We hope that the learning from this module will help students appreciate the evidence base required to plan interventions to reduce the threat from these conditions.
Lets start by setting the scene with a few key resources:
Facts from a WHO fact sheet:
- Noncommunicable diseases (NCDs) kill 40 million people each year, equivalent to 70% of all deaths globally.
- Each year, 15 million people die from a NCD between the ages of 30 and 69 years; over 80% of these "premature" deaths occur in low- and middle-income countries.
- Cardiovascular diseases account for most NCD deaths, or 17.7 million people annually, followed by cancers (8.8 million), respiratory diseases (3.9million), and diabetes (1.6 million).
- These 4 groups of diseases account for over 80% of all premature NCD deaths.
- Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from a NCD.
- Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs.
In his polemic Offline: NCDs—why are we failing? Richard Horton, Editor of the Lancet and a strong advocate for global health states: "Many political leaders believe that NCDs are just too big and too complex a challenge. And so they are paralysed.....Access to medicines for NCDs should be a decisive matter of human rights...investing in the prevention and treatment of NCDs is good for economic growth." During this course we will be exploring some of the policy changes required to deal with this major threat to global health and development.
The paper Cardiovascular disease in Africa: epidemiological profile and challenges states "From a global perspective, the large and diverse African population is disproportionately affected by cardiovascular disease (CVD). The historical balance between communicable and noncommunicable pathways to CVD in different African regions is dependent on external factors over the life course and at a societal level. The future risk of noncommunicable forms of CVD (predominantly driven by increased rates of hypertension, smoking, and obesity) is a growing public health concern. The incidence of previously rare forms of CVD such as coronary artery disease will increase, in concert with historically prevalent forms of disease, such as rheumatic heart disease, that are yet to be optimally prevented or treated."
For an in-depth exploration of NCDs and economics, take a look at The Lancet Taskforce on NCDs and economics. "The five Taskforce papers show that poverty drives and is driven by NCDs, but that financial protection from high medical costs can break this cycle; price policies and taxation are effective means to reduce NCD risk factors, such as tobacco and unhealthy diet, and can reduce inequalities; and that investment in NCD control results in increased economic growth."
The figure below shows the changes in Disability Adjusted Life Years over time -redrawn from the 2015 Global Burden of Disease study by the NCD Alliance.
Note: While this course focuses on cardiovascular diseases and diabetes, you might also like to explore other Peoples-uni Open Online Courses on Injury Prevention and Global Mental Health which you can also find on this site.
Course Structures and Expectations:
You will find a set of 5 topic areas moving from describing the size of the problem, developing an understanding of the causes, reviewing the evidence for interventions, and thinking about how to set up your own interventions to reduce the burden of illness from NCD. You will find links to a number of online resources in each of these topic areas. The basis of learning is to access these resources, and to reflect on them.How to navigate the course. Click on the hyperlinks to access the various parts of the course. You will find links to a number of relevant readings in the sections marked resources. You are also invited to reflect on the issues identified in the presentations (click on the reflection links - you will then be able to see reflections of previous students and will receive email copies of those who post a reflection after you).
You will find a quiz at the end of the course, and you can gain a certificate if you pass the quiz, access all of the resources and post reflections.
This work is licensed under a Creative Commons Attribution 4.0 International License. -
Size of the problem (burden of illness, macroeconomics)
By the end of this Topic, you should be able to understand the burden of disease from diabetes and cardiovascular disease from a public health perspective
See this short video, from WHO: Global Noncommunicable Disease Network, as an introduction
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Make forum posts: 1
Reflect on the global burden of cardiovascular disease and diabetes, and whether this first section of the course has given you an indication of the burden of illness that is relevant to your own setting?
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Causes (risk factors, including individual, population and socio-cultural determinants)
By the end of this Topic, you should have an understanding of the contribution of major risk factors, including socio-cultural factors, to the causes of diabetes and CVD.
This graphic Determinants and chronic conditions of NCDs (modified from Dans et al., 2011 by Medicus Mundi Switzerand) from Health Promotion and Health Literacy: Toward transformative action for non-communicable diseases is a nice summary of what you will find in the resources section below:
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Make forum posts: 1
Reflect on which of the risk factors for cardiovascular disease might be relevant in your own setting
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Appraising the evidence that underpins international interventions and prevention programmes
By the end of this Topic, you should be able to assess the evidence that underpins international initiatives in the prevention and provision of care for diabetes and cardiovascular diseases including primary and secondary prevention programmes and between population-based and individual-based interventions
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Make forum posts: 1
How good do you think is the evidence underpinning interventions for NCD, and how relevant do you think is the evidence in your setting, since most of it comes from developed countries?
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How can we make health policies to reduce the burden of NCD
By the end of this Topic, you should be able to discuss how diabetes and CVD might be incorporated in a policy agenda relevant to developing countries
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Make forum posts: 1
Do you have an example of a really effective health policy that worked in your country? Do you think it might be possible to develop a policy that could help prevent heart disease where you live?
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Implementing prevention programmes (plan your own)
By the end of this Topic you should be able to consider the implementation of a strategy to implement a successful intervention programme to reduce the burden of illness for CVD or diabetes in your own setting.
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Make forum posts: 1
Reflect on a policy / intervention you might implement in your setting, and then identify any challenges or barriers to implementation, and how they can be overcome.
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Receive a grade Receive a passing gradeOpened: Sunday, 4 August 2019, 11:54 PM
Take this quiz - a mark of 7/10 will qualify towards a certificate for the course
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