Dear Young Professionals,
We all know about the epidemiological transition. The term ‘transition’ implies the act of passing from one state to the next. I think this is not helpful in today’s NCD climate. There is an overlap now as we all know, the so-called ‘double burden’.
The main phenomenon that concerns me is rate of change. It took 200 years for the ‘West’ to develop, yet developing countries are doing it in decades. This rate of change can itself be harmful – as in the macro-economic field in which countries that adopted neo-liberal markets without adequate infrastructure teetered on the brink of collapse. Witness the drastic public health situation with the rapid economic collapse of the Soviet Union. A rapid curve uptake of lifestyle factors that predispose to CVD without adequate public knowledge, public health controls and secondary care is surely analogous to this.
The rate of increase of non-communicable diseases are much higher in developing countries now– this is due to a number of factors (which we could talk endlessly on) but broadly is down to the fact that countries are industrialising more quickly, partly as a result of the forces of globalisation - we live in an ever-faster society. However, what we should also consider is that the rate of decline of communicable disease is slower – hence there is an overlap that is markedly different to that of the developed world chart 100 years ago. I’m no mathematician, but I m sure that an ‘area under the curve' could measure what I allude to.
We can ruminate over why the rates differ – but why is it that communicable diseases are only slowly declining in the developing world? Could it be that it was the developed world that invented the cures and properly installed sanitation measures, hence resulting in their own rapid decline of communicable disease whilst the developing world cannot afford these products of the ‘rich’ world? Market forces? Goes into the issue with cost of anti-retrovirals for instance…
As for NCDs, the practical issue would be rather than trying to ‘stem’ an epidemic of non-communicable disease, we need to slow uptake of lifestyles that encourage it – as I think sadly we will never truly be able to stem it. I believe in part that Japan’s low rate of coronary disease is due to their slow uptake of Western diets and smoking – I think however that their epidemic is still to come. Note however if Japan (rather than the US) had been the leading influence on global diet – then would we all have a much higher cancer rate, and more hypertensive disease?
Last year I taught cardiology for 2 weeks in Nigeria (Lagos). The drivers on the roads there are nuts! I said to them they have a problem in that they have embraced Western ideas but not the infrastructure. The West took 100 years to develop their road system, learning from their mistakes (and deaths) along the way. In that time, they learnt about road rules, traffic control, law and legislation. To a Westerner, the way people drive in the developing world is crazy. In the West, the vast majority of drivers stop at red lights, stick to their lanes, do not over speed, and are courteous to others. Much of this is because our laws are clear and strong, but importantly they are enforced strictly through thorough policing and technology (eg speed cameras).
The same analogy can be had of CVD. The West took 50-100 years to get fat and unhealthy. In that time we built up health care systems to deal with the problems we created. The problem of the developing world is that due to globalisation, it is embracing change too quickly, and without the infrastructure (in both roads and public health and in other areas like environmental protection) that the West built over half a century.
'Rome was not built in a day'
Those in communicable and non-communicable disease must work together to change policy. Rather than competing, the rate of decline of communicable disease must be quicker in parallel to control of measures for NCDs. We need to shift those curves.
Dr Justin Zaman BSc MBBS MRCP MSc PhD
Consultant Cardiologist, James Paget University Hospital, Great Yarmouth, UK
Honorary Senior Lecturer, University of East Anglia, Norwich, UK
Founder member, Young Professionals Chronic Disease Network
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