How LGUs, city leaders can reduce ‘invisible epidemic’ responsible for most deaths globally
MANILA, Philippines — An “invisible epidemic” which is not contagious is the leading cause of death worldwide.
Known as “non-communicable diseases (NCD),” these illnesses cannot be transmitted from one person to another, but kill 41 million people globally each year and account for 71% of all deaths, according to the World Health Organization.
The global organization said these illnesses "disproportionately affect" low- and middle-income countries where more than three in four NCD deaths occur. It added that NCDs “force millions of people into poverty annually” through exorbitant health care costs and incapacitating household breadwinners.
The most common NCDs are cancers, diabetes, cardiovascular disease, chronic respiratory diseases, while others include Alzheimer's and Parkinson's diseases.
NCDs are generally chronic or progress slowly over a long period of time, but account for more deaths than all communicable diseases combined, including tuberculosis, flu, ebola, and sexually transmitted diseases.
The Centers for Disease Control and Prevention also said “a complete cure is rarely achieved” for NCDs.
What can we change?
One way to address the problem is to reduce the risk factors associated with NCDs.
The CDC defines risk factors as "an aspect of personal behavior or lifestyle, environmental exposure, or a hereditary characteristic that is associated with an increase in the occurrence of a particular disease, injury, or other health condition.”
It said that there are non-modifiable risk factors like age, gender, race and genetics that cannot be reduced or controlled by an intervention.
The CDC, however, also defined modifiable behavior risk factors “that can be reduced or controlled by intervention, thereby reducing the probability of disease.”
Shared modifiable risk factors among the main NCDs are tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol.
WHO said proven, cost-effective solutions exist for governments to reduce the common modifiable risk factors, but added that reducing the impact of NCDs at the individual and societal level entails a “comprehensive approach” involving all sectors, like health, finance, transport, education, and agriculture.
Fortunately, direct interventions can be taken to address the impact and causes of NCDs, according to a new WHO report directed to mayors, local government officials and city policy planners.
Where can city leaders start?
“The Power of Cities: Tackling Non-Communicable Diseases and Road Traffic Injuries,” published Thursday lists initiatives and countermeasures that city leaders can pursue to “tackle the drivers of NCDs, including tobacco use, air pollution, poor diets and lack of exercise, and improve road safety.”
“City leaders make decisions that impact on the health of billions, and for cities to thrive, everyone needs access to services that will improve their health – public transport, safe, clean and attractive outdoor spaces, healthy food, and, of course, affordable health services,” doctor Tedros Adhanom Ghebreyesus, WHO director-general, said in a release.
Ghebreyesus said solutions are urgent since over half of the world’s population lives in cities.
The WHO report dated October 31 said the development of NCDs is affected by “social, economic and environmental determinants, and are often driven by aspects of urbanization.”
Compared to the national government, cities are said to have particular strengths in community engagement, local partnerships, agility, public assets, leadership, innovation and peer-to-peer learning.
The 10 interventions listed in the report are monitoring NCD risk factors, creating a smoke-free city, banning tobacco advertising, reducing the consumption of sugar-sweetened beverages, reducing salt consumption, creating walkable, bikeable and liveable streets, cleaner air, reducing drink-driving, speed management and increasing seat-belt and helmet use.
City monitoring and evaluation are said to have advantages like local focus, enforcement authority, boundaries and jurisdictions, detailed geolocation, and data sources.
“By replicating the most effective measures on a global scale, we can save millions of lives,” WHO global ambassador for NCDs and injuries Michael Bloomberg said.
Can it really be done?
The Philippines’ own lower-middle-income Balanga City is one of the report’s 19 case studies of cities working on NCDs and road safety interventions.
Balanga’s intervention is described as “[a] city-wide approach to creating a smoke-free city and banning tobacco advertising.”
The report said that political leadership and vision-setting are a key external factor in pushing for any local change.
“Mayors and other city leaders play an important role in establishing comprehensive big-picture visions, establishing overarching goals, and fostering support for a policy or programme,” the report read.
“An initiative that does not have explicit approval from the highest levels of city government is less likely to gain widespread acceptance or be sustained over a sufficiently lengthy time to produce meaningful outcomes or impact.”
The report said that former Balanga Mayor and now Bataan Rep. Jose Enrique Garcia III during his time in office from 2007 to 2016 banned tobacco use within designated areas, ran public awareness campaigns, and established a Smoke-Free Task Force to help enforce anti-tobacco legislation.
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