Recognizing Non Communicable Diseases (NCDs)-Nationally and Globally

Non-communicable diseases (NCDs) are the leading cause of health concerns in

the 21st century, causing more deaths than all other deaths combined and they strike

hardest at the low-middle income populations. They account for two-thirds of all global

deaths, and in large parts of the developing world, NCDs are detected late, leading to

hospital care, and enormous medical expenditures. These cause billions in losses to

national income and they put millions of people below the poverty line each year.

(2011) The global rise in NCDs suggests that all members of the population are

increasingly being affected by chronic conditions. From children, teenagers, parents, the

elderly and the general public, NCDs have been a major health concern. In various parts

of the world, NCDs have been identified as a health emergency affecting all members of

the population. Findings reveal that nutrient-poor diet, lifestyle choices and lack of

exercise are associated with obesity and subsequent NCDs that lead to morbidity and

mortality of the affected. In fact, NCDs have replaced the communicable diseases as the

most common causes of premature mortality in the world. NCDs have a major impact

on health care costs, productivity, and development of the population. On the opposite

side, there has been a lot to learn from these diseases in the past thirty years. The

World Health Organization is working with 190 countries to reduce the four main types

of NCDs with a global target of 25% mortality rate by 2025. (2013) For the reasons

above, this paper will review the background of NCDs nationally and globally. A

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reflection on the United States workforce and the impact of the introduced Affordable

Care Act or Obamacare will be used to assess its role on the aspects of NCDs.

Introduction

Non-communicable diseases (NCDs), also known as chronic diseases are non-

infectious and non-transmissible diseases that may be caused by genetic or behavioral

factors and generally have a slow progression and long duration. (2015) NCDs have been

reported as the number one cause of death globally. The term NCDs is associated with

some conditions that are not caused by acute infections, lead to the development of

long-term health consequences and create a need for long-term care. These include

cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. NCDs have

also been caused by genetic factors and tend to have a slow progression. According to

Alleyne et al. (2013), about half of all adults in the United States were reported to have

one or more of the chronic health conditions in 2012. That represented about 117

million people, a number that has evidently risen in the past three years with

devastating consequences on health-care costs (2010) the global economic impact of

NCDs is huge, and the US has increased its efforts to tackle the growing health challenge

that is threatening the productivity of the skilled workforce. A brief snapshot of the

increasing global burden of NCDs reveals that 50% of the economic burden is accounted

for by the cardiovascular diseases that cause more deaths than malaria, HIV/AIDS, and

TB combined. The high rates of chronic disease create substantial challenges for the

worldwide health care systems as healthcare experts have noted that not many systems

prioritize on sustained long-term investments in either health promotion or disease

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prevention. This challenge requires sustained policies and programs that will focus on

high-value prevention targets.

Background on NCDs

In recent years, NCDs have become an emerging pandemic in the world with

disproportionately higher rates recorded in developing nations. NCDs were once

referred to as the diseases of affluence but have come to encroach the developing

nations (D.E. Bloom, 2011). In 2007, 80% of the NCDs were reported in low-and-middle-

income nations, rising sharply from just what was under 40% in the 1990s. Reports from

the World Health Organization indicate that the NCDs will account for 80% of the global

burden of disease, being the cause of 70% of deaths in developing nations, with 50% of

them being premature deaths of people under the age of 70. According to Alwan (2011),

people with NCDs are the most frequent users of the health care in the United States.

Consequently, they impose a large burden on human wealth in the United States and

globally. Alarmingly, mortality rates related to NCDs are occurring at earlier stages in

both developing and developed nations. Currently, an estimated 63% of all deaths in the

world are related to NCDs. Moreover, NCDs are increasingly having an effect throughout

the age distribution. That is, already 30% of all deaths related to chronic diseases are

among people who fall below 60 years. What is more is that NCDs are responsible for

50% of the healthy years lost all over the world. The rationale for paying more attention

to the chronic diseases debate is the projected likelihood that shows that the number of

people suffering from the diseases will rise substantially in the next decades. The UN

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projects that an estimated 2 billion more people will be affected by NCDs by 2050.

Figure 1 in the appendix shows a graph comparison of NCD deaths to non-NCD deaths

globally. The lower-middle income in both male and female is ranked highest. The

numbers are staggering. Figure 2 in the appendix shows the proportion of global NCD

deaths under the age of 70, by cause of death. Its very easy to see that cardiovascular

disease is the number one cause of death.

Meanwhile, nations are coming up with strategies that for addressing NCDs as

well as risk factors through changing health infrastructure, funding mechanisms, and

improved policy responses. So far the reality shows that the approaches as they are

today are making progress but are not on course to meet the target for 2025.

NCDs are not a new problem in the US and globally. They are a major concern for

these nations because of the impact of globalization on consumption and the aging

populations. Across the world, NCDs have caused more than 38 million deaths annually

(63% global) including more than 14 million people who die between the ages of 30 and

70 (2013, 2013) and are among the leading causes of disability and preventable illness.

The growing burden of chronic diseases creates an economic cost as the population

becomes increasingly less productive and less able to continue working to their optimal

years in life, thereby, dying prematurely. According to Balbus et al. (2013), if the trend of

NCDs peaks up as projected, they will cause a cumulative loss of productivity of over $48

trillion by 2030. The most pronounced effect of NCDs in the world is the escalating

health care costs. Also, the effects of the rising cases of people with chronic diseases

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around the world can be felt on the lost productivity as a result of the disability and

subsequent death among the working age population (2014).

The Burden of NCDs: Global and National Statistics

Noncommunicable diseases represent an urgent global public health emergency. They

are a critical challenge for the United States and developing nations at every stage in

their development. In the US, NCDs account for 80% of the deaths, limit the day-to-day

operations of tens of millions of more American citizens and cost its economy billions of

dollars every year. Across the globe, NCDs have been reported to kill consistently over

38 million annually, representing almost two-thirds of the deaths in the world. As

mentioned earlier, more of these deaths are in low-and-middle income nations where

there are inadequate health systems that cannot deal with the disease burden of these

conditions.

In the United States, the Medicare expenditure for people above 65 years was

more than $300 billion in the year 2010. To add on to that, 93% of this Medicare

expenditure was for the population with more than two NCDs (2012). A decade ago,

chronic diseases attracted a total spending of an estimated $2 trillion of which 75% was

used to treat chronic diseases. The ailing workforce costs employers $153 billion

annually, set to rise to $1.2 trillion by 2023 and $5.6 trillion by 2050. (Ehrlich) Employees

spend most of their time at work so employers have an advantage to lessen the impact

on their bottom line and help affect NCDs from being intensified. The cost of chronic

diseases is expected to rise in the next decade and at the moment, treating people with

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chronic diseases accounts for 86% of the nations health care costs (2015). NCDs have a

broader impact on the economy. Just five years ago, chronic diseases accounted for

over 75% of the approximately $2.6 trillion used every year on health care. (2012)

Staggering Costs of Chronic Disease: (2015)

1. Cardiovascular diseases (heart disease and stroke) estimated to be $315 billion

2. Cancer care- $157 billion

3. Diabetes- $245 billion and $69 billion in decreased productivity (absent from

work, less productive at work or not being able to work at all).

4. Obesity- $147 billion. Annual medical costs for people who are obese were

$1,429 higher for people of normal weight since 2006.

5. Smoking- $289 billion including $156 billion lost for productivity.

6. Alcohol - $233 billion and most is from binge drinking which resulted in loss in

workplace productivity.

Impact of NCDs on the U.S Working Force and the Effect of the Affordable

Care Act

NCDs are significant drivers of health care costs. The American workers

represent one of the largest groups with high rates of chronic diseases. Extensive

research indicates that a large proportion of the American employees has at least one of

the aforementioned chronic conditions. More specifically, almost 80% of the employees

have been found to have at least one chronic condition while 56% have more than one

chronic condition. This leaves the future of the U.S. workforce at a delicate place. The

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rapidly rising costs on health care are making it difficult for businesses to continue

offering health benefits. Of all the conditions, the most expensive health condition in

the United States is cardiovascular disease that costs an estimated $411 million per

state. Also, the costs of lost productivity in the form of absenteeism from cardiovascular

disease fall between $24 million and $1.4 billion for every state per year (2010). The

number of workers with chronic diseases is expected to rise in the next five years in the

United States. Consequently, medical costs are expected to rise at an alarming rate at

the same time when the workforces productivity is projected to significantly decrease.

According to Bloom et al. (2011), the high number of the US workforce with

chronic diseases demands greater rates of employee compensation claims than other

groups. Many employees are, reportedly, going to work despite being sick and are,

therefore, less productive. More employers are reporting more cases of presenteeism

with the leading cause being chronic conditions. Some of the costly chronic illnesses to

businesses on presenteeism are arthritis and hypertension. However, obesity costs the

American businesses billions in lost productivity. Noting that 85% of the full-time

workers are either overweight or have at least one chronic condition, the levels of lost

productivity are expected to be a major cause of critical concern in the next decade.

According to Beaglehole et al. (2011), absenteeism related to overweight and chronic

conditions costs organizations over $1555 billion annually in lost productivity. The lost

productivity due to chronic conditions is associated with enormous costs for those

employees remaining in the workforce as well as those who leave as a result of

disability. High rates of NCDs among the United States workforce hinder the ability of

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American businesses to compete globally. The problems associated with reduced

productivity and efficiency represent real losses of productivity for American businesses.

Obamacare, or the Affordable Care Act, has had a huge impact on chronic care.

Before Obamacare, the insurance companies would deny coverage to people who were

found to be too risky by having a pre-existing condition. According to Bauer et al. (2014),

the Affordable Care Act has had a meaningful effect on both diagnosis and management

of the chronic illnesses affecting Americans. This has helped more than 600,000 people

to gain control of their previously unmanageable conditions (2011). People suffering

from chronic illnesses were always suffering from the broken healthcare systems. Too

many people suffered as they tried to struggle with enormous medical bills, but with the

Affordable Care Act the levels of treatment have improved. The future of people with

chronic diseases is positive as affordable care relieves them of huge expenses and

guarantees better care. It has also provided a team-based form of care for the American

people in all age groups.

Conclusion

NCDs have had a huge impact on societies worldwide. From the developed to the

developing nations, the rates of people with chronic illnesses are rising at an alarming

rate. The morbidity and mortality rates as a result of NCDs have been rising in the

United States in the past decade with a negative impact on the health of the American

workforce. NCDs are a critical challenge for United States and other nations at every

stage on their growth. In the United States, chronic diseases have been reported to

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account for 80% of deaths, limiting the day-to-day operations of tens of millions of more

American citizens. However, the Affordable Care Act promises to improve the

management of chronic illnesses among the US workforce. Collaboration between

different stakeholders is required to form a collaborative platform to counter the

negative effects of chronic diseases. Sustained policies and programs that focus on

prevention targets will be required in clinical health care. If the current trend of chronic

diseases in developed and developing nations continues, the world will suffer from a

health crisis in the future. Together with the interventions that have been integrated by

WHO, such as advertising bans for tobacco, and reduction of salt in food, chronic

diseases can be prevented and managed. (2005)

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Appendix

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