Non-Communicable Disease

Control
Introduction.

Part ONE:
Epidemiologic transition and determinants of
NCDs
Omech Bernard(Dr)
Lecture outline
• Demographic transition
• Epidemiological transition
• Definition of NCDs
• Burden of NCDs
• NCD risk factors
Demographic transition

• Systematic decrease in fertility and mortality rates of a

population over time ( from high to low)
• Drop in mortality first, followed by drop in fertility some
time later, thus a rise in the population in the
intermediate
• Decline in mortality and fertility due to social and
economic development
Demographic transition

• The combined effect of a shift from high to low mortality

and from high to low fertility (commonly referred to as
the demographic transition) is population ageing:
• Fewer children enter the population while more
individuals survive into old age.
Epidemiological transition

• Population ageing will increasingly bring important

challenges to health care policy makers.
• The changing pattern of diseases, translated into
changing causes of death and morbidity - commonly
referred to as the epidemiological transition.
• This term describes the increasing importance of
disease and death attributable to non-communicable
diseases (NCDs) happening simultaneously with to a
decrease in the importance of infectious diseases.
 The Epidemiological transition (Omran 1971)
•Changes in the burden of • Communicable or infectious diseases
disease • To diseases associated with
• From disease associated • Relative affluence
with
• Smoking, obesity, lack of exercise,
• Poverty alcohol
• Malnutrition • Non-communicable
• Inadequate water and
sanitation
 Epidemiologic transition: Stage 1
Stage of pestilence and famine
• Infectious and parasitic
diseases, accidents, animal and
human attacks (wars) were the
major causes of death
• Inadequate food, fresh water,
infrastructure, services
• High mortality and fertility
(LE 20-40yrs) (some dev in
this stage)
Examples in stage 1:
• The Black Plague, or bubonic
plague, originated in present-day
Kyrgyzstan and was brought from
there by a Tatar army when it
attacked an Italian trading post on
the Black Sea. Italians fleeing
carried infected rats on ships to
major cities of South Eastern
Europe in 1347.
• About 25 million Europeans died between 1347 and
1350, at least one-half of the continent’s population.
• Five other epidemics in the late fourteenth century
added to the toll in Europe.
• In China, 13 million died from the plague in 1380.
Stage of receding pandemics
• A pandemic is disease that occurs over a wide geographic area
and affects a very high proportion of the population.

• Fall in mortality rates (LE 35-50), fertility rates still high

• Increase in economic growth (drop in deaths due to
malnutrition and infectious diseases)
• Social factors become important due to improved pop health
Epidemiologic transition: Stage 2

• Introduction of morden healthcare and health technologies

• Improved sanitation, nutrition, and medicine during the
Industrial revolution reduced the spread of infectious diseases.
• Poor people who crowded into Industrial Cities had high death
rates due to Cholera
Epidemiologic transition: Stage 3

Stage of degenerative and human-created diseases

• Characterized by a decrease in deaths from infectious
diseases and an increase in chronic disorders
associated with aging (CVD and CA)
• Increase in morbidity (high levels of morbidity)
• Health patterns now depend on lifestyle, social and
cultural behavior
 Epidemiologic transition: Stage 4
Stage of delayed degenerative diseases
• The major degenerative causes of death are
cardiovascular diseases and cancers
• Life expectancy improves due to medical advances
• Cancer medicines, bypass surgery, better diet, reduced
use of tobacco, and alcohol
• However, consumption of non-nutritious food and
sedentary behaviour have resulted in an increase in
obesity in this stage.
•Epidemiologic transition: Possible Stage 5

• Stage of reemergence of infectious and parasitic

diseases (hypothesized)
• Infectious diseases thought to have been eradicated or
controlled have returned, and new ones have emerged.
 Reasons for stage 5
Three reasons help to explain the possible emergence of a stage 5
of the epidemiologic transition.
1.Evolution:
• Infectious disease microbes have continuously evolved
and changed in response to environmental pressures by
developing resistance to drugs.
• Malaria was nearly eradicated in the mid-twentieth
century by spraying DDT in areas infested with the
mosquito that carried the parasite.
Reasons for stage 5….

• The disease returned after 1963, however, and now

causes more than 2 million deaths worldwide.
• The reason was the evolution of DDT-resistant
mosquitoes

2. Poverty
3. Re-emergence of epidemics due improved travel.
• As they travel, people carry diseases with them and are
exposed to the diseases of others.
 Epidemiological transition: Current status
• Different countries are at different stages of the
epidemiological transition.
• The epidemiological profiles of developing countries
increasingly reflect diseases and health problems of
adults rather than those of children. (ageing in
developed countries).
• The transition occurs at different paces in different
places, depending on the rate of fertility change, the
distribution of risk factors that contribute to the
incidence of disease, and the health system’s ability to
respond to the changing epidemiological profile.
 Different stages of Regions.
• The gradual shift away from infectious diseases towards
NCDs poses a different sort of challenge for developing
countries.
• According to WHO estimates, in 1990 about 50% of the
burden of disease in developing countries was attributable
to communicable diseases, around 40% to NCDs
(including neuropsychiatric diseases) and the remaining
share attributable to external causes (mostly injuries).
• By 2020 NCDs and injuries are expected to be responsible
for over three-quarters of the disease burden in developing
countries and newly-industrialized countries
 The Double Burden of Disease.
• While infectious diseases are expected to decrease in
importance as a cause of morbidity, resources will
continue to be required for both their treatment and the
prevention.
• At the same time NCDs will increase in both
prevalence and cause of death in most of the
developing countries.
• Hence, the term double burden of disease has been
used to reflect what will emerge as a dominant feature
of public health within the next few decades in the
majority of developing countries.
 Age Period Cohort Effect.
• Age period cohort: three types of time varying phenomena:
Age effects, period effects and cohort effects.

• Age effects: are variations linked to biological and social

processes of aging specific to individuals
• They include physiologic changes and accumulation of
social experiences linked to aging, but unrelated to the time
period or birth cohort to which an individual belongs. In
epidemiological studies age effects are usually denoted by
varying rates of diseases across age groups.
 Age Period Cohort Effect….

• Period effects result from external factors that equally affect all
age groups at a particular calendar time.
• It could arise from a range of environmental, social and
economic factors e.g. war, famine, economic crisis.

• Cohort effects are variations resulting from the unique

experience/exposure of a group of subjects (cohort) as they
move across time.
THE END.