The Triple Burden

Non-communicable diseases, communicable diseases and trauma are emerging as a triple burden for healthcare system of developing countries like Nepal thus hindering our efforts to increase life expectancy, spur economic growth and halting the global strategy for obtaining good health for all. Only prompt and appropriate measures can prevent the nation from the triple burden that, otherwise, might lead us to the vicious cycle of increased death toll, disability and devastating healthcare system among others.

Non-communicable diseases account for 36 million deaths (WHO, 2008) in the world. Among them, 80 % of deaths occur in low and middle income countries. According to World Health Organization (WHO), every year, an estimated 14 million people die prematurely in developing countries from preventable heart disease, stroke, diabetes, cancers and asthma, with major negative consequences for socioeconomic development. By 2020, these diseases are expected to account for seven out of every ten deaths.

Similarly, the number people with diabetes in the world are expected to increase from 194 million in 2003 to 330 in 2030 with three in four living in developing countries. This burden of diseases is the result of complex constellation of social, economic, and behavioral factors like increased exposure to tobacco use, unhealthy diets, sedentary lifestyle and harmful use of alcohol. The problems are going to be severely exacerbated by aging population, urbanization and community planning, unhealthy diets and lifestyles, climate change and rapidly increasing cost of medical technologies in developing countries.

It is predicted that the burden of non-communicable diseases will cost $84 billion by 2015 straining the capacity of the afflicted countries to provide adequate healthcare services if measures are not taken to stabilize and slow this growth.

Similarly, communicable diseases account for one in two deaths in the developing countries where the victims are usually children and young adults. In WHO’s estimation, communicable diseases claim 13 billion deaths a year, making it the cause of 32 percent of total deaths. Almost 90 percent of these deaths are caused by pneumonia, tuberculosis (TB), diarrheal diseases, malaria, measles, and the human immunodeficiency virus (HIV). The increasing spread of communicable diseases has to do with low living standard, urbanization, migration, illiteracy, unavailability of pure drinking water and inadequate sanitation facilities.

An estimated 2.62 million deaths are caused by these infectious diseases in the countries of South East Asia Region where poverty rate is high. In the same way, the poor underlying nutritional status and inadequate immunization coverage are the main predisposing factors for measles which cost 250 000 children’s’ lives in these counties. The curse of the diseases does not end here. New epidemics of SARS, avian influenza and Nipah virus are also severely damaging the exhausted healthcare system in developing countries by sharply increasing the health expenses and thus halting the economic growth.

Unlike the two diseases discussed above, trauma has a significant impact on physical, mental and social well being of the afflicted people. WHO has estimated that trauma and injury account for around nine percent of the global mortality and 12 percent of the global disease burden. More than 90 percent of injury deaths occur and millions more are disabled, temporarily or permanently, in low and middle income countries from road traffic accidents, burns, falls, other types of unintentional injury, violence and suicide.

Sadly in those countries, preventive efforts are often nonexistent; treatment and rehabilitation resources are woefully inadequate; and health-care systems are least prepared to meet the challenge. Alarmingly, road traffic accidents are second only to AIDS in killing young adults. Evidently, this will significantly magnify economic loss from injuries through treatment and rehabilitation costs, not to mention lost wages and wasted productivity. Therefore, trauma is a big curse for healthcare system in developing countries that contributes to rising poverty of an individual and the community.

However, it is possible to come out of this catastrophic impact of triple burden with efficient actions and strategies such as promoting healthy life style, strengthening the healthcare infrastructure and advocating for the effective policies and regulations. Prominent causes for heart disease, diabetes, cancer and pulmonary diseases can simply be reduced by just altering the life style. It is proven that up to 80 percent of cases of coronary heart disease, and up to 90 percent of diabetes, could potentially be avoided by changing lifestyle.

Therefore, emphasis should be given on public health education and awareness programs to persuade the people to quit smoking and reduce the amount of alcohol intake. A healthy diet in place of an unhealthy and obesogenic poor nutrient diet and physical activities like aerobics and yoga in place of sedentary life style can substantially reduce the risk of obesity and chronic diseases.

Similarly, safe water supply and sewage disposal, advances in food hygiene, improvement in housing and general civic environments and adequate immunization can considerably reduce the burden of infectious disease. In case of trauma, though the preventing measures like increasing infrastructure, improving road and vehicular safety and traffic management, tackling the inappropriately high speeds and alcohol impaired driving by implementation of traffic laws may interfere the incidents and lower the death and disability, the victims are in dire need of post-injury treatment and rehabilitation services.

Therefore, the combination of preventive as well as curative methods like providing safe and timely medical care, easy access to essential surgical services can yield better result while coping with the injuries. Moreover, this requires a greater investment in infrastructure, physical resources and supplies, and trained health workers to tackle trauma burden.

The triple burden is a major healthcare problem in developing countries that is claiming millions of lives and thousands of disabilities. This, in turn, is exerting extra pressure on healthcare expense and leading the victims into abysmal poverty. Only by adopting preventive, curative and supportive measures, strengthening healthcare infrastructures, public health promotion and broadening international coalition, we can fight this burden.

(This article was published in Republica Daily on 17/01/2012)

My education includes training in medicine, public health, clinical research, biostatistics and health response in complex emergency. I have more than seven years of experiences in health research (Survey, Case control studies, Randomised Controlled Trials (RCT), Health Policy and Systems Research). My areas of expertise also include the project management particularly in health sector. I have also experience and interest to work in health emergency in large population in disaster setting.

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One Response to “The Triple Burden”

  1. annonymous says:

    Article is highly informative. No doubt, the burden of disease is in world now shifting towards the non communicable disease. According to WHO, Of 57 million global deaths in 2008, 36 million, or 63%, were due to noncommunicable diseases. Among them, cardiovascular diseases (17 million deaths, or 48% of all NCD deaths), cancers (7.6 million, or 21% of all NCD deaths), and respiratory diseases, including asthma and chronic obstructive pulmonary disease (4.2 million). Diabetes caused another 1.3 million deaths.

    So developing countries should adopt the appropriate policies to minimize the avoidable consequences of these non communicable diseases urgently…

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