21-27 February 2014 #695

Communicating about non-communicable diseases

Countries like Nepal will bear the brunt of of the global cancer pandemic unless we act fast
Elina Pradhan and Bigyan R Bista

BIKRAM RAI
LINE UP: Women and children await their turn at a health camp organised in Siddhi, Chitwan earlier in the year.
Earlier this month, the International Agency for Cancer Research (IARC) released the World Cancer Report 2014 with dire warnings on global cancer burden over the next 20 years. Sadly and predictably, nations like Nepal that lack resources and effective health policies, will bear the brunt of cancer pandemic. The most impoverished will be disproportionately affected due to inequities in access to health services.

The burden of care on Nepal’s health systems from non-communicable diseases (NCD) is high, causing 82 per cent of outpatient visits and 89 per cent of hospitalisations. The National Living Standards Survey (2010/11) reveals a rise in both chronic and acute illnesses. NCDs are responsible for nearly half of total deaths, yet despite the overwhelming need, health infrastructure to deal with these diseases remains inadequate. Only 0.7 per cent of the government budget is allocated for NCDs.

The first national survey into NCDs in 2008 found 37 per cent of the people used tobacco and 28.5 per cent consumed alcohol. Diabetes prevalence was at 10 per cent and hypertension at nine per cent. Sugar consumption, adoption of western-style diets, and air pollution are known risk factors for many NCDs including cancer. A leading cause of death among women is suicide, yet mental health issues remain the most stigmatised and least-addressed of health problems.

More than half of Nepal’s population is between 15-59 years and there is a decreasing dependency ratio. The demographic dividend can provide tremendous boost to economic growth only if aligned with the right fiscal and health policies.   The following policy actions should be taken into consideration to deal with non-communicable diseases:

1. Provide more resources to the NHEICC:

 National Health Education, Information, and Communication Centre (NHEICC) is the government entity responsible for prevention strategies, facility level dissemination of knowledge, and public health communication. Given the upward trend in NCD risk factor prevalence and disease incidence at every level of care, prevention must be the principal strategy in Nepal. The primary recipient of the annual tobacco tax revenue should be the NHEICC whose current budget is a mere 1.8 per cent of that revenue. A Health Education Officer post must be set up in every district hospital to provide preventative counseling and launch awareness campaigns through mass media.

2. Approve and implement a national NCD

policy A national NCD policy draft has been awaiting government approval since 2009. It should be discussed among experts and stakeholders such as the Nepal Public Health Foundation, National Research Council, the Ministry of Finance and Department of Health Services, and pushed through legislation by the Ministry of Health and Population (MOHP) immediately.

3. Create a surveillance system for NCDs and risk factors

MOHP has conducted only one national survey for NCD risk factors in 2008, this should continue focusing on alcohol and tobacco use, diabetes, and hypertension prevalence. The ministry needs to partner up with and mobilise health service NGOs.

4. Alcohol abuse prevention bill

Specific measures to reduce alcohol consumption like regulating existing excise tax on alcohol, increasing public awareness, rallying support around creating a comprehensive anti-alcohol abuse bill should be adopted until the passage and implementation of the bill.

5. Increase mental health-specific resources

The legacy of the conflict, the effect of poor working conditions of millions of Nepalis, and the suffering of separation of their families need to be addressed. Neuropsychiatric conditions are responsible for 10.2 per cent of total disability-adjusted life year lost in Nepal. Mental health disorders are underreported, so awareness, prevention, and treatment programs are a must.   6 Expand early detection and screening centres One of the NCD policies currently in place in a few districts is screening for breast and cervical cancer, hypertension, and diabetes. This should be extended nationwide as a preventive measure. Vaccinations against Hepatitis B and human papillomavirus can greatly reduce liver and cervical cancers.

Nepal has come a long way in the last 30 years in reducing poverty, improving sanitation, and decreasing the total fertility rate. It is on track to meet most of the millennium development goals. However, the country is facing an epidemiological transition, which makes it critical to focus on high morbidity and mortality from non-communicable diseases across the socio-economic spectrum. The newly elected government and Constituent Assembly must make health equity a priority through legislative action and their implementation.

Elina Pradhan is a doctoral student in the Department of Global Health and Population at the Harvard School of Public Health. Bigyan R Bista is a doctoral candidate in Cancer Research at the Department of Biology at Massachusetts Institute of Technology.

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