Slow-motion pandemic of non-communicable diseases

WHILE the world mounts a rapid, unprecedented and justifiably massive response to the global coronavirus pandemic, one chronic pandemic continues unabated. Although it was once seen as the “diseases of affluence”, this worldwide burden now affects every country on the planet and contributes to 41 million deaths annually. It is the slow motion pandemic of non-communicable diseases (NCDs).

The lack of political and societal commitment to tackling the NCD pandemic has created a huge, yet avoidable health burden, not to mention the countless lives already lost to it. However, with coronavirus disease 2019 (COVID-19) sweeping across the globe, it appears that the confluence of these two pandemics has created a dangerous double burden of disease.

Emerging literature suggests that the same populations that are affected the most by the NCD pandemic are also at risk of poorer outcomes from COVID-19, as many NCDs or NCD-related risk factors are also risk factors and predictors for severe COVID-19, such as diabetes mellitus, cardiovascular disease, respiratory disease, cancer and obesity. There is also anecdotal evidence of delayed health-seeking behaviour due to fear of contracting COVID-19. Consequently, late presentations for both acute and chronic conditions are triggering concerns that they may increase risks to the NCD burden and the health system in general.

Therefore, it is imperative that we focus on tackling the long overlooked NCD pandemic in our recovery from COVID-19 and apply the learning from our response to the current pandemic to the challenges we face against NCDs. Cities and governments should prioritise pedestrians, cyclists, and public transport, and invest in the relevant infrastructure to promote a low carbon post-COVID-19 future. This would not only increase physical activity, a noted protective mechanism against many chronic diseases, but also decrease air pollution, which has been shown to have a connection to increased risk of certain infectious respiratory diseases and higher COVID-19 death rates.

There are recent commitments to create healthy sustainable cities around the world by promoting active transport, such as in New South Wales, London and Milan. We strongly encourage that more cities and local governments embrace similar urban policies to safeguard and enhance their populations’ health against future pandemics, both communicable and chronic.

According to the 2020 Global Nutrition Report, one in nine people in the world is hungry or undernourished, and one in three is overweight or obese. Emerging data from China and France now suggest a possible link between obesity and the health risks posed by COVID-19. Weight appears to be an important risk factor for COVID-19 severity, especially among young adults. Given the strong relationship between obesity and low socio-economic status, this means that COVID-19’s impacts on our society are extremely unequally distributed, with those who are the most socially disadvantaged also suffering the most. Yet, this pandemic presents governments with the opportunity to reset and build more diverse food systems that will increase the availability of healthier food and improve people’s health. We must build food systems that are not only less susceptible to disruptions, but more sustainable and equitable for the benefit of people around the world as well as the planet itself.

Moving forward, we will need to manage the direct impacts stemming from both pandemics, including the increased burden that will be created due to COVID-19’s impacts on the health system, the delays which have occurred in health seeking and screening, as well as the economic impacts of NCDs on vulnerable populations. But we also must realise that there will be indirect, generational impacts that will be felt years from now, which we must also prepare for.

We propose the following objectives to responsibly manage the post-COVID recovery and transition.

First, NCD prevention must be included in the post-COVID recovery strategy. We can no longer afford to overlook this equally significant and deadly pandemic, for myriad health and economic reasons.

Second, governments should expand investment to avoid a second wave of chronic disease and the associated widening of health and societal inequities. Preventive health services and local small businesses are two different areas of investment that would help promote good health.

Third, this is an opportunity to aim for a healthier population overall, not only to recover from the COVID-19 pandemic. The lack of action thus far to tackle the NCD pandemic globally has placed populations at greater risk from this acute threat. But with more of us currently focused on protecting our health, let’s ensure the massive changes reshaping our work, lives, cities and economies result in it being easier for all Australians to improve their mental and physical health. Let’s aim for a healthier and fairer society long term, not just one free from COVID-19.

Dr Sandro Demaio is the CEO of VicHealth, and the co-host of ABC’s Ask the Doctor.

Edwin Kwong is a Research Assistant at the University of Melbourne.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.