Lecture 29: Non-communicable Disease

Question 1

what is the epidemiological transition?

Answer 1

characteristic shift in common causes of death + disability from perinatal and communicable to non communicable disease

Question 2

what are the key factors influencing risk burden?

Answer 2

1. strength of causal association bt risk factor + health condition (rr)
2. how common is the exposure to this risk in pop (prevalence)

Question 3

what are the emerging trends in ncds?

Answer 3

increase in non-communicable risk
decrease risk for perinatal/communicable disease

low income —> high income
middle income disease countries, both types of disease co-exist = double burden of disease –> major challenge for health policy

Question 4

what is the risk transition?

Answer 4

change in risks factor profile as countries shift from low to high income countries, where common risks for perinatal + communicable disease

Question 5

myths and reality of ncd/chronic disease

Answer 5

false/true

• high income/>80% of ncd in lmics
• rich people/concentrated among poor
• lmic control infectious diseases first/double burden requires double response
• old people/almost half in 30-69yo
• chronic disease cant be prevented/it can

Question 6

which pop groups are most affected by ncds?

Answer 6

populations living in poverty
those living in lmics

Question 7

role of commercial sector in ncd epidemics

Answer 7

commercial sector:
- creates uneven distribution of risks
- structural driver, unequal ncd epidemic

1. social norms changed
   market to vulnerable targets (socioeconomically deprived, women, children)
   b) shape preferences:
   - influence public policy development
   - concentrate outlets in low socioeconomic areas.
2. greater emphasis on downstream (compared to upstream) strategies has put equity in public health at risk
   a) public health measures have focused on behaviour change (downstream determinants)
   b) difficulties with behaviour change are actively exploited by industries
   - frame education as the most effective solution
   - offer choice and pleasure (so individuals THINK that they are in control)
   - emphasis on moderation.

Question 8

what are strategies used by the industry?

Answer 8

1. shaping the evidence (lobbying, shaping research/funding priorities)
2. employing narratives: focus on youth, individual problem. part of the solution, focus on corporate social responsibility
3. constituency building
   - promoting or sponsoring efforts beyond core business
   - partnerships with charites or health/education-related foundations
4. policy substitution, development, and implemention
   - partnerships or voluntary agreements with government
   - contributing to health policy consultations.

Question 9

policy inertia on implementing food policies

Answer 9

1. food industry opposition
2. government reluctance to regulate tax
   - weak governance systems, conflicts of interest
   - belief in education approaches and market solutions
   - unwilling to battle food industry
3. lack of sufficient public demand for policies
   - usually supportive of policy actions
   - not translated into pressure for change
4. recommended policies not implemented.
   - industry opposition
   - political timidity
   - lack of public pressure

Question 10

to address the commercial determinants of NCDS

Answer 10

1. shift focus from individual behaviours to broader environment and upstream drivers of unhealthy product consumption
2. tackle the broader determinants of health
3. develop effective health policy recognising the tension between commercial and health objectives.

Question 11

tobacco control strategies

Answer 11

monitor tobacco use + prevention policies
protect ppl from tabacco use (liegilations
occer help to quit tobacco use (downstream)
warn about the dangers of tobacco
enforce bans on tabacco advertising, promotion and sponsorship
raise taxes on cigarettes.