Hi. I'm Alessandro, and I'll be talking to you about NCDs. Let's start by asking what are NCDs? NCDs, or non-communicable diseases, are a group of diseases characterized by the fact that you cannot catch them from another person. They are non-communicable or non contagious. The main four NCDs are diabetes, cardiovascular disease, cancer and chronic lung diseases. We won't cover them today, but kidney disease, mental illness, chronic back pain, road accidents, epilepsy and many others are also actually non-communicable diseases. In this lecture, I'll just cover the main four. We focus on these four for two reasons. First, is that they are the major contributors to global mortality, but also because these four main diseases share four modifiable risk factors. This means that through addressing these four risk factors, we can make considerable progress in reducing the burden of all four diseases at once. Let's take a closer look at diabetes. Over time, diabetes can damage the heart, blood vessels, eyes, kidneys and nerves. As a result, adults with diabetes have a two to threefold increase our risk of heart attacks and strokes. Diabetes is a long-term or chronic disease that occurs when either the pancreas doesn't produce sufficient insulin for the body or when the body cannot use or respond to the insulin it produces efficiently. Insulin is a hormone produced by the pancreas, and it regulates blood sugar levels allowing the body to power its cells. Hyperglycemia, or increased blood sugar, is a common outcome of poorly controlled diabetes. Over time, the high sugar levels result in serious and sometimes permanent damage to many of the body's systems and organs, particularly the nerves and blood vessels. There are four main types of diabetes. Type 1, type 2, gestational diabetes and impaired glucose tolerance or pre-diabetes. Type 1 Diabetes, sometimes known as insulin dependent, juvenile or childhood-onset diabetes, is when the body is unable to make enough insulin or any insulin and requires daily injections or administration of insulin, as well as close blood sugar monitoring. The cause of type 1 diabetes is not known, and it's not preventable. It usually begins to manifest in the second or third decades of life. Symptoms include excessive urine, thirst, consistent hunger, rapid or large amounts of weight loss, visual changes, and fatigue. These symptoms may occur suddenly and can be life-threatening. Different from this is type 2 diabetes. This largely results from the body's ineffective use of insulin. Type 2 Diabetes is by far the most common form of diabetes around the world today, and largely results from the rising levels of overweight and obesity and physical inactivity. Symptoms may be similar to Type 1 diabetes but are often subtler to begin with and developed over many months or even years. As a result, the disease may be diagnosed several years after onset and even once complications have began to arise. Until recently, this type of diabetes was seen only in adults, but it is now also occurring increasingly frequently in children and adolescents. While normal hormonal and physical changes in pregnancy due increased insulin resistance, gestational diabetes is high blood sugar levels with values above normal, but below the diagnostic criteria for diabetes, and occurring during pregnancy. Women with gestational diabetes are at an increased risk of complications during pregnancy, such as pre-eclampsia and at delivery, often as a result of larger childbirth weights. They and their children are also at increased risk of type 2 diabetes in the future. Gestational diabetes is usually diagnosed through prenatal screening. Impaired glucose tolerance and impaired fasting glycemia, are conditions on the continuum of developing diabetes from Healthy to type 2 diabetes. In other words, the body is beginning to develop diabetes but has not fully lost its capacity to produce sufficient insulin, and may still be able to utilize it but in a nonetheless effective way than normal. These days conditions often go undiagnosed, but if found, can be amenable to lifestyle-based interventions like weight-loss, improvements in diet and increases in physical activity. So, how can we avoid Type 2 diabetes? Well, the best ways to reduce your chance of developing type 2 diabetes or even impaired glucose tolerance is to maintain a healthy lifestyle, achieve and maintain a healthy body weight, be physically active, eat a diverse and balanced diet rich in whole grains and fruit and vegetables, avoiding sugar and saturated fats, and not use tobacco. Those living with diabetes should continue to lead a healthy lifestyle, but also control their blood sugar levels closely, particularly in type 1 diabetes. People with type 1 diabetes require insulin, and people with type 2 diabetes can often be treated with oral medication but may also require insulin injections. In addition, people living with diabetes should be mindful of their blood pressure and keeping their blood pressure well-controlled, have their eyes checked, their kidneys and feet checked regularly by health care professional, and have regular check-ups in primary care. Let's now look at another of the four NCDs, namely cancer. Cancer is a generic term for large and diverse group of diseases associated with the abnormal growth of cells. beyond the usual anatomical boundaries. Other terms include tumors and neoplasms. Cancers can affect almost any cell in any part of the body, and has many anatomic and molecular sub-types that each require specific treatment approaches. Worldwide, the most common types of cancer in men include lung, prostate, colorectal, stomach, and liver cancer, while breast, colorectal, lung, cervix, and thyroid cancer are the most common in women. So, how do we treat cancer? Well, treatments for cancer vary widely. Some people will have treatments that require only one modality, while most people will receive a combination of treatments. Common treatment groups include surgery, radiation, chemotherapy, immunotherapy, targeted therapy, hormone therapy, stem cell transplants, and the emerging areas of precision medicine. Cancer can also be prevented by removing key risk factors. While risk factors like age, gender, and ethnicity cannot be altered, others can. Current evidence shows that between 30% and 50% of cancer deaths can be prevented by modifying or avoiding key risk factors, such as avoiding tobacco products, avoiding alcohol consumption, maintaining a healthy body weight, exercising regularly, and addressing infection-related risk factors. The use of tobacco deserves specific mention, as it kills approximately six million people each year from cancer and other diseases. Tobacco smoking causes many types of cancer, including lung, esophagus, larynx or voice box, mouth, throat, kidney, bladder, pancreas, stomach, and even cervix. In addition, smoke from those around us or secondhand smoke is a known cause of lung cancer in nonsmoking adults. Overweight and obesity are also linked to many types of cancer. Diets high in fruit and vegetables, rich in fiber, and together with physical activity and the maintenance of a healthy body weight can reduce the risks of cancer. Alcohol use is also associated with cancer of the mouth, throat, esophagus, liver, bile, and breast. By reducing the amount of alcohol consumed, the risk of cancer will also be decreased. While they are an NCD, approximately 15% of all cancers in 2012 were actually linked to infectious agents, such as Helicobacter pylori, human papilloma virus or HPV, Hepatitis B and C, and Epstein-Barr Virus or EBV. Cardiovascular disease is the third NCD I'll now talk about. CVDs are group of disorders of the heart and blood vessels. These include coronary heart disease, diseases of the blood vessels supplying the heart muscle; cerebrovascular disease, diseases of the blood vessels supplying the brain; peripheral arterial disease, diseases of the blood vessels supplying the legs and the arms; rheumatic heart disease, damage to the heart muscle and heart valves from rheumatic fever caused by streptococcal bacteria; congenital heart disease, which have malformations of heart structures existing at birth; and pulmonary embolism, blood clots in the legs and veins which can dislodge and move to the heart and lungs and often cause breathing difficulties. Heart attacks and strokes are usually acute events, meaning their onset is very sudden. They're predominately caused by a blockage that prevents blood from flowing through an artery to the critical tissues of the heart or the brain. So, what are the most important risk factors when it comes to CVDs? Well, unhealthy diet, physical inactivity, tobacco use, and the use of alcohol are all key risk factors for heart disease and strokes. In addition, it is proven that older age and family history of heart disease are both important factors in determining risk. The effect of these risks may show up in individuals as raised blood pressure, raised blood glucose, raised blood fats, or as overweight and obesity. These are intermediate risk factors. Individuals can be checked for these in primary care or general practice facilities and receive further prevention depending on the indicated risk of developing a heart attack, stroke, heart failure, or other complications. The last NCD I'll now mention is chronic respiratory or lung disease. Chronic respiratory or lung diseases are diseases of the airways and structures of the lung crucial for the breathing process. Some of the most common forms of chronic lung disease include chronic obstructive pulmonary disease or COPD, asthma, respiratory allergies, occupational lung diseases, and pulmonary hypertension or high blood pressure. The main risk factors for chronic respiratory diseases include tobacco use, indoor air pollution, outdoor air pollution, allergies, occupational exposures like dust or chemicals, and frequent chest infections during childhood. Chronic obstructive pulmonary disease is one of the most common lung diseases, and is a term used to actually describe a group of lung diseases that are caused by limitations in lung airflow and oxygen transfer. More than three million people die each year from COPD, accounting for more than 1 in 20 deaths globally. The causes of COPD vary substantially depending on where you are in the world. In high and middle-income countries, tobacco use is by far the most significant risk factor. An important additional risk factor in low-income countries, though, is the exposure to indoor air pollution, such as using biomass fuels for cooking and heating often inside a closed home. Another common chronic lung disease is asthma, thought to affect 235 million people worldwide and very common among children. Asthma is a long-term disease characterized by recurrent attacks of breathlessness and wheezing. Asthma often begins early in life, but varies in severity and frequency from person-to-person. It is frequently undiagnosed or untreated, creating a substantial burden on individuals and their families, often with lifelong effects on health, educational, and employment opportunities. The symptoms may affect an individual on a daily, weekly, or even less often basis, and vary or worsen with physical activity, cold weather, and at night. During an attack, the walls of the tubes in the lungs swell, causing the airways to tighten and narrow and reducing the flow of air into and out of the lungs. This can quickly become life-threatening if not treated appropriately and quickly. Let's bust the common myths we hear about NCDs. First of all, are NCDs diseases of tomorrow? Well, sadly, no. NCDs already account for 63% of all global deaths, 36 of the 57 million each year. That's more than HIV, TB, and malaria combined. Number 2, NCDs are only a problem for the rich, right? We're wrong again. Eighty percent of NCD deaths occur in low and middle-income countries. In addition, NCDs are a cause of and drive in turn poverty, both directly and often massive and lifelong health care costs, but also indirectly through the costs on productivity across whole families and even communities. Number 3, we're getting older and so we need to all die of something, right? Well, while death is a natural part of life, more than 9 million of the 36 million deaths attributed to NCDs occur before the age of 60. That's about one in four, and at the same time, more than 40 million children globally are now overweight or obese, and that number is rising in almost every nation. NCDs are therefore set to increase even further and affect these populations early in their life course. Number 4, NCDs are diseases of men. Well, no. Worldwide, NCDs affect men and women equally. On top of the direct disease burden, though, women are often the caregivers in many cultures and geographies. NCDs often require long-term care, and this indirect burden often overwhelmingly is born by women. Number 5, well, we can't do anything about this problem, and that's absolutely not true. NCDs are largely preventable epidemic. In fact, up to 80% of diabetes, and heart disease, and a third to half of all cancers are preventable today. Finally, NCDs are an outcome of laziness or poor choice by individuals. I hear this all the time and it's not true. NCDs are deeply linked to the social and commercial determinants, as well as our urban and food environments. While these are major shapers of disease risk, they're also key to tackling NCDs. Many of the most cost-effective interventions are at the population and policy levels in addressing the environmental, social, and commercial determinants of NCDs, and the risk factors we've already discussed. Well, this has been a quick run-through of NCDs. Thanks for listening.
