**1.2 The global perspective on NCDs**

In 2011, the United Nations High-Level Meeting presented and promised a unique opportunity for international communities to take action against the rising

**Figure 1.**

*Percentage of mortality associated with NCDs in Africa, high-resourced and low-resourced countries.*

*Public Health in Developing Countries - Challenges and Opportunities*

meso, and micro level of healthcare.

growing burden of NCDs in low-resourced countries.

**1.1 The global burden of non-communicable disease**

and obesity [1, 2]. For countries with minimal health budgets, every effort needs to be made to reduce patients' reliance on costly medical solutions to health problems, including NCDs, for which drugs are often the first line of treatment to reduce the associated morbidity and premature mortality [3]. Prevention efforts within the healthcare system need to take a broader public health approach to motivate people to address their unhealthy lifestyles that result in the development of NCDs. To achieve this, however, Ministries of Health in low-resourced countries needs factual, timely, and reliable NCDs data that can build a comprehensive information system to provide evidence-based decision-making and to develop appropriate prevention strategies for the specific population affected by NCDs [4, 5].

All healthcare organisations, including governmental and non-governmental institutions, have their strategies to prevent and control diseases and to maintain the health of their community effectively and efficiently. Likewise, healthcare organisations have a strategy for disease prevention and control to maintain the health of the community. Most healthcare systems rely on accurate, timely, correct, and factual data to make political and administrative decisions [4–6]. Moreover, healthcare systems should have a balanced approach in preventing both infectious communicable disease and NCDs, which require factual data at the mega, macro,

This chapter aims to create a better understanding of the growing global burden and perspectives on NCDs. It also aims to reflect on the prevention of NCDs, the global status and availability of NCDs data, and effective strategies to prevent the

Non-communicable diseases (NCDs) are the leading public health challenges globally in the twenty-first century, resulting in ill health, economic loss, life loss, diminished quality of life, and poor social development equally in both high-resourced and low-resourced countries [7, 8]. According to the World Health Organisation Global Status Report (GSR) on non-communicable disease, from 38 million deaths due to NCDs each year, more than 40% were premature and were preventable [9]. Based on the projection of the WHO, by 2025 NCDs will account for over 70% of all deaths globally, with 85% of these occurring in developing countries [10]. Evidences show that if proper prevention approaches are not designed and applied, an estimated 41 million people in low-resourced countries will die from NCDs by 2025, mainly due to cardiovascular diseases (CVDs) (48%), cancers

(21%), chronic respiratory diseases (12%), and diabetes (3%) [11].

Globally, more than 9 million deaths occurred due to NCDs in people under the age of 60, with most being preventable. Untimely losses from NCDs range from 22% amongst men and 35% amongst women in low-resourced countries to 8% amongst men and 10% amongst women in high-resourced countries [10]. According to current research, more than 80% of heart diseases, stroke, hypertension and type 2 diabetes, and over a third of cancers can be prevented by eradicating the common risk factors, mainly tobacco use, unhealthy diets, physical inactivity, and the harmful use of alcohol [12]. The effective prevention and management of common NCDs risk factors require the establishment of a strategic framework which can tackle health problems associated with the growing burden of morbidity and mortality of these diseases [13]. According to evidence by the WHO, globally, NCDs deaths will increase by 17% over the next 10 years, with the most considerable increase being in low-resourced countries such as Africa (27%) and the Eastern Mediterranean region (25%) [7, 8]. Current research indicates that cancer, diabetes, high blood pressure, cardiovascular diseases, and kidney diseases are no longer the

**10**

epidemic of NCDs. The WHO asserts that the world has reached a decisive point in the history of NCDs and has an unprecedented opportunity to alter its course. In an attempt to alter the damaging progression of NCDs, the WHO Member States agreed on a time-bound set on the following nine voluntary global targets to be attained by 2025 [9, 28]:


Furthermore, the world health assembly set a target of a 25% reduction in overall mortality from four major NCDs, including cancer, diabetes, cardiovascular-, and chronic respiratory disease by 2025 [28]. The 25 × 25 strategy is today included in the World Health Organisations Global Action Plan 2013–2020. Amongst the nine voluntary national strategies, two are intended to reduce deaths due to the four illnesses mentioned earlier and to stop the increase in obesity and diabetes. The remaining national strategies focus specifically on incorporating decreased alcohol intake, promoting physical exercise, reducing nutritional salt and smoking, enhancing hypertension control, and improving the treatment of those at risk from the main NCDs. Countries need to make progress on all these targets to attain the overarching target of a 25% reduction of premature mortality from the four major NCDs by 2025 [29–32].

The action plan advocates a comprehensive vision, recognising the social, economic, and political determinants of diseases and the wide-ranging developmental healthcare scheme [29]. Conversely, it is uncertain, in low-resourced countries at a much lower economic level, how these declarations of commitment will be interpreted and implemented [33–35]. The prioritising of infectious communicable disease, a frail healthcare system, and poorly designed NCDs prevention policies prevent low-resourced countries not to implement these declarations of commitment [1, 4].

Moreover, to improve the prevention and control of NCDs, the United Nations High-Level Meeting presented four additional time-bound commitments in 2014

**13**

life [39, 40].

*The Global Burden and Perspectives on Non-Communicable Diseases (NCDs)…*

plodding and incomparable with that of high-resourced countries [1, 36].

which incorporates: "*1) by 2015, consider setting national NCD targets for 2025, 2) by 2015, consider developing national multisector policies and plans to achieve the national targets by 2025; 3) by 2016, reduce risk factors for NCDs, building on guidance set out in the WHO Global NCD Action Plan, and 4) by 2016, strengthen health systems to address NCDs through people-centred primary health care and universal health coverage, building on guidance set out in WHO Global NCD Action Plan*" [28]. Despite the formulation of these four additional time-bound commitments by United Nations High-Level meeting, progress made by the majority of low-resourced countries is

The WHO argues that the global epidemic of NCDs can be reversed through modest investments in interventions that are so low in cost that countries' income levels need not be a significant barrier to successfully implement the nine voluntary global targets and the 25 × 25 strategy. However, what is needed, more importantly, is high levels of commitment, proper planning, community mobilisation, and an intensive focus on a small range of critical actions. The above will ensure quick gains to reduce the significant behavioural risk factors, namely tobacco use, harmful use of alcohol, an unhealthy diet, and physical inactivity, as well as biological

If the current trends continue, the probability of dying prematurely from the four main NCDs is projected to increase in Sub-Saharan Africa but will show a relative decrease in areas such as Europe, the western Pacific, Americas, eastern Mediterranean, and Southeast Asia [37]. It is believed that if the risk factor targets set by the WHO are achieved, the 25 × 25 target will be surpassed in Europe amongst both men and women. In the western Pacific, the target will be achieved in women and almost achieved in men, whist the Americas, Eastern Mediterranean, and Southeast Asia will approach the target with the rising trend in Africa be reversed. In most regions, a more striving 50% tobacco reduction instead of the agreed 30% by 2016 will contribute the most to reducing premature NCD mortality amongst men, followed by addressing raised blood pressure [29, 38]. For women, the highest contributing risk factor towards the premature NCD mortality target will be raised blood pressure in every region except Europe and the Americas, where the ambitious but not approved tobacco reduction would have the most

Different factors predict healthcare systems' capacity to prevent NCDs and its related risk factors. These predictors are determinants of NCDs prevention including the level of physical exercise, dietary choice, organised infrastructure, urbanisation and related policy, cultural norms, and accessibility of health information.

Worldwide industrial expansion and an increased service sector have resulted in less work-related physical exercise, whilst at the same time, modern technology has also made it increasingly convenient to remain sedentary. Many people lead a life with little or no physical exercise, and their leisure time is often spent on sedentary activities such as live online chats, playing computer games, and watching television, with 60% of the world's population being estimated to lead a sedentary

Research indicates that low-resourced countries are experiencing rapid nutritional transitions, lifestyle changes, and epidemiological transition

*DOI: http://dx.doi.org/10.5772/intechopen.89516*

risk factors, such as blood glucose [29, 37].

substantial benefit [33, 35].

**2.1 Level of physical exercise**

**2. Factors influencing the quality of NCDs prevention**

*The Global Burden and Perspectives on Non-Communicable Diseases (NCDs)… DOI: http://dx.doi.org/10.5772/intechopen.89516*

which incorporates: "*1) by 2015, consider setting national NCD targets for 2025, 2) by 2015, consider developing national multisector policies and plans to achieve the national targets by 2025; 3) by 2016, reduce risk factors for NCDs, building on guidance set out in the WHO Global NCD Action Plan, and 4) by 2016, strengthen health systems to address NCDs through people-centred primary health care and universal health coverage, building on guidance set out in WHO Global NCD Action Plan*" [28]. Despite the formulation of these four additional time-bound commitments by United Nations High-Level meeting, progress made by the majority of low-resourced countries is plodding and incomparable with that of high-resourced countries [1, 36].

The WHO argues that the global epidemic of NCDs can be reversed through modest investments in interventions that are so low in cost that countries' income levels need not be a significant barrier to successfully implement the nine voluntary global targets and the 25 × 25 strategy. However, what is needed, more importantly, is high levels of commitment, proper planning, community mobilisation, and an intensive focus on a small range of critical actions. The above will ensure quick gains to reduce the significant behavioural risk factors, namely tobacco use, harmful use of alcohol, an unhealthy diet, and physical inactivity, as well as biological risk factors, such as blood glucose [29, 37].

If the current trends continue, the probability of dying prematurely from the four main NCDs is projected to increase in Sub-Saharan Africa but will show a relative decrease in areas such as Europe, the western Pacific, Americas, eastern Mediterranean, and Southeast Asia [37]. It is believed that if the risk factor targets set by the WHO are achieved, the 25 × 25 target will be surpassed in Europe amongst both men and women. In the western Pacific, the target will be achieved in women and almost achieved in men, whist the Americas, Eastern Mediterranean, and Southeast Asia will approach the target with the rising trend in Africa be reversed. In most regions, a more striving 50% tobacco reduction instead of the agreed 30% by 2016 will contribute the most to reducing premature NCD mortality amongst men, followed by addressing raised blood pressure [29, 38]. For women, the highest contributing risk factor towards the premature NCD mortality target will be raised blood pressure in every region except Europe and the Americas, where the ambitious but not approved tobacco reduction would have the most substantial benefit [33, 35].
