What are the main types of noncommunicable disease (NCD)?
The main types of NCD are cardiovascular disease, cancer, chronic respiratory diseases and diabetes.
These have been identified as the principal conditions for three main reasons. One is that, collectively, they contribute the most to the total disease burden.
Secondly, they share risk factors such as tobacco use, harmful use of alcohol, physical inactivity and unhealthy diet.
Thirdly, because we have cost-effective interventions, to reduce exposure to shared risk factors and to control the four major NCDs.
How many people die prematurely from NCDs?
The total number of deaths in 2012 was 38 million, but 16 million of those people were below the age of 70, which is in the premature category.
Are most premature NCD deaths preventable?
Yes the majority of premature NCD deaths can either be prevented or delayed.
How many of premature NCD deaths occur in low- and middle-income countries and how does this compare to high-income countries?
Out of the 16 million deaths, 82% occur in low and middle income countries and the remainder occur in developed countries. So the proportion of premature deaths is very high for low- and middle-income countries.
There are several reasons for this. First, the risk factor profiles are getting worse in low- and middle-income countries.
Second, people in low and middle income countries have inadequate access to health services including health financing. This means that diseases are detected late with complications.
Third, public health policies that have been put in place to address risk factors at the population level, are not as comprehensive and robust as the ones implemented in high income countries.
To develop and implement such comprehensive policies, you need action not only by the ministry of health but also by other ministries responsible for development of policies that influence physical activity, diet, tobacco use and harmful use of alcohol.
For example, if you want people to engage in regular physical activity, then you need to have suitable, conducive environments which are secure and not too crowded, particularly in urban settings. Thus policies on urban development have a bearing on the physical activity patterns of people.
Are deaths due to NCDs overtaking those from infectious diseases in low- and middle-income countries?
Yes, definitely. They are gradually taking over and becoming a priority. This is happening in practically all WHO regions and even in Africa, NCDs are expected to take over very soon. So, eventually it will be the case all over the world.
What policies can governments put in place to reduce premature NCD deaths?
Government policies must make efforts to reduce people’s exposure to behavioral risk factors such as smoking, harmful alcohol use, physical inactivity and unhealthy diet.
For example, in the case of tobacco, there are very cost-effective interventions and policies that governments can put in place for tobacco control such as increasing the tax on tobacco products or preventing tobacco advertising, promotion and sponsorship.
Similar policies are also available to control harmful use of alcohol. There are policies that can make alcohol less accessible, particularly to the younger generation, but also to the population as a whole.
Regarding a healthy diet, we know what a healthy diet constitutes, but often a healthy diet is not affordable and healthy food products are not always easily available.
A good example is fruits and vegetables. We know it is very important to consume five servings or more of fruit and vegetables on a daily basis, but the majority of people in most countries cannot afford to buy adequate amounts of fruits and vegetables because they are too costly.
Today, people also have a tendency to eat out more, but in restaurants, the food prepared is often high in fat, energy and salt.
We need policies which will help to control all of these problems and decrease exposure to these risk factors.
In addition, of course we need good health services, but in many countries, particularly the low- and middle-income countries, they only focus on health services at the hospital level and tertiary care level. There is inadequate attention given to primary care and also to early detection.
There needs to be a combination of strong primary healthcare combined with interventions at a hospital level and that has to go hand-in-hand with population prevention policies and strategies.
Please can you outline the 9 global NCD targets outlined in WHO’s report and what is needed to achieve these targets?
Out of the nine targets, the overarching one is a reduction in premature mortality of 25% by 2025. The baseline figures we will use are from the 2012 mortality data. We provide these baseline data in the report, but monitoring will start this year (2015), and by 2025, a 25% reduction is expected in premature mortality.
Then we have four targets for the four behavioral risk factors. The target for harmful use of alcohol is to achieve a relative reduction of at least 10%; for current tobacco use, the target is a 30% relative; for physical activity, it is 10% and for salt it is 30% relative reduction in the population’s mean salt intake.
We also have two other targets: one is to reduce the prevalence rate of raised blood pressure in the population by 25% and for diabetes and obesity, the aim is to maintain the current prevalence rates and not allow it to increase. It is very difficult to reduce the rate of diabetes and obesity with the available interventions and that's why the target is modest.
We also have health system targets. One target is to prevent heart attacks and strokes by detecting high-risk individuals and offering them appropriate primary care treatment in a timely fashion, before it is too late. This can be achieved simply by introducing an intervention where patients’ overall risk for heart attack is assessed.
The other target is to improve access to medicines and technologies. The expectation is that there will be 80% availability of basic sets of medicines and technologies by 2025.
Are most countries currently on-track to meet the 2025 targets?
We didn't find that to be the case when we looked at the WHO member states. Some countries have made progress, but they are mainly developed countries. If you look at the low and middle income countries, there are some that are making progress, but many are not.
If you look at how many countries have operational government policies for the use of alcohol at a national level, the number is only 52 out of 109 countries. Similarly, only 69 countries have policies in place to reduce tobacco use.
The same is true for improving physical activity – only 56 countries have a national policy in place to address physical inactivity. . In general, you find that there are countries that will reach the targets and some countries are making good progress, but the majority need to accelerate their progress.
Further, most countries have a shortage of resources, but there is a set of 14 public health interventions that any country can start implementing, which we refer to as “WHO best buy” interventions.
We know, for example, that in low income countries, current healthcare expenditure only needs to increase by one dollar per person for these interventions to be implemented.
All non-communicable diseases programs are longterm programs. It is not sustainable to support these programs with external resources only.
Whatever countries put in place, they need to be long-haul strategies and it is best for them to be funded by available domestic resources, with modest temporary support from outside.
Where can readers find more information?
For more information on where countries are in terms of targets, there is a lot of data in the Global Status Report. It contains text, diagrams, articles, and also tables at the end of the document, which provide the baseline figures for individual countries. 
https://www.who.int/
About Dr Shanthi Mendis
Dr Shanthi MENDIS, MBBS, MD, FRCP, FACC is Senior Adviser, Prevention and Management of Noncommunicable Diseases in World Health Organization (WHO), Geneva, Switzerland.
She is a Fellow of the Royal College of Physicians of London and Edinburgh and of the American College of Cardiology.
Prior to joining WHO she practiced clinical medicine in UK, USA and Sri Lanka.
Her expertise are in global public health, Internal Medicine, Cardiology, Medical Education, Health Research, and program and policy development and evaluation in developing countries.
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