A top official of the World Health Organization (WHO) yesterday warned that more young people are dying of noncommunicable diseases (NCDs) in the Eastern Mediterranean region than in any other region across the world.
Dr. Ala Alwan, chief of the WHO Regional Office for the Eastern Mediterranean, said: “Up to 50 percent of those who die from NCDs, die below the age of 60 in some countries of this region, compared to less than 10 percent in the Europe.”
Referring to the prevalence of NCDs in 23 countries of the region including Saudi Arabia, Alwan said that NCDs account for over 50 percent of annual deaths and 60 percent of the disease burden in the region. The WHO regional chief spoke to Arab News in an exclusive interview.
Alwan, who is participating in the international conference on healthy lifestyles and NCDs, will chair the concluding session with Health Minister Dr. Abdullah Al-Rabeeah today to release the Riyadh Declaration on NCDs.
He pointed out that the WHO Regional Office for the Eastern Mediterranean region responsible for research on NCDs is one of the WHO’s six regional offices around the world. It serves the region comprising 22 member states and the occupied Palestinian territories with a total population exceeding 583 million. “This is why we are more concerned about the NCDs,” said Alwan, referring to the four main NCDs — cardiovascular diseases, cancer, diabetes and chronic respiratory diseases.
He said these diseases were the largest contributors to mortality in the region. Promoting healthy practices during adolescence and taking steps to better protect youth from health risks is critical to the future of countries’ health and social infrastructure and to the prevention of health problems in adulthood. He added that morbidity, disability and premature death reduce productivity and exert a seriously negative impact on sustainable development, particularly in developing countries.
“… the cost of health care for NCDs creates a significant burden on household budgets for lower income families, particularly in countries with weak health systems,” he explained. He referred to the epidemiological surveys which reveal that the Eastern Mediterranean region has the highest prevalence of diabetes in the world besides the substantial prevalence of other NCDs. “Six out of 10 countries with the highest prevalence of diabetes are reported from this region,” he cautioned.
In some countries, up to 25 percent of the adult population has diabetes, he noted. The rapidly growing burden of NCDs is accelerated by the negative effect of globalization, rapid unplanned urbanization and increasingly sedentary lifestyles. People in this region are increasingly eating foods with the higher levels of total energy and are being targeted as top consumers of tobacco, alcohol and junk food, while availability of these products increasing by the day.
Alwan said that NCDs, particularly cardiovascular disease, diabetes, cancer and chronic respiratory disease, are responsible for an average of 53 percent of all deaths and in some countries up to 80 percent of all deaths in the Eastern Mediterranean Region.
“As the impact of NCDs increases, annual deaths due to such diseases are projected to continue to rise worldwide, and the greatest increase is expected to be seen in the Africa and the Eastern Mediterranean regions,” he warned. He pointed out that nearly 80 percent of deaths due to such diseases occur in low and middle-income countries. There are four shared risk factors that lead to the increasing magnitude of cardiovascular disease, diabetes, cancer and chronic lung disease, he added.
“Almost six million people die from tobacco use each year. By 2020, this number will increase to 705 million, accounting for 10 percent of all deaths globally.” He pointed out that smoking is estimated to cause about 71 percent of lung cancer, 42 percent of chronic respiratory diseases and nearly 10 percent of cardiovascular diseases.
He pointed out that the highest incidence of smoking among men is in lower-middle-income populations, adding that tobacco use is a major killer in the Eastern Mediterranean Region. In some countries, more than 50 percent of adult males are smokers, he said, adding that insufficient physical activity leads to the death of approximately 3.2 million people every year. People with insufficient physical activity are at up to 20 percent to 30 percent increased risk of mortality.
Spelling out the benefits of regular physical activity, Alwan said that it reduces the risk of cardiovascular disease, including high blood pressure, diabetes, breast and colon cancer, and depression. Countries in the Eastern Mediterranean Region top the list for the least physical activity undertaken. More than 40 percent of adults are insufficiently active, said the WHO official. In all WHO regions, women are less active than men, he added.
Another risk factor, he said, is unhealthy diet. “Adequate consumption of fruit and vegetables reduces the risk of cardiovascular disease, stomach and colorectal cancer,” said Alwan, adding that high consumption of saturated fats and trans-fatty acids is linked to heart disease. Unhealthy dietary patterns are rising quickly in the countries of the region, particularly among lower resource populations, he added. No serious action is being taken to address the problems caused by unhealthy foods and beverages, particularly for children, he cautioned.
Referring to the harmful use of alcohol, he said that about 2.3 million people die each year in the Eastern Mediterranean region because of alcohol, accounting for about 3.8 percent of all deaths in the world. More than half of these deaths occur from NCDs, including cancer and cardiovascular disease. He nevertheless added that the adult per capita consumption of alcohol is still low in this region compared to other regions.
“However, to prevent a rising trend, it is important for countries in this region to implement the key evidence-based interventions recommended in the Global Strategy on Harmful Use of Alcohol,” said the WHO regional chief. He said that shared risk factors are responsible for an increasing magnitude of overweight and obesity, high blood pressure, high blood sugar and elevated cholesterol. To this end, he noted that about 2.8 million people die each year as a result of being overweight on a global level.
He warned that the risk of coronary heart disease, stroke and type 2 diabetes would increase steadily with an increased body mass index (BMI). “An elevated BMI increases the risk of cancers of the breast, colon/rectum, uterus, kidney, esophagus, and pancreas,” noted Alwan. The Americas and Europe have the highest overweight record followed by the Eastern Mediterranean Region including the Gulf states, he said. In some countries of this region, up to 70 percent of adults are overweight, he observed.
Asked about the measures to be taken by governments to monitor the prevalence of NCDs, Alwan said that interventions to prevent non-communicable diseases on a population-wide basis are not only achievable but also cost-effective. “The income level of a country or region is not a barrier to success,” he said. “In the presence of political will and commitment, low cost solutions can work anywhere to reduce the major risk factors for non-communicable diseases,” he added.
While many interventions may be cost-effective, some are considered “best buy” actions that should be undertaken immediately to produce accelerated results in terms of lives saved, diseases prevented and heavy costs avoided, he added. In addition to the best buys, there are many low-cost methods to check NCDs. They include nicotine dependency treatment, enforcing laws against drunken-driving, promotion of breastfeeding and feeding restrictions on market foods and beverages that are high in salt, fats and sugar, especially for children.
Referring to the political declaration of the UN General Assembly on NCDs, Alwan said that the declaration was a major breakthrough that provided a road map for addressing the problems and the challenges posed by the prevalence of non-communicable diseases. In addition to acknowledging the pressing need to address the rapidly increasing magnitude of NCDs and their devastating impact on health and socioeconomic development, the UN declaration emphasizes that governments need to integrate NCD policies into the development agenda.
The roles and responsibilities of other stakeholders, in particular civil society and the private sector and clearly defined in the declaration, should be emphasized. “Like countries in other regions, member states of the Eastern Mediterranean region should take immediate steps to review and elaborate their health plans and put in place comprehensive national plans for the prevention and control of non-communicable diseases by 2013,” said a document released by the WHO at the conference yesterday.
A UN declaration calls for promoting intersectoral action by 2013 and national multisectoral policies and plans for non-communicable diseases in accordance with global strategy. It also calls for increasing and prioritizing budgetary allocations for addressing NCDs and exploring the provision of sustainable resources through domestic, regional and international channels.
In reducing exposure to non-communicable diseases risk factors, countries will be required to accelerate implementation of the WHO Framework Convention on Tobacco Control, said the declaration document.
The UN declaration also calls for promoting community mobilization, health literacy, breast-feeding and strengthening the implementation of the International Code of Marketing of Breast-milk Substitutes. It also calls for reviewing health systems, address gaps and weaknesses besides improving access to safe, affordable and quality essential medicines and technologies. It further calls for promoting the production, training and retention of health workers; while developing national targets and indicators based on WHO guidance.
Another component of the UN declaration is implementing stronger surveillance and monitoring schemes for non-communicable diseases and integrating them into national health information systems. The declaration, however, laments that no serious action is being taken to prevent the rapidly increasing rates of unhealthy behavior and risk factors. In many countries, the epidemic already extends far beyond the current capacity of health systems to deal with it, which is why death and disability are rising disproportionately in the region.

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