Ayesha Tammy Haq, a lawyer and a known broadcast journalist, has urged that government and the key pharmaceutical industry players need to work together to tackle the issue of non-communicable diseases in Pakistan.
"Together, they also need to review national health policy and make changes in health sector planning and budgeting in the context of non-communicable disease prevention and control," she said.
Owing to increasing number of people being caught by various ailments every passing day, healthcare in Pakistan is in dire need of improvement in terms of both communicable and non-communicable diseases (NCDs). Also known as chronic diseases, NCDs are a group of diseases that are not passed from person to person and are of long duration and generally of slow progression. According to a research report by the Global Alliance for Chronic Diseases (GACD), five main types of NCDs are cardiovascular diseases, chronic respiratory diseases, certain cancers, type 2 diabetes and mental disorders. Some other common NCD examples include Alzheimer's, Asthma, Cataracts, chronic kidney disease, chronic lung disease, Fibromyalgia, Osteoporosis, Stroke, Cancer (including breast cancer) and several other cardiovascular diseases.
According to the recent statistics by the World Health Organisation (WHO), nearly 2000 persons die every day because of NCDs, while some 40 million people die each year because of them, equivalent to 70% of all deaths globally. Every year, cardiovascular diseases account for most NCD deaths (17.7 million), followed by cancers (8.8 million), respiratory diseases (3.9million), and diabetes (1.6 million). On an average, NCDs are the cause of over 80% of premature deaths occurring in low and middle-income countries.
According to a research report in collaboration with Aga Khan University (AKU) and the Journal of Pakistan Medical Association (JPMA), an estimated 32 million individuals in the country suffer from different heart diseases, 40 million from high blood pressure, 8 million from diabetes, 18 million from high cholesterol, 24 million from obesity and about 50 million from different mental health disorders. Owing to communicable and non-communicable diseases (NCDs), Pakistan has had equal contribute burden (38.4% vs. 37.7) till 1994, but now NCDs exceed the communicable diseases (59% vs. 41%), according to WHO. These figures suggest one-third of the country's total population is suffering from non-communicable diseases.
However, despite such staggering figures, the national capacity to address and respond to NCDs is quite negligible. It is a fact that various factors contribute to the alarming rise of NCDs in Pakistan, whereas the leading causes are rapid urbanization and a sedentary lifestyle. Globally, there is a direct link between urban living and NCD risks increase such as obesity, overweight, diabetes mellitus and hypertension.
As revealed by the WHO's Non-communicable Diseases (NCD) Country Profiles, Pakistan has no NCD surveillance and monitoring system in place to enable reporting on the attainment of the 9 global targets for NCDs by 2025.
Out of 9 global targets for NCDs, Target 1 aims for a 25% relative reduction in the overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases. Target 2 aims for at least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context. Target 3 is aimed at achieving a 10% relative reduction in the prevalence of insufficient physical activity, while Target 4 seeks a 30% relative reduction in mean population intake of salt/sodium. Target 5 aims for a 30% relative reduction in the prevalence of current tobacco use in persons aged 15+ years.
Target 6 seeks a 25% relative reduction in the prevalence of raised blood pressure or contains the prevalence of raised blood pressure, according to national circumstances. Target 7 is aimed at halting the rise in diabetes and obesity; Target 8 seeks at least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes, and Target 9 seeks an 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities.
Unfortunately, Pakistan lags far behind in the attainment of global NCD targets. According to WHO, the country has not devised any evidence-based national standards for the management of major NCDs through a primary care approach. To make things worse, it has no population-based cancer registry maintained on a national basis. It seems that Pakistan has no operational policy, strategy or action plan to reduce physical inactivity and unhealthy diet, the chief reasons behind the rise of NCDs among the local population of Pakistan.
Seen as a particular threat to Pakistan, it is estimated that by 2020, two out of three people in the country will suffer from NCDs. Taking into account the Global Action Plan for the prevention and control of NCDs, the country needs to develop a multi-sectoral national NCD plan.
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