The Threat of Non-Communicable Diseases in Developing Nations

My last blog was a very personal and difficult look at the state of global health, specifically, the non-urban areas of Guatemala where I recently travelled for a medical and surgical mission. The healthcare needs of the rural populations in this country are nearly overwhelming.

It was very hard to see simple conditions and problems go untreated for months and years, and the pathology that modern healthcare in countries such as the U.S. has virtually eliminated in all but the most impoverished and distant reaches of our population.

I have a PA friend in legislative affairs that likes to relate that, “geography is destiny,” when it comes getting things and achieving meaningful change. This statement has a new meaning to me because of the significant disparity in the world’s humanity that is solely based on where one is born. Having worked in close proximity with the underserved in a developing country, it is overwhelming to think about the scope of this disparity on a global basis; let alone in the small slice of the Guatemalan Highlands in which I traveled.

Based on very simplistic and possibly naive observations, it seems to me that much of the basic healthcare problems in developing countries, especially in their rural areas, have to do with a simple lack of infrastructure. While the metropolitan areas of Guatemala are distinctly different than cities in the U.S., you will find water, sanitation, physicians, hospitals and other accoutrements we have come to expect in a modern country.

However, there are distinct differences in water and sanitation standards. Tap water is not safe to drink, and I saw many sewage lines dumping directly into creeks, rivers, and other watersheds. Knowing how much of this likely contributes to parasitical and bacterial disease makes me shudder.

The U.S. currently spends a significant amount of money on global health, mainly focused on communicable diseases, such as HIV/AIDS, tuberculosis, malaria and other diseases. All of these diseases are important to contain and reduce, because it has implications for the health of all populations, both global and domestic.

However, the emerging threat of non-communicable diseases (NCD) in developing countries, and its associated morbidity and mortality, is dwarfing the problem of communicable diseases. Our effectiveness in dealing with communicable diseases in developing countries has resulted in resulted in a shift in prominence of NCD.

For millions, a diagnosis of breast or cervical cancer, leukemia, chronic obstructive respiratory diseases, among other NCDs, represents a death sentence in many developing countries. The success in dealing with communicable disease in these places means that longevity among these populations is rapidly increasing, a making NCDs a more prominent cause of morbidity and mortality.

Another sign of this trend is the difference 20 years has made. In 1990, the top health risks in low and middle income countries was underweight children, household air pollution and suboptimal breast feeding. In 2010, the top three are dietary risks (obesity), hypertension and smoking, or exposure to second-hand smoke. Most healthcare systems in developing countries are built for acute care, with few resources for preventive and chronic care. This is a global healthcare crisis that requires flexibility and transition of all stakeholders, from non-government organizations to global health professionals, in addressing the healthcare needs of the world and our fellow humankind.

As a neophyte on the global health scene, with only one international mission under my belt (with many more to come), all I can do at this point is to try to make a difference in every patient that I treat, both domestically and internationally. It seems as but a drop in the bucket of need, however, I always try to keep one of my favorite quotes in mind when thinking about problems that seem overwhelming in size.  

“Each time a man stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, he sends forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring, those ripples build a current which can sweep down the mightiest walls of oppression and resistance.” Robert F. Kennedy. 1966.

I will do my best to be a “ripple of hope” to those in the world, and encourage my colleagues to do the same.