{"id":47740,"date":"2020-06-10T08:12:02","date_gmt":"2020-06-10T07:12:02","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47740"},"modified":"2020-06-19T10:36:10","modified_gmt":"2020-06-19T09:36:10","slug":"non-communicable-diseases-and-covid-19-a-perfect-storm","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/06\/10\/non-communicable-diseases-and-covid-19-a-perfect-storm\/","title":{"rendered":"Non communicable diseases and covid-19:\u00a0a perfect storm\u00a0"},"content":{"rendered":"<p><span style=\"font-weight: 400\">For decades academics and policy makers have warned of the risks of a viral pandemic with effects as devastating as the Spanish Flu in 1918. What they did not anticipate, however, was its interaction with a co-existing pandemic of non-communicable diseases (NCDs). Covid-19 is that perfect storm, particularly for poorer communities, where NCDs and their risk factors are disproportionally high among all age groups.<\/span><\/p>\n<p><span style=\"font-weight: 400\"> While NCDs are more common among older people, for younger people, <\/span><a href=\"https:\/\/www.thelancet.com\/pdfs\/journals\/lancet\/PIIS0140-6736(20)31189-2.pdf\"><span style=\"font-weight: 400\">NCDs and underlying metabolic conditions\u2014<\/span><\/a><span style=\"font-weight: 400\">obesity, hypertension, kidney disease, and diabetes\u2014are all associated with higher risk of severe illness, hospitalisation, and death from covid-19. Of particular worry is the association with <\/span><a href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(20)31024-2\/fulltext\"><span style=\"font-weight: 400\">obesity<\/span><\/a><span style=\"font-weight: 400\">, which in the US and many parts of the world is associated with poverty. In the <\/span><a href=\"https:\/\/www.oecd.org\/els\/health-systems\/Obesity-Update-2017.pdf\"><span style=\"font-weight: 400\">US and Mexico<\/span><\/a><span style=\"font-weight: 400\">, more than one third of people 15 years and older are obese and more than 20% in South Africa, Costa Rica, Colombia, Brazil, Hungary, and Chile.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The global response has been to treat covid-19 as a vertical disease rather than addressing the full ecosystem of our response to covid-19 or its interaction with NCDs and poverty. This is particularly urgent given that poverty is now both a driver of covid related mortality and an outcome of the response. From Mexico City to New York City to the Western Cape, covid-19 has both targeted and amplified poverty as a powerful determinant of health and hit hardest in communities that also lack access to care. In the US, for example, where poverty intersects with structural marginalization, people from non-Hispanic black communities make up <\/span><a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/69\/wr\/mm6915e3.htm\"><span style=\"font-weight: 400\">33% of the covid related deaths<\/span><\/a><span style=\"font-weight: 400\">, though represent only 18% of the population.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Measures including lockdown and social distancing have caused health service disruptions affecting access to <\/span><a href=\"https:\/\/www.thelancet.com\/journals\/lanonc\/article\/PIIS1470-2045(20)30243-6\/fulltext\"><span style=\"font-weight: 400\">medicines, diagnostics, and treatment<\/span><\/a><span style=\"font-weight: 400\">, including for NCDs. The result is an overall worsening of health outcomes in particular for poorer communities, further exacerbated by <\/span><a href=\"https:\/\/globalnutritionreport.org\/reports\/2020-global-nutrition-report\/2020-global-nutrition-report-context-covid-19\/\"><span style=\"font-weight: 400\">food insecurity<\/span><\/a><span style=\"font-weight: 400\"> and reduced social services access that predate the pandemic. With <\/span><a href=\"https:\/\/www.wider.unu.edu\/sites\/default\/files\/Publications\/Working-paper\/PDF\/wp2020-43.pdf\"><span style=\"font-weight: 400\">nearly half a billion people<\/span><\/a><span style=\"font-weight: 400\"> projected to fall into extreme poverty due to the covid response, loss of income, high out-of-pocket costs for healthcare, food insecurity, increased unemployment levels, and lower educational attainment. These will all have a direct effect on morbidity and mortality worldwide in the longer term.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The Sustainable Development Goals, which called out the need to address universal health coverage, pandemic preparedness, and NCDs, were built with the rationale that complex social problems, including health, need complex multisectoral interventions\u2014there are no magic bullets\u2014and the context and the strength of health systems matter. The <\/span><a href=\"https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/272710\/9789241514163-eng.pdf?ua=1\"><span style=\"font-weight: 400\">WHO Independent High-Level Commission on NCDs<\/span><\/a><span style=\"font-weight: 400\"> similarly called for integration of NCDs and mental health into national SDG and universal health coverage implementation. These goals and recommendations should be brought to bear in the face of covid-19.\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Given the interaction between covid-19 and NCDs, we must urgently address the underlying drivers of the NCD pandemic that are fueling covid-19 mortality. First, this requires adhering to the tenants of \u201cprecision public health:\u201d focusing interventions on risk reduction for those most susceptible. This cannot be accomplished without better data sharing. While the signals are clear that NCDs are a risk factor for covid-19, the granular data from the more than 400,000 deaths worldwide are not freely available to global health researchers to analyze the role of competing risk factors, disease history, medicine interactions, or other potential socioeconomic or demographic associations. Where available, it is either for <\/span><a href=\"https:\/\/www.bmj.com\/content\/369\/bmj.m2279\"><span style=\"font-weight: 400\">purchase<\/span><\/a><span style=\"font-weight: 400\"> or researchers must sign restrictive data sharing agreements.\u00a0\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">However, even without these data, we know enough about the risk factors to do better. It is time to move from a vertical approach to applying the techniques of population health to assess risks, target prevention, and engage communities in the response, and to build synergies across care platforms, in particular between NCDs and infectious diseases. Rather than applying blunt tools such as lockdowns to the entire population, we must target those at risk, with more localised interventions. At the same time, we must provide support to those who are socioeconomically vulnerable with the means to mitigate the pandemic response effects on poverty, which is a direct determinant of health. An example of such a strategy is underway in <\/span><a href=\"https:\/\/www.weforum.org\/agenda\/2020\/05\/using-cash-payments-protect-poor-pakistan\/\"><span style=\"font-weight: 400\">Pakistan<\/span><\/a><span style=\"font-weight: 400\">, where the government has provided over 80 million people with emergency cash transfers.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">To date, the global response to covid-19 has focused on covid-19 only and targeted the entire population rather than those most at risk. The result has been mass fear and confusion and, arguably, a tremendous misallocation of resources. However, as covid-19 continues to spread and there are concerns of a second wave, it is not too late to apply the tools of precision, evidence-based public health and move from a sole focus on covid-19 deaths to addressing the underlying drivers of morbidity and mortality. This means focusing prevention efforts on people suffering from NCDs and applying a Sustainable Development Goal agenda 2030 lens which looks past a single public health endpoint to address the multiple factors affecting population health.\u00a0<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Nina Schwalbe<\/strong> is a Principal Visiting Fellow at the United Nations University International Institute of Global Health and\u00a0 an adjunct professor in the Heilbrunn Department of Population and Family Health at the Columbia University Mailman School of Public Health.<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Susanna Lehtimaki<\/strong> a Senior Advisor at Spark Street Advisors.<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Juan Pablo Gutierrez<\/strong>\u00a0is a Professor at the Center for Policy, Population &amp; Health Research, School of Medicine, National Autonomous University of Mexico, Mexico.<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Competing interests<\/strong>: none declared.<\/span><\/em><\/p>\n<p><i><span style=\"font-weight: 400\">The authors would like to thank Cy Schwalbe, Katherine Holland and Anna Matterson for contributing to this piece.<\/span><\/i><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>For decades academics and policy makers have warned of the risks of a viral pandemic with effects as devastating as the Spanish Flu in 1918. What they did not anticipate, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/06\/10\/non-communicable-diseases-and-covid-19-a-perfect-storm\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":46948,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-47740","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Non communicable diseases and covid-19:\u00a0a perfect storm\u00a0 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/06\/10\/non-communicable-diseases-and-covid-19-a-perfect-storm\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Non communicable diseases and covid-19:\u00a0a perfect storm\u00a0 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"For decades academics and policy makers have warned of the risks of a viral pandemic with effects as devastating as the Spanish Flu in 1918. 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Much of central London was virtually empty today, a day after British Prime Minister Boris Johnson ordered the closure of all pubs, bars, cafes and restaurants around the country. The move represents a toughening of measures to enforce the 'social distancing' that is being urged on citizens to reduce the growth of covid-19 coronavirus infections. Nightclubs, theatres, cinemas, gyms and leisure centres were also ordered closed. Some shops in the centre of capital remained open today, albeit mostly deserted of customers; many retailers however have temporarily closed their doors until the crisis abates. 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