Why we need to talk about NCDs in children ?

Recent years have seen a notable shift in the field of Global Health. Whereas attention used to focus on the prevention, management and control of the ‘big three’ infectious diseases – HIV, tuberculosis and malaria – the Sustainable Development Goals and WHO’s  Global Action Plan mark the beginning of a new era. This puts welcome emphasis on conditions that cannot be passed from one person to another. Non-communicable diseases, or NCDs if you will.

Why? The numbers speak for themselves. According to the WHO, NCDs are responsible for 71% of all global deaths. Mostly affecting adults, every year 15 million people aged between 30-69 die prematurely from an NCD – with heart disease, chronic respiratory disease, cancer and diabetes the four usual suspects. Given the nature of these conditions, it is unsurprising to see much of the world’s response is mostly focussed on ‘modifiable behavioural risk factors’. Smoking, physical inactivity, an unhealthy diet and excessive alcohol consumption are all key players here. Address these and major gains in the control and management of NCDs will be made.

In light of the above, it is fair to say that NCDs have become known as a ‘lifestyle disease’. But whilst it is easy to lay responsibility at the feet of individuals, I am concerned that this narrative has become over-bearing, particularly in the field of international development. As an experienced fundraiser, I have seen many opportunities to address causal behaviours for NCDs in adults. This begs the question: what about children? Cancer. Type 1 diabetes. Congenital Heart Disease (CHD). There are no behavioural risk-factors here – and so little recognition as to the need to invest in their diagnosis, treatment and care. It is a dangerous silo that cuts childhood NCDs from a conversation that is only just beginning. This puts thousands of young lives at unnecessary risk.

Let’s start with the Big C: Cancer. The WHO estimate that 300,000 children are diagnosed with cancer every year. Most do not have a known cause. Impressively, 80% of cases are now curable – many with inexpensive, generic medications. Yet in the developing world cure rates fall as low as 20%. Often the chance for early diagnosis is missed. Few countries have the resources needed to save these children’s lives. The prognosis is bleak. But it doesn’t have to be.

What about heart disease? According to Dr De Decker of the Red Cross War Memorial Children’s Hospital in South Africa, heart disease is an emerging health priority for children worldwide. Data is limited – but evidence suggests that 1% of the world’s children are born with a congenital defect. This means that as many as 500,000 children in Africa could be being born with ‘significant’ CHD each year. Open heart surgery is risky and expensive. Cardiac catheterisation laboratories, though growing in number, are still few and far between (with a shortage of resources and trained staff meaning most are under-used). Left untreated, half of those children born with significant CHD will die in infancy or early childhood. One third in their first month of life.

Then there’s diabetes. We’re not talking Type 2. I mean Type 1, insulin dependent diabetes – a genetic condition the cause of which is generally unknown. The World Diabetes Foundation tells us that Type 1 diabetes accounts for roughly 5% of diabetes cases worldwide and is the most common form of diabetes in children. Insulin was discovered almost 100 years ago, yet research shows that globally, one in two people do not have access (physical and/or financial) to this essential medicine. Without insulin therapy a person with Type 1 diabetes will die. In some African countries, life expectancy is less than one year post-diagnosis. That is assuming it is detected. As with cancer and CHD, late and missed diagnoses seriously confound disease identification, treatment and control.

So there you have it. Three different NCDs. Three compelling arguments. Yet the need goes largely unrecognised (admittedly, there is some movement in the field of childhood cancer, with the Global Initiative for Childhood Cancer launched in September last year).

Whether yours is the child diagnosed with Stage 4 Leukaemia, the toddler whose pancreas ceased to function, or the baby girl born with a hole in her heart…The condition might not be preventable, but their deaths are.

NCDs do not just affect adults. They are not just about lifestyles and modifiable risk factors. It is time to break the silo. The world needs to talk about NCDs in children. Global health actors must work together to increase funding for – and access to – early diagnosis, treatment and care.

Only then can we be sure that no child is left behind.


About the author :

Jen Jennifer Ruthe  is an upcoming MSc graduate in Global Health with the HCRI at the University of Manchester. With almost 10 years professional fundraising experience in health and international development she currently works as a freelance charity copywriter. She tweets at @Written_Jen . 

Competing Interests: I have read and understood the BMJ Group policy on declaration of interests and declare that as the former UK Charity Manager for the Children’s Hospital Trust South Africa (UK charity 1121573) I have a historic professional relationship with the team from The Children’s Hospital Trust – official fundraiser for the Red Cross War Memorial Children’s Hospital in South Africa (South African NPO 127-685). During this time, I provided proposal development and grant management support to a range of Hospital-based programmes. This includes partnership work with World Child Cancer UK and also with Dr De Decker for his work to promote catheter-based treatment for children with significant CHD. I am no longer employed by the Trust but ‘specialist child healthcare in Africa’ is an issue that remains close to my heart. I have no other competing interests to declare.

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