The infectious disease has been talked about a lot since the Covid-19 pandemic occurred. We should be confident that the infectious disease is much easier to contain than noncommunicable diseases (NCDs). With successful vaccines and other successful measures, we will be able to overcome such infectious diseases. NCDs have been a major challenge to human health worldwide.
We are facing serious challenges of NCDs globally and in many countries, including China, as one example. On the one hand, it is a good example and, on the other hand, it’s a poor example. I will share with you about some of the issues we have in China and the potential future, lessons that China can contribute to the world in terms of the serious challenges we’re facing.
The prevalence of NCDs including such as diabetes, some types of cancer and obesity is very high and the awareness and management rates in general are low, especially in low and medium income countries including China. For example, many of the chronic disease patients, such as type 2 diabetes patients, even do not know they have the disease. These patients do not take the treatment, and the patients taking the treatment cannot manage their condition. In general, in many low-income countries, including middle income countries like China, only about one-third of people with NCD are aware of their diseases and take the needed measures to control them. All of these are huge challenges.
NCDs kills about 41 million people each year, accounting for about 70% of all deaths globally. Each year more than 15 million people die from NCD between the ages of 30-69 years, which is premature deaths. About 85% of these premature deaths occur in low- and middle-income countries. In China, NCD deaths accounted for more than 80 percent of the total deaths. About 80% of all NCD deaths are in low-and middle-income countries. That’s why many low- and middle-income countries are facing such a double burden: infectious disease and chronic disease.
Fortunately, we do know many of the factors that contributed to NCD that include tobacco use, physical inactivity, harmful use of alcohol and poor diets. Take tobacco use as one example, even though the harm of tobacco is clearly understood, many countries including China are not successful in controlling tobacco use. NCDs threaten the progress towards the 2030 Agenda Sustainable Development Goals (SDGs). The costs of NCDs treatment, combined with loss of income, force millions of people into poverty annually.
Critical actions are needed from government and individuals to manage NCD. Many of such NCD intervention efforts need policy and also need the support of individuals. If we cannot take such successful actions, we will not be able to achieve the global target of a 25% reduction in the risk of premature mortality from NCD by 2025, and the SDG target of a one-third reduction in premature deaths from NCD by 2030. So investing in better management of NCD is critical. NCD management includes a number of actions such as detection, screening for the patients, and providing them with the successful treatment and also such palliative care.
International collaboration is important to fight the NCD epidemic. And China can play important roles in such collaborations, including sharing some of the lessons we learned in the past several decades. However, China has seen a very rapid increase in chronic diseases as the most recent data reported in December, 2020 in the national NCD report. The report indicated that many of the main chronic diseases and the related risk behaviors such as poor diets had been steadily increasing. Also, at this moment in China, more than 50% of adults are obese or overweight.
About two decades ago, many people thought that malnutrition was the major challenge for countries like China. That is not true, and not anymore. At present China is becoming the country with the largest number of people with overweight and obesity. Even among children, about 20% of them are overweight or obese.
Obesity is just one indicator of many poor behavior and the environmental factors for poor health. The WHO and the United Nations have put a lot of effort and attention into fighting the NCD epidemic, and have taken a number of actions including producing a series of important reports. The “Global Noncommunicable Disease Action Plan 2013-2020” was released in 2013 by WHO setting up nine global targets for NCD control by 2020.
However, now we fail in achieving these goals such as lowering the prevalence of type 2 diabetes and obesity to a limited level. With the ongoing COVID-19 pandemic, we are facing even more challenges than before to fight the NCD epidemic. Many of the measures taken to fight COVID-19 would facilitate physical inactivity and poor diets, which may put more people at risk of NCDs, especially those suffering from obesity and cardiovascular diseases. In addition, the global aging, the more rapidly increasing aging puts additional challenges .
Taking obesity as an example of the NCDs, there are 40% of adults who are obese worldwide. In China, based on the new national NCD report released in December 2021, more than 50% of adults and 20% of children are obese. In 2019, we published this China Obesity Prevention and Control Bluebook as one effort that China is taking to face the epidemic. The projections indicated that 61.5% of Chinese adults will be overweight and obese by the year 2030 if there is no effective approach taken. This is because of the changing food environment and changing behaviors on diet and physical activity.
The WHO has recommended countries to take effective approaches to fight this growing obesity epidemic, especially to provide a supportive environment and communities for desirable lifestyles including healthy diets and adequate physical activity to fight NCDs. Many of such actions need strong government commitment and support and engagement of individuals. China can try to provide a good potential example for the world with the Healthy China 2030 Initiative and also the National Nutrition Plan . For example, “Reduce intake of salt, cooking oil and sugar” is one of the key clear messages taken by China, and have made some good progress thus far.
Our team published a 246-page comprehensive report entitled “China Blue Paper on Obesity Prevention and Control” and a paper entitled “Prevention and control of obesity in China” in Lancet Global Health in 2019. We proposed the following policy recommendations for China: 1) Make the government responsible and enhance cross-sector collaboration. This includes integrating obesity prevention and control into government mandates and the day-to-day work of relevant government agencies and authorities, improving and completing the nutrition policy system, and fostering the training of nutritional experts and professionals. 2) Make better use of health professionals’ institutions to promote large-scale, population-level educational programs and campaigns, to provide individual-level counselling and guidance on obesity prevention, control, and treatment, to implement 360˚, multilevel, multi-component, and multisector prevention and intervention programs and related research, and to develop and improving surveillance systems at national and local levels. 3) Engage families and individuals in obesity prevention and control by making individuals accountable for their health. And 4) Improve the obesogenic environments.
This is one of the papers we published regarding the global health with an example of some recommendations we made for China to take to fight the growing obesity epidemic.
There is another example of an international collaboration project that my team got funded in 2011 when I worked as a professor at the John Hopkins University . The NIH in the U.S. invested more than 16 million US dollars to support this international collaboration project to fight obesity and NCDs. In the future, we are hoping that countries like the United States will continue to commit to such international efforts. As part of this program we have an ongoing research project in China.
In 2011, we received more than two mission US dollars to support this project in China to fight the obesity epidemic, named “Multilevel Systems-oriented Childhood Obesity Study in China”. The aim was to study the interplay, impact and feedback loops of the built, social, economic, environmental and policy factors, and their changes on individual children and their families' decisions, eating, physical activity, and adiposity outcomes. Also, this project aimed to study why some individuals /families may respond differently to the environments and how they may affect their environments (i.e., feedback loops) - Explore potential intervention options. This project used unique rich longitudinal data, novel statistical analysis and systems models.
Moreover, our team has been trying to develop a large new program which includes the effort targeted at the local, regional, and global to fight the NCD epidemic. This program is based on a strong theory like system science and will use big data.
(Prof. WANG Youfa, Dean, Xi'an Jiaotong University Global Health Institute)
