Non-communicable diseases (NCDs) are the diseases or conditions that affect individuals over an extensive period of time and for which there are no known causative agents that are re-transmitted from one affected individual to another. Once primarily a concern in developed nations, NCDs are now surging in developing countries, leading to high mortality and morbidity. Today, NCDs constitute approximately around 74 percent of total mortality and morbidity globally, and of all NCD deaths, 77 percent are in low- and middle-income countries.

NCDs include cardio-vascular diseases, diabetes, hypertension, cancer and chronic respiratory diseases (chronic obstructive pulmonary disease and asthma). The top four killer diseases among NCDs are cardiovascular (30 percent deaths annually), cancer (9 percent), chronic respiratory (10 percent) and diabetes (4 percent). Risk factors vary from modifiable factors like tobacco use, harmful alcohol use, physical inactivity and unhealthy diet to non-modifiable risk factors like age, gender, gene, race and ethnicity. Metabolic factors include overweight, increased blood pressure, hyperglycemia (increased blood sugar level) and hyperlipidemia (high cholesterol in blood). Environmental factors like air pollution also play a significant role, contributing to 6. 7 million deaths annually.

Nepal, in particular, has witnessed a marked epidemiological transition from communicable to non-communicable diseases. Over the last few decades, there has been surge in the number of NCDs in Nepal, with premature mortality rising from 51 percent in 2010 to 71 percent in 2019. The double burden of communicable and non-communicable diseases in a developing country like Nepal poses a huge challenge to already strained healthcare system.

Action plan

Considering the gravity of the situation, Nepal has adopted and implemented the Package of Essential Non-Communicable Diseases (PEN) to screen, diagnose, treat and refer major NCDs such as cardiovascular diseases, diabetes, chronic obstructive pulmonary disease (COPD), cancers and mental health at health posts, primary health care centers and district hospitals. It is a good progress as it has been implemented in all seven provinces and 77 districts of Nepal. PEN Programme was developed in accordance with the Multisectoral Action Plan (MSAP II) for NCDs Prevention and Control (MSAP 2021-2025). The goal of MSAPs is to reduce the burden of NCDs through “whole of government” and “whole of society” approaches. It focuses on creating high impact, politically and socially acceptable and potentially implementable interventions. The programme has an overarching target of reducing premature mortality from NCDs by 25 percent in 2025 and by one third in 2030.

The NCD Action Plan is to achieve 80 percent availability of cheap basic technologies and necessary medications, including generics, needed to treat major NCDs in both public and private sectors. MSAP involves medication therapy and counseling (including glycemic management ) for 50 percent of eligible people (defined as those aged 40 and older with a 10-year cardiovascular risk of more than 30 percent including those with established cardiovascular disease).

Despite efforts to address NCDs , challenges persist, especially in rural areas where access to essential drugs, equipment and instrument is inadequate. The treatment of hypertension, diabetes and respiratory diseases is often marred by a lack sufficient resources or effective management, leading to premature deaths. The retention of skilled personnel in primary healthcare centers is challenging, contributing to disparities in the quality of care across Nepal. The diverse terrain and remote locations pose logistical challenges in delivering medical supplies and services, potentially compromising the positive outcomes. The geographical barrier not only affects access to healthcare but also limits the reach of educational initiatives and trainings for healthcare providers.

Prevention and control

NCDs are considered as a silent killer as they can deteriorate health without visible symptoms until reaching advanced stages, highlighting the vital need for health monitoring.

Behavioral and lifestyle modification interventions are one of the most effective strategies to reduce risks. Several studies highlight significant positive outcomes after the modification of risk factors. Taking personal responsibility is key to mitigating risks, such as quitting smoking, avoiding alcohol, and taking 30 minutes of brisk walk daily. Adopting a balanced and healthy diet that includes green vegetables and fruits, reducing salt intake (less than 5 gm/day), limiting the consumption of sugar, saturated fats and packaged foods is essential. High consumption of processed meat and sugar sweetened beverages, combined with smoking and physical inactivity, have marked association with NCDs. Furthermore, prioritising mental health well-being is integral. Practices like meditation, yoga and stress management can provide invaluable support in reducing the risks. Regular screening of the disease, particularly for high-risk groups, enable early detection and intervention which prevents adverse health outcomes.

The detection of NCDs at a young age is a huge concern these days. This is fueled by easy access to the unhealthy fast or junk foods, leading to the rise of overweight and obese children. The urgency of promoting healthy behavior from an early age is hence crucial. Addressing childhood obesity can build a strong foundation in preventing NCDs and its complications in the long run. Moreover, in the adolescent stage, risk of smoking and consumption of alcohol can emerge, exacerbating NCDs. Hence, by instilling healthy behavior during formative years can positively impact long-term health trajectory.

Beyond individual levels, societal and political interventions like food marketing, promotion of physical activities in schools and communities, and creating supportive infrastructure can foster an environment of healthy choices. Reducing risk factors not only save lives but also provides a huge economic boost for the countries.

Managing NCDs is a holistic approach. While interventions across different levels are crucial, the most impactful action occurs at the individual level. Prioritising conscious choices regarding one’s own health should be made a priority. Regardless of the modern technologies and innovations that make our life easier, maintaining a healthy lifestyle is paramount. Globalisation, rapid urbanisation and sedentary life style are the key factors responsible for NCDs and demand attention. Implementing innovative solutions like telemedicine and mobile healthcare units can bridge the gap in access to healthcare services, especially in remote areas.

Managing NCDs extends beyond mere health concerns. It encompasses preventive, promotive, curative, rehabilitative and curative aspects. The treatment approach should be tailored to individuals rather than focusing solely on the disease. Robust research evidence is crucial for effective management, and it is necessary to create research roadmaps adapted to country-specific needs. We must promote the implementation of research to support cost-effectiveness interventions for people living with NCDs and pay sustained attention to cross-cutting interventions. Only then can we fulfil the vision of “Leaving No One Behind” underpinned by 2030 Sustainable Development Agenda and the concept of universal health care advancing towards a healthier, more equitable future.