Web Appendix to: The Lancet Taskforce on NCDs and economics paper #2 Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda (original) (raw)
Related papers
Risk, lifestyle and non-communicable diseases of poverty
Globalization and Health
Common discourse in public health and preventive medicine frames non-communicable diseases, including cardiovascular and metabolic diseases, as diseases of ‘lifestyle’; the choice of terminology implies that their prevention, control and management are amenable to individual action. In drawing attention to global increases in the incidence and prevalence of non-communicable disease, however, we increasingly observe that these are non-communicable diseases of poverty. In this article, we call for the reframing of discourse to emphasize the underlying social and commercial determinants of health, including poverty and the manipulation of food markets. We demonstrate this by analysing trends in disease, which indicate that diabetes- and cardiovascular-related DALYS and deaths are increasing particularly in countries categorized as low-middle to middle levels of development. In contrast, countries with very low levels of development contribute least to diabetes and document low levels o...
The Global Distribution of Risk Factors by Poverty Level
Bulletin of the World …, 2005
Objective To estimate the individual-level association of income poverty with being underweight, using tobacco, drinking alcohol, having access only to unsafe water and sanitation, being exposed to indoor air pollution and being obese. Methods Using survey ...
Healthcare Access - New Threats, New Approaches [Working Title]
Poverty is not merely the absence of money but the absence of resources to get the necessities of life. Poverty and health are always in a reciprocal relationship. This relation came to light in 1948 when the WHO defined health as complete physical, mental and social wellbeing. In 1987, the Alma-Ata declaration opened the discussion on health inequity. This opened the door for thousands of projects, proposals, and publications on this relation. Although the relationship between poverty and infectious diseases was clear, there was inequity in funding. The Global Fund invests US$ 4 billion annually for AIDS, tuberculosis, and Malaria, while other diseases lack funds. That is why they were considered neglected tropical diseases. However, the relationship between health and poverty is not limited to infectious diseases but includes noninfectious problems like malnutrition and injuries. In this chapter, we will assess the association between poverty as a predictor and health as an outcome.
PLOS ONE
Introduction Non-communicable diseases (NCDs) disproportionately affect low-and lower-middle income countries (LLMICs) where 80% of global NCD related deaths occur. LLMICs are the primary focus of interventions to address development and poverty indicators. We aimed to synthesise the evidence of these interventions' impact on the four primary NCDs (cardiovascular disease, diabetes, chronic respiratory disease and cancer) and their common behavioural risk factors (unhealthy diets, physical inactivity, tobacco and alcohol use). Methods We systematically searched four online databases (Medline, Embase, Web of Science and Global Health) for primary research conducted in LLMICS, published between January 1st 1990 and February 15th 2016. Studies involved development or poverty interventions which reported on outcomes relating to NCDs. We extracted summary level data on study design, population, health outcomes and potential confounders. Results From 6383 search results, 29 studies from 24 LLMICs published between 1999 and 2015 met our inclusion criteria. The quality of included studies was limited and heterogeneity of outcome measures required narrative synthesis. One study measured impact on NCD prevalence, one physical activity and 27 dietary components. The majority of papers (23), involved agricultural interventions. Primary outcome measures tended to focus on undernutrition. Intensive agricultural interventions were associated with improved calorie, vitamin, fruit and vegetable intake. However, positive impacts were reliant on participant's land ownership,
BMC Public Health, 2012
Background: Monitoring inequalities in non communicable disease risk factor prevalence can help to inform and target effective interventions. The prevalence of current daily smoking, low fruit and vegetable consumption, physical inactivity, and heavy episodic alcohol drinking were quantified and compared across wealth and education levels in low-and middle-income country groups. Methods: This study included self-reported data from 232,056 adult participants in 48 countries, derived from the 2002-2004 World Health Survey. Data were stratified by sex and low-or middle-income country status. The main outcome measurements were risk factor prevalence rates reported by wealth quintile and five levels of educational attainment. Socioeconomic inequalities were measured using the slope index of inequality, reflecting differences in prevalence rates, and the relative index of inequality, reflecting the prevalence ratio between the two extremes of wealth or education accounting for the entire distribution. Data were adjusted for confounding factors: sex, age, marital status, area of residence, and country of residence.
Lancet , 2018
Five Sustainable Development Goals (SDGs) set targets that relate to the reduction of health inequalities nationally and worldwide. These targets are poverty reduction, health and wellbeing for all, equitable education, gender equality, and reduction of inequalities within and between countries. The interaction between inequalities and health is complex: better economic and educational outcomes for households enhance health, low socioeconomic status leads to chronic ill health, and non-communicable diseases (NCDs) reduce income status of households. NCDs account for most causes of early death and disability worldwide, so it is alarming that strong scientific evidence suggests an increase in the clustering of non-communicable conditions with low socioeconomic status in low-income and middle-income countries since 2000, as previously seen in high-income settings. These conditions include tobacco use, obesity, hypertension, cancer, and diabetes. Strong evidence from 283 studies overwhelmingly supports a positive association between low-income, low socioeconomic status, or low educational status and NCDs. The associations have been differentiated by sex in only four studies. Health is a key driver in the SDGs, and reduction of health inequalities and NCDs should become key in the promotion of the overall SDG agenda. A sustained reduction of general inequalities in income status, education, and gender within and between countries would enhance worldwide equality in health. To end poverty through elimination of its causes, NCD programmes should be included in the development agenda. National programmes should mitigate social and health shocks to protect the poor from events that worsen their frail socioeconomic condition and health status. Programmes related to universal health coverage of NCDs should specifically target susceptible populations, such as elderly people, who are most at risk. Growing inequalities in access to resources for prevention and treatment need to be addressed through improved international regulations across jurisdictions that eliminate the legal and practical barriers in the implementation of non-communicable disease control.
Background: Historically, the international development community has often held the view that those living in extreme poverty (at less than $1.90/day) are likely to have a low prevalence of cardiovascular disease (CVD) risk factors due to calorie scarcity, a largely plant-based diet, and physical labor. Evidence on CVD risk factor prevalence among adults living below the World Bank's international line for extreme poverty globally is sparse because studies have used measures of socioeconomic status that are not comparable across study populations and countries. For adults living in extreme poverty, this study aimed to determine i) the prevalence of each of five key CVD risk factors, ii) how the prevalence of these CVD risk factors varies across and within countries, and iii) the level of treatment coverage with statin, antihypertensive, and diabetes therapy. Methods: We pooled individual-level data from 105 nationally representative household surveys with physical measurements ...
Lancet (London, England), 2018
Five Sustainable Development Goals (SDGs) set targets that relate to the reduction of health inequalities nationally and worldwide. These targets are poverty reduction, health and wellbeing for all, equitable education, gender equality, and reduction of inequalities within and between countries. The interaction between inequalities and health is complex: better economic and educational outcomes for households enhance health, low socioeconomic status leads to chronic ill health, and non-communicable diseases (NCDs) reduce income status of households. NCDs account for most causes of early death and disability worldwide, so it is alarming that strong scientific evidence suggests an increase in the clustering of non-communicable conditions with low socioeconomic status in low-income and middle-income countries since 2000, as previously seen in high-income settings. These conditions include tobacco use, obesity, hypertension, cancer, and diabetes. Strong evidence from 283 studies overwhe...
BMJ open, 2013
To identify the chronic health conditions associated with multidimensional poverty. Cross-sectional study of the nationally representative Survey of Disability, Ageing and Carers, conducted by the Australian Bureau of Statistics. Australian population in 2003. 35 704 individuals randomly selected from the Australian population by the Australian Bureau of Statistics. Multidimensional poverty status, costs of disability, short form 6D health utility score, income, education attainment. Among those who were multidimensionally poor, 75% had a chronic health condition and the most common health conditions were back problems (11% of those in multidimensional poverty had back problems) and arthritis (11%). The conditions with the highest proportion of individuals in multidimensional poverty were depression/mood affecting disorders (26% in multidimensional poverty) and mental and behavioural disorders (22%). Those with depression/mood affecting disorders were nearly seven times (OR 6.60, 95...
Global health action, 2015
Economic growth in low- and middle-income countries (LMIC) has raised interest in how disease burden patterns are related to economic development. Meanwhile, poverty-related diseases are considered to be neglected in terms of research and development (R&D). Developing intuitive and meaningful metrics to measure how different diseases are related to poverty and neglected in the current R&D system. We measured how diseases are related to economic development with the income relation factor (IRF), defined by the ratio of disability-adjusted life-years (DALYs) per 100,000 inhabitants in LMIC versus that in high-income countries. We calculated the IRF for 291 diseases and injuries and 67 risk factors included in the Global Burden of Disease Study 2010. We measured neglect in R&D with the neglect factor (NF), defined by the ratio of disease burden in DALYs (as percentage of the total global disease burden) and R&D expenditure (as percentage of total global health-related R&D expenditure) ...