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Battling the biggest killers

A soldier lights a cigarette at a construction site in Koh Kong province.

Non-communicable diseases are the biggest killers in the World Health Organisation’s Southeast Asia region.

They are estimated to cause almost eight million deaths every year.

But cardio-vascular disease, cancer, chronic respiratory disease, diabetes and mental disorders can be prevented through effective public-health approaches that address the risk factors, such
as tobacco use, an unhealthy diet, physical inactivity and harmful use of alcohol.

Interventions are needed, however, from multiple sectors such as health education, food and nutrition, the environment, transport and communications.

Community education and the use of appropriate technology to address equity and social-justice issues are also essential tools in the effort to tackle these diseases.

The World Health Organisation has organised a meeting of health experts, policy-makers and partners from its 11 member states in the region – Bangladesh, Bhutan, the Democratic People’s Republic
of Korea, India, Indonesia, the Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste to follow up on this week’s high-level United Nations meeting on non-communicable diseases.

The two-day meeting, which opened yesterday in Yangon, will also discuss projects in the mental-health field.

These include strengthening primary care to enable the delivery of mental-health care, reducing harm from alcohol use and the promotion of mental well-being in communities.

“The reported burden of non-communicable diseases in South-East Asia is just the tip of the iceberg,” Dr Samlee Plianbangchang, the World Health Organisation’s director for this region, says.

“A public-health approach, backed by appropriate research, is urgently needed to bring this largely invisible problem to our attention for action.

“Our current health systems are highly skewed towards medical care, despite indisputable evidence that public-health interventions are much more cost-effective.

“This is disheartening, because the resources for health are scarce and the health systems in this region are overstretched.”

Mental and neurological disorders are among the leading causes of disability for people affected by mental-health issues and their families.

Measured in terms of disability-adjusted life years (DALYs), these disorders account for 13 per cent of DALYs around the globe.

In low-income countries, mental disorders account for 25 per cent of the years lived with a disability, compared with a somewhat higher 34 per cent in middle-income countries.

Unfortunately, however, roughly between 75 per cent and 85 per cent of people in low- and middle-income countries in South-East Asia who have severe mental disorders receive no treatment whatsoever for them.

In the region, national surveys of morbidity as a result of mental and neurological disorders have been conducted in Bangladesh, Bhutan, India, the Maldives, Thailand and Timor-Leste.

Harm caused by excessive use of alcohol is now increasingly recognised as a serious public-health problem. It is linked to almost

2.5 million deaths each year and 69 million DALYs.

Alcohol abuse also causes immense social, psychological and economic harm, such as gender-based violence, poverty, loss of employment and psychological distress.

Pilot studies in this region have conclusively shown that harm from alcohol use can be substantially reduced through community action, in which communities develop solutions to reduce the harm.

Appropriate policies to control the manufacture, distribution and availability of alcohol are also needed.

There is a growing commitment in the Southeast Asian region to respond to the huge burden of non-communicable diseases, mental health and neurological disorders.

Myanmar has shown the way by taking steps to address non-communicable diseases.

Comprehensive legislation on tobacco control in that country was adopted in 2005 and came into force in 2006.

As a result, the prevalence of smoking is gradually decreasing among students and adults.

Recently, a multi-sectoral national policy on non-communicable diseases was also finalised.

As well, the Myanmar government plans to implement interventions for prevention and control of non-communicable diseases through the primary health-care system.

Vismita Gupta-Smith is the public information and advocacy officer at the World Health Organisation’s Southeast Asia regional office in New Delhi, India.



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