Prevention of Infectious and Chronic Diseases

An indispensable investment

Md Moshiur Rahman, Associate Professor, Graduate School of Biomedical & Health Sciences, Hiroshima University

Md Adnan Hasan Masud, Consultant, Haematology Department, Bangabandhu, Sheikh Mujib Medical University (BSMMU)

Sajeda Chowdhury, Research Institute for Radiation Biology and Medicine, Hiroshima University

Evolving ecology, changing human behaviour, and shifting disease pattern, have created a growing burden of emerging and re-emerging infectious and chronic diseases. The world’s most vulnerable populations continue fighting with this double whammy of diseases. It is important to understand disease epidemiology and act urgently for strengthening prevention and control measures.

The world has developed an expanded global health system for the protection of known and unknown infectious disease threats and to promote human health. However, the system continues to be challenged by emerging and reemerging infectious disease threats. These threats vary in terms of severity and probability with the consequences for morbidity and mortality. Recent outbreaks of a novel coronavirus (COVID-19), Ebola, Zika, Dengue, Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and influenza have been raised concerns about whether the current global health system is ready to provide effective protection against the global threats. Several factors complicate the disease management as rapid population growth with weak health systems, urbanisation, globalisation, civil conflict, climate change, and the changing nature of pathogen transmission between human and animal populations. There is also the risk of human-originated outbreaks deriving from laboratory accidents or intentional biological attacks. The world currently lacks the integrated system for managing and responding in an efficient and coordinated manner. This article explains the global health challenges and rationale for the investment in preventing infectious and chronic diseases.

In December 2019, a group of patients with pneumonia were confirmed to be infected with COVID-19 in Wuhan, Hubei province, China. Epidemiological evidence suggested as the virus obtained from these patients was highly similar to that identified in bats. We live in a world that is globally connected, in terms of the movement of people, goods, and food. As a consequence, the COVID-19 started spreading all over the world. The outbreak was confirmed as a Public Health Emergency of International Concern on 30 January 2020. The situation analysis was released and considered scenarios for potential disruptions around the world. On 11 March 2020, the World Health Organization (WHO) announced that COVID-19 can be characterised as a global pandemic. In various regions around the world, the COVID-19 causes the fear and panic that resulted in social distancing, closing of schools, enterprises, commercial establishments, transportation, and public facilities, which disrupt economic and other social activities. As of 27 April 2020, a confirmed 2,883,603 people have been infected with COVID-19 globally across 213 countries, areas or territories. Currently, there is no effective drug treatment or vaccine. It is essential to be strengthened for surveillance of the virus and drugs and vaccines to be developed against COVID-19 infection within the earliest time. It is also important to conduct daily public-wide educational campaigns on precautionary measures against exposure to COVID-19, encouraging people to cancel traditional or avoidable gatherings to prevent the large-scale spread. The ongoing COVID-19 pandemic response requires rapid action from all societies and governments. Individuals need to adopt new preventive and control behaviours and as well societies need to implement new public health strategies. Today, the whole world realises the importance of life-saving risk communication and demanding evidence-based guidance to reduce the burden of COVID-19. A combination of public health measures are recommended as rapid identification, isolation and case management, contacts identification and follow up, infection prevention and control in health care settings, population awareness and limiting movement, and risk communication.

Until now, vaccines have been a core component of preventive measures and the most cost-effective  preventive approaches for the vaccine preventable diseases. Childhood immunisation usually provides a very high return on investment. During the 20th century, there has been an increase in life expectancy due largely to immunisation and child survival. Though infectious disease mortality is reduced, emerging and re-emerging infectious diseases remain a major cause of illness, death, and disability. Today, people are demanding new vaccines against COVID-19, ebola, malaria, and other infectious diseases for saving lives around the world.

Currently, chronic diseases are the leading causes of death and disability worldwide and will result in over three quarters of all deaths by 2030. At present, cancers, autoimmune or immune-mediated diseases, and neuro-developmental disorders are susceptible candidates for transmission of infectious agents. Many chronic diseases have an infectious origin, such as liver cancer (hepatitis B and C viruses) and cervical cancer (human papillomavirus) and require longterm care. Many chronic diseases are also associated with high-risk behavioural factors. Rising chronic disease also linked to changing food consumption patterns, such as processed food, especially targeted to children, has a negative impact on health.

It is time to understand chronic disease epidemiology and infectious disease epidemiology together. There are new prospects to strengthen the prevention of chronic diseases, especially cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases. Chronic diseases are generally represented because of particular health-damaging behaviors, such as smoking, hazardous drinking, physical inactivity, or overeating. The creation of smoke-free public places is important to protect non-smokers from the hazards of passive smoke to prevent cardiovascular diseases and cancer. Several lines of evidence indicate that modifiable behaviours related to dietary (consumption of fruits and vegetables, limit excessive caloric, sodium, and sugar intake) and lifestyle changes (regular physical activity and sleeping pattern) can reduce the incidence of chronic disease.

Chronic diseases are still neglected globally, receiving very few resources from development agencies and governments of low-income and middleincome countries. These diseases disproportionately affect the poor and can increase poverty. There is a vicious cycle of poverty and illness. There are several factors indicating the association between poverty and chronic diseases and their risk, such as social exclusion, inadequate education, mental stress, and poor nutritional status most likely lead to premature death. The evidence suggests that early-childhood poverty can lead to chronic diseases later in life. The comprehensive programmes and investments in early-childhood development as one of the most cost-effective interventions to reduce the increasing burden of chronic diseases in adults and have huge immediate and long-term returns on investment. The participation and support of development agencies and governments are crucial to prevent chronic diseases in low-income and middle-income countries. There has been a slow progression in chronic disease prevention due to lack of strong political commitment. Recently, the United Nations (UN) resolution on chronic diseases has contributed to a shift in strengthening global support for action with a priority for the prevention of chronic diseases. A priority for primary health care, improvement of chronic disease surveillance, reorientation in stepwise approach, and strengthening of health systems are important to improve the prevention and management of chronic diseases in low-income and middle-income countries. An emphasis on infectious and chronic disease prevention is a key strategy for poverty reduction.

Chronic diseases negatively impact population health and accounts for seven of the top 10 causes of death. Cost, access, and quality are the key issues addressing the healthcare needs. The investments in population-health strategies appear to be costeffective to improve long-term-health outcomes and address high mortality and high-morbidity diseases. Community-based interventions and populationwide prevention policies prove to be much more powerful. It is the time to invest in prevention methods and evidence-based programs that will increase the quality of lives.

Primary health care (PHC) is globally recognised as an essential driving force for fostering universal health coverage (UHC) and achieving the sustainable development goals (SDGs). There is a huge shortage of healthcare workers worldwide. Resource mobilisation, expanding and investing in PHC, and overall health workforces need to increase for bringing substantial health benefits and build human capital. Additionally, research indicates that PHC is linked to more effective, appropriate, and less costly care. To strengthen primary health care in low-resource settings, research also suggests the chronic care model needs improvement in the areas of community resources, health systems, self-management support decision support, delivery-system redesign, and clinical information systems. PHC workers have a focal role in supporting patients to their illnesses for self-management through disease education, motivated and skill development. Integrated primary health-care approaches are important in dealing with the growing burden of chronic diseases.

The SDGs have increased global attention on chronic diseases to ensure healthy lives and promote wellbeing for everyone at all ages to reduce premature mortality through the prevention and control strategies. The focus of SDGs is the changing environment surrounding health strategies, and fight against poverty and illness. Investing in cardiovascular disease prevention is essential to progress towards achieving SDG target 3.4. In 2017, the Best Buy interventions were updated at the World Health Assembly and incorporated for the prevention and ontrol of chronic diseases.

Climate change and health have shown complex inter-relations. Investmenting in climate change issues and addressing vector-borne, food-borne and water-borne diseases can play a key role in preventing roughly a quarter of global disease burden by reducing environmental risks. Crosssectoral investments are also essential for sustainable health outcomes and broader health security, such as water and sanitation, air quality, food safety, road safety, and zoonotic disease control.

Human behaviour is one of the major factors for the underling emergence and spread of infectious pathogens. These include such as hand-washing, food hygiene, exercise, nutrition practices, and improve environmental sanitation. There is still limited consensus about health information-seeking, risk communication, trust, and reputation management. In order to achieve behaviour change that can prevent the acquisition and further spread of infectious disease, public health strategy needs a focus on reducing disparities and inequities and to improve health promotion and health communication. School-based and worksite educational programmes can also play an important role in maintaining physical and mental health, which includes health education on nutrition and physical activity and a wide variety of health promotion activities.

The world tackles multiple challenges at once, and their resolution demands novel approaches through innovations in public health. It is an essential step in reframing the strategies in the global health and development agenda to mobilise resources to accelerate available cost-effective interventions for appropriate disease management. A framework of investment needs to be developed for prevention and control of infectious and chronic diseases in connection with the SDG targets and estimate the economic and social benefits of better health.

--Issue 48--

Author Bio

Md Moshiur Rahman

Md Moshiur Rahman is Associate Professor of International Health and Medical Care, Hiroshima University, Japan. He has outstanding academic credentials combined with experiences in global health, population and health science, research, administration, and leadership. He has more than 20-year experiences in health-related programs and researches in Bangladesh, Africa, and Japan.

Md Adnan Hasan Masud

Md. Adnan Hasan Masud is a Consultant in Haematology Department, BSMMU, Shahbag, Dhaka, Bangladesh. He has versatile & dynamic academic qualifications combined with excellent professional experiences in clinical medicine, chest & blood diseases and leadership in physicians’ society. He has more than 15-year experiences in various health-related programs and researches in Bangladesh.

Sajeda Chowdhury

Sajeda Chowdhury is a multidisciplinary Researcher at Hiroshima University, Japan. She has research experiences both in molecular biology and epidemiological field. Formerly, she worked as Lecturer of undergraduate medical students and Trainer of nursing students in Bangladesh. Her research interest included antiviral candidates, Oncology and public health issues.

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