Non-Communicable Diseases and the Onset of Disabilities: An increase in morbidity compared to mortality

When one begins to explore the relationship between NCDs (non-communicable diseases) and disability, one must comprehend the meaning of both of these conditions. NCDs are those diseases that cannot be communicated, transmitted, or spread from one person to another. Examples of NCDs include diabetes, coronary artery disease, hypertension, and strokes.

Figure 1: WHO's International Classification of Functioning (ICF)

According to the World Health Organisation's International Classification of Functioning (ICF), disability is defined as "a dynamic interaction between a person's health condition, environmental factors, and personal factors." (shown in fig 1)

According to Josephine E Prynn and Hannah Kuper, "a person with a disability is someone with a health condition causing physical, psychological, or cognitive impairment, which can then lead to activity limitation and participation restriction, including in work, social, and family life."

Globally, the WHO estimates that there are one billion people with disabilities, and disability may be both a risk factor and a consequence of non-communicable diseases.

Two irrefutable facts are worth noting: 

• Both disability and NCDs are increasing due to a rapidly aging population and an increase in morbidity compared to mortality, both contributing to a rise in chronic conditions. 

• Disability and NCDs are strongly interlinked. People with NCDs may develop complications that result in diminished activity, seriously hampering their daily routines and rendering them unfit or incapable of performing routine tasks without assistance. This, in itself, is a form of disability. 

On the other hand, people with NCDs are more vulnerable than the general population to disabilities, either because they are immunocompromised or simply because of their underlying health conditions. Since both of these conditions can predispose individuals to the other, we should take steps to tackle both disability and NCDs with urgency, especially in India.

India is often referred to as the 'diabetes capital of the world,' according to a study by the Indian Council of Medical Research (ICMR), which shows that the country now has 101 million diabetics, with an additional 136 million pre-diabetic individuals in need of prevention. It is expected to overtake China, which currently has the largest number of diabetics in the world. 

According to Basu S. and King A., India is also expected to bear a higher burden of chronic non-communicable diseases than any other country in the world over the next decade. This is due to steadily decreasing maternal and infant mortality rates, as well as greater access to quality healthcare, which has led to a significant aging population in India.

The overall burden of disease is assessed by the WHO using DALYs (Disability-Adjusted Life Years). One DALY represents the loss of the equivalent of one year of full health. The most common NCDs (shown in fig 2) include cardiovascular diseases (both heart attacks and strokes), diabetes, cancers, chronic lung diseases, chronic kidney diseases, mental health disorders, and other neurological conditions. 

These diseases can lead to various impairments related to hearing, speech, vision, mobility, and even result in amputations.

NCDs can cause disability both directly and indirectly. The direct association can be seen in NCDs such as cardiovascular diseases and diabetes. Cardiovascular diseases like heart attacks and strokes can directly cause severe limitations in patient morbidity and mobility, dramatically altering their lifestyles almost instantly. Diabetes, on the other hand, affects most organs of the body, though the process of affectation is gradual over a prolonged period, especially if left unchecked. Diabetes can affect most organs, with the eyes (diabetic retinopathy), the kidneys (diabetic nephropathy), and the nerves (diabetic neuropathy) having profound consequences.

Examples of NCDs that cause disabilities indirectly are chronic lung diseases and most types of cancers. According to Lizzy K. et al., "Chronic respiratory diseases can lead to functional limitations and dyspnoea, but also to anxiety and depression." According to Smith S.R. et al., cancers can have wide-ranging effects on a patient's functional status. In my opinion, cancer is an example of an NCD that can cause disabilities both directly and indirectly. Cancers can affect almost any organ in the body and can also spread to distant sites, resulting in a wide range of disabilities. For example, cancers of the throat can cause dysphagia, while cancers of the head can cause blindness, deafness, and loss of balance. Cancer is also known to cause anxiety and depression in patients, which can prevent them from leading a normal lifestyle and even from working. According to Edoardo Aromataris, MD, Joanna Briggs Institute, University of Adelaide, Australia, cancer-related disability manifests in functional, cognitive, and psychological limitations that can impact a person's physical, social, and emotional well-being and quality of life (QOL). He states, "Impairment of functioning can be a result of cancer or its treatment, and disability may vary in severity or be temporary or permanent."

In India, poverty is also an issue. According to Banks L. et al., disability and poverty are believed to operate in a cycle, with each reinforcing the other. According to Yoe R. and Elwan A., in low- and middle-income countries (LMICs) such as India, conditions associated with poverty, such as lack of access to healthcare, inadequate water and sanitation, malnutrition, and poor living conditions, increase the risk of disability.

Prince M. et al. have researched that dementia is also associated with extremely high levels of disability and is by far the leading NCD cause of disability and care needs in older people worldwide. Dementia can also lead to mental health disorders.

The most distressing yet ironically positive fact is that approximately 80% of all NCDs are largely preventable. The magic potion remains the simplest and yet most significant piece of advice that has been handed down for generations: exercise, adequate sleep, a balanced diet, along with refraining from alcohol and tobacco.

It is truly remarkable and refreshing that, Biometric Asia is taking the initiative to support and assist people affected by disability, by creating an ecosystem which provides adequate insurance coverage including income protection at the advent of disability along with other services which enables an individual to lead a respectable life.

More about Dr Neil:

Dr Neil is an accomplished Radiologist with more than 25 years of experience in the medical field. He’s also done his MBA from the University of Western Australia. He is currently based out of Perth, Australia.

References: