Where did NCDs bring us? Back to COVID

Post-COVID conditions have increased the risk for heart disease and stroke. (Photo: Marcel Crozet)

Have you ever had an anxiety dream? I've had a few. 

It usually goes like this: I’m out and about in public, just doing normal stuff you do outside: clothes shopping, eating at a restaurant. And then, I look around me, and everyone is wearing a mask—but I’m not. My hand flies to my chest, but I’m not wearing my mask strap. I search my pockets, my bag, but for some reason, I don’t have any extras. 

Everyone’s staring at me, judgment clear in their eyes. I cover my mouth and nose shamefully, and then I wake up sweating and breathing heavily, glad that I'm home and in my bed, where it’s okay that I’m not wearing a mask.

When my anxiety dreams used to be about tanking in the middle of a presentation, or embarrassing myself at my college graduation, I was suddenly panicking in my dreams about being maskless in public. It was only then that I realized just how much the pandemic had taken over my life.

But it looks like I’m not the only one. COVID has become such a central part of our lives that we’re overlooking some other things that we need to be paying more attention to—like a major public health shift that happened right under our noses.

COVID is still the main character

In September, the World Health Organization (WHO) released a report and a portal that explores data about NCDs, which are now the top killers globally.

NCDs include heart diseases and stroke, cancer, diabetes, and chronic respiratory diseases. As of 2022, they cause almost three quarters of deaths around the world—that’s about 41 million deaths each year. The WHO reports that every two seconds one person below the age of 70 dies from NCDs, and 86% of those deaths come from low- and middle-income countries.

Cardiovascular disease, the top killer, causes about 18 million deaths each year. Cancer causes 9.3 million deaths, chronic respiratory disease causes 4.1 million, and diabetes causes about 2 million. 

These illnesses are associated with various risk factors like smoking, which is the leading cause of preventable deaths, as it’s attributed to more than 8 million deaths, with over a million coming from second-hand smoke. Unhealthy diets—both from undernutrition and overnutrition, also cause about 8 million deaths. Alongside alcohol abuse, physical inactivity, and air pollution, these are the top risk factors for NCDs.

So while the WHO notes that there are factors beyond our control—like genetics, which are linked to type 1 diabetes and some forms of cancer, NCDs are largely preventable. But, while the world was busy dealing with the COVID-19 pandemic, other illnesses were kind of ignored for a couple of years.

In early 2020, 75% of countries reported that their essential NCD services were disrupted because of lockdown restrictions, and because they had to funnel their resources to more urgent matters (like the estimated 15 million deaths caused by COVID from 2020 to 2021.)  Also, conditions during the pandemic weren’t exactly conducive to a healthy lifestyle. Being restricted to our homes meant less physical activity, and the economic insecurity also meant that for most of us, a healthy diet was simply not something we could afford. 

Plus, people who already have NCDs are at higher risk of becoming seriously ill from COVID-19. Recent studies are showing that people with obesity, diabetes, coronary artery disease and chronic obstructive pulmonary disease, and smokers, have a much greater risk of dying from COVID—which only proves that preventing and treating NCDs are key to reducing COVID-19 deaths, among other infectious diseases.

The cost of NCDs

Studies show that economic status and NCDs are inextricably linked in a vicious cycle: developing an NCD increases the risk of falling into poverty, and those in poverty have a higher risk of death and disability from NCDs—and as mentioned before, almost nine out of 10 NCD-related deaths happen in middle- and low-income countries. 

The fact of the matter is this: Addressing issues in inequality, education, and unsustainable food systems can address the growing problem of NCDs and save millions of lives—and a ton of money. In fact, the WHO estimates that globally, we spend about $8.5 trillion on NCD-related health care, and between 2011 and 2030, the cost of lost productivity from NCDs was about $30 trillion. Investing in preventative care for NCDs across all low- and middle-income countries could generate an estimated $2.7 trillion in economic benefits. 

But fixing the NCD pandemic requires investment. Filling the funding gap is crucial, and low- and middle-income countries require an estimated $18 billion each year to provide health services to those living with NCDs. But with governments like the Philippines’ not allocating the appropriate funding for healthcare, instead sneaking in billions in “confidential, intelligence funds” and proposing ridiculous solutions (unli-kamote, anyone?) to the health crisis, it’s unlikely that we’ll see any real solutions to the NCD pandemic anytime soon.

As we continue to respond to the COVID-19 pandemic (which isn’t over yet, btw) we should also make room to respond to this major health shift that is adding to the hospitalizations and deaths that our health systems were already too overloaded to address in the first place.

One of my smaller and more negligible concerns is what my next anxiety dream will be about. Maybe now I’ll have nightmares about eating too much lechon kawali, or inhaling all that smoke from my daily commute. I almost miss the days when my biggest fear was failing exams.