Is there really a difference between NCDs and Infectious Diseases?

I am, with two of my favorite fellow Peace Corps volunteers, working on a mass media campaign to address health beliefs and hopefully change poor health behaviors. The other day, one of them and I had a conversation about whether we should focus on the “preventable” non-communicable diseases(NCDs or lifestyle diseases) solely or to also include infectious disease(malaria, STIs etc). At the time I was thinking we should only focus on the one’s the people have control over right? Then I started thinking about it and realized that NCD vs infectious disease is really a false dichotomy.

Diabetes, hypertension, some cancers, and chronic pain are all non-communicable diseases though to be preventable. But so isn’t malaria right? I mean, get an insecticide treated bug net can reduce childhood deaths from malaria by 20%(1). Add in intermittent prevention treatment during infancy, and indoor residual spraying combined with utilizing bug spray, wearing light colored clothing and medication as needed and the risk is significantly reduced. How about STI’s? Don’t cheat on your partner and wear protection and you should be good.

But not everyone has access to the means to these medications and tools and therefore cannot really be considerable preventable. Well, by that argument, neither should any of the NCDs. Put a person in a high-stress environment with poor air quality, no safe areas to exercise in a food desert(2) and see how well they do. For example, one study of Chicago neighborhoods found the death rate from diabetes in food deserts to be twice that of areas offering access to grocery stores(3). Or look at children experiencing high level of trauma as children, they face higher risks of everything from suicide to heart disease later in life(4).

Okay. But maybe we are thinking about it incorrectly. Maybe all diseases are preventable in ideal situations. But regardless the difference lies in the fact that one group is contagious while the other group is not(hence, non-communicable).

Errr. Not so fast. Let’s go back to diabetes. A mother who is obese, greatly increases her child’s risk of developing metabolic syndrome which is the precursor to heart disease and diabetes(5).  Same goes for smoking(6). And we all know the risk of lung cancer from second hand smoking, but did you know that it has been estimated that exposure has  caused 379,000 deaths from ischaemic heart disease, 165,000 from lower respiratory infections, 36,900 from asthma, and 21,400 from lung cancer. A total 603,000 deaths were attributable to second-hand smoke in 2004, which was about 1.0% of worldwide mortality(7)! Smoking sounds contagious to me! 

But that’s not all. Suicide is contagious, both related to media exposure(8) and clustering(9). Chronic pain has been shown to be communicable(11) in that a positive family history of pain was associated with increased reports of pain over the previous month and poorer general health as well as enhanced sensitivity to experimental pain stimuli(11). Additionally studies have found that not only is chronic pain associated with problems in the marital relationship but increases the distress and physical symptoms is previously non-chronic pain spouses as well. However, it is important to note, that these effects appeared to be related less to the existence of a chronic pain problem per se but rather to patients' and spouses' manner of coping with the situation(12).

Bad News? It seems like almost everything we can die from is potentially communicable.

Good News? There is already evidence suggesting that pain-related beliefs, attitudes and behaviour could positively be influenced by media campaigns(10). We have control some over who we hang out with, how we manage stress, what we do for exercise, choosing the most nutritious options available to us, developing positive coping strategies and utilizing preventive measures(i.e bug nets, condoms etc) to reduce risk of infectious disease transmission. For sure, there are things that will always be out of our control, but if we can successfully manage the ones that we do have control over and not stress over the ones we don’t, I think we can all live happier and healthier lives.

Until next time,

Danny

REFERENCES

1. Insecticide-Treated Bed Nets. http://www.cdc.gov/malaria/malaria_worldwide/reduction/itn.html
2. USADA Defines Food Desert. http://americannutritionassociation.org/newsletter/usda-defines-food-deserts
3. Curry, Andrew. “Bringing Healthy Fare to Big-City ‘Food Deserts.'” Diabetes Forecast. December 2009. http://forecast.diabetes.org/magazine/your-ada/bringing-healthy-fare-big-city-food-deserts (4/17/11)
4. The Adverse Childhood Experiences (ACE) Study. Centers for Disease Control and Prevention.
5. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005 Mar 1;115(3):e290-6.
6. Oken E, Levitan EB, Gillman MW. Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis. International journal of obesity. 2008 Feb 1;32(2):201-10.
7. Öberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. The Lancet. 2011 Jan 14;377(9760):139-46.
8. Gould MS. Suicide and the media. Annals of the New York Academy of Sciences. 2001 Apr 1;932(1):200-24.
9. Joiner TE. The clustering and contagion of suicide. Current Directions in Psychological Science. 1999 Jun 1;8(3):89-92.
10. Raspe H, Hueppe A, Neuhauser H. Back pain, a communicable disease?. International journal of epidemiology. 2008 Feb 1;37(1):69-74.
11. Fillingim RB, Edwards RR, Powell T. Sex-dependent effects of reported familial pain history on recent pain complaints and experimental pain responses. Pain. 2000 May 1;86(1):87-94.
12. Flor H, Turk DC, Scholz OB. Impact of chronic pain on the spouse: marital, emotional and physical consequences. Journal of psychosomatic research. 1987 Dec 31;31(1):63-71.