CAMBRIDGE, Massachusetts — When one thinks of poverty, usually the mind jumps to lack of nutrition and access to safe drinking water, unsanitary environments and infectious diseases. Poverty is rarely associated with non-communicable diseases like cancer, cardiovascular disease and diabetes. Consequently little attention is paid to NCDs in development goals. However, the statistics say we should in fact be very concerned.
In 2008, of the 38 million people who died from NCDs, 80 percent were in low- and middle- income countries. According to a 2009 discussion paper from the WHO, World Bank estimates that one-third of the poorest two quintiles die prematurely from NCDs. As more and more people migrate into urban areas, the sharp increase in population density relative to infrastructure and housing leads to deteriorating living conditions. People in difficult living conditions are more likely to be exposed to second-hand smoke, excessive alcohol use, indoor air pollution and other such risk factors. They can be severely stressed and suffer from mental health deprivation. Study after study has found that risk factors are increased in urban areas and that these particularly affect the urban poor.
Under-nourishment during early life has been shown to be a risk factor for cardiovascular disease and diabetes. The WHO reports that since the number of competing expenditures is high, the money left over for food purchases among the urban poor is limited. Not to mention, the residue and smoke generated from using solid fuels like wood or coal for cooking and boiling water literally create a toxic atmosphere under which to live. With increasing research investment into finding cheap alternatives for inefficient fuels, this problem is slowly being addressed.
Housing conditions have a causal relationship to ill-health. Much of the urban poor live in informal settlements sometimes called slums. According to U.N. Habitat, in some cities, up to 80 percent of the residents live in slums. Basic infrastructure, proper sanitation and running water can be difficult things to promise as urbanization exceeds the pace of housing development. Residents are exposed to dangerous housing materials like lead or asbestos, and sometimes overcrowded to the point of lacking ventilation. At times, living spaces also function as work spaces for cottage industries and that brings with it the associated waste and toxins. All these contribute to debilitating conditions including chronic lung disease, various kinds of cancers, and heart disease.
Governments of several countries are investing in slum-upgrading and government housing projects. Starting from the grassroot level is another option. Shack Dwellers International seeks to increase the ownership of the community in their amelioration by working together with local authorities to identify the most sustainable way to ameliorate living conditions. A recently launched project in Nairobi, Kenya, of this “Federation” of community-based organizations brokered deals with Lixil (a sanitary ware and household fittings company) and philanthropic foundations to develop an indoor composting toilet that does not use water for disposal of waste. There are many such successful programs operating across the world.
The problem with NCDs is that they are chronic. The long-term medication and health care costs due to an NCD can be unsustainable for the low-income populations. Moreover, the lack of access to health care allows many treatable conditions to go undiagnosed. According to WHO estimates, annually eight million NCD-related deaths just in the Caribbean and Africa could be prevented if healthcare was available to urban poor. Education, as always, plays a part in complicating these issues. If people are not knowledgeable about proper diets and the options available to them, it is harder for them to attain healthy living.
Partly due to the fact that the current millennium development goals do not cover NCDs, funding for solutions to this crisis has been low. With the MDGs for the next 15 years soon to be finalized, attention is turning toward the need for making NCDs a priority.
– Mithila Rajagopal