Non-Communicable Diseases: A Medical Anthropological Perspective

           The rising global population, increasingly sedentary lifestyles, and unhealthy diets have led to a significant increase in risk factors for non-communicable diseases over the past few decades resulting in a drastic surge in deaths caused by NCDs all over the world according to the World Health Statistic 2012 Report (World Health Statistics). Although the WHO report explains the increasing occurrence of a few risk factors of NCDs as the sole cause of the rising death rate due to NCDs, it is important to take on a medical anthropological perspective in order to gain a more holistic view of the problem. For instance, in the cases of the hunter-gatherers in North America, the significant change in morbidity due to NCDs was not exclusively determined by the named NCD risk factors in the WHO report. A complete understanding of the sudden change was only found after close ethnographic and epidemiological studies of the population. The extensive studies resulted in the discovery that genetic adaptations to a hunter-gatherer diet caused significant health problems when they changed to a diet of starchy and processed foods. When trying to find a solution to this important global health problem of the 21^st century, a medical anthropological perspective needs to be used in order to gain a far-reaching understanding of the global health problem.

The rising rates of non-communicable diseases has been determined a major global health problem of the twenty first century according to the WHO World Health Statistics report for 2012. While the rate of deaths from infectious diseases is expected to decline over the next twenty years, the number of deaths caused by NCDs has been projected to escalate, possibly reaching 55 million annual deaths by the year 2030 (World Health Statistics). The United Nations has already recognized this issue as a major global health challenge and has begun taking steps to address the problem. They plan to strengthen health systems to provide better treatment of NCDs, to monitor the number of NCDs, and to attempt to decrease the incidences of NCDs through the reduction of NCD risk factors.

The main four NCDs are cardiovascular disease, cancer, chronic respiratory disease, and diabetes and they account of a majority of deaths worldwide. The introduction to the section on NCDs in WHO’s report begins, “Of the estimated 57 million global deaths in 2008, 36 million (63%) were due to noncommunicable diseases (NCDs). Population growth and increased longevity are leading to a rapid increase in the total number of middle-aged and older adults, with a corresponding increase in the number of deaths caused by NCDs.” (World Health Statistics). Although increasing longevity has prompted the rate of deaths caused by NCDs to increase, other factors have been influential in causing this global health problem. The WHO report also mentions, “In 2008, around 80% of all NCD deaths (29 million) occurred in low- and middle-income countries. In addition, a higher proportion (48%) of all NCD deaths in low and middle-income countries are estimated to occur in people under the age of 70 – compared with an estimated 26% in high-income countries and a global average of 44%.” (World Health Statistics). In developing countries, the problem of longevity is clearly not a main cause of deaths by NCDs because a much higher percentage of deaths occur in people under age 70 in comparison to developed countries. Speculations behind the high numbers of deaths caused by NCDs in developing countries mainly blame the lack of adequate health care in these countries to diagnose and treat NCDs. In order to understand the problem, all of the factors causing the problem need to be fully understood.

Clearly a solution to this rising problem needs to be found. In order to alleviate the problem, it should be addressed from a medical anthropology perspective. Ethnographic studies of communities need to be performed in order to completely understand the root of the problem. The rising rate of deaths by NCDs has many complicated causes and the only way to fully understand how all the factors interrelate requires the use of ethnographic work by a medical anthropologist. Once the cause of the problem can be understood in communities, steps can be taken to prevent the deaths caused by NCDs from rising.

The medical anthropology academic article, Chronic health effects of dispossession and dietary change: Lessons from North American hunter‐gatherers by Russel Lawrence Barsh from the journal, Medical Anthropology: Cross-Cultural Studies in Health and Illness describes the biochemical reasons behind the rising rates of morbidity due to NCDs in the Inuit and North American Indian hunter-gatherer population over the past several decades. The article explores the relationship between the recent significant change in diet of the Inuit and North American Indian hunter-gatherers and the simultaneous change in morbidity patterns. The past advantageous metabolic adaptations to a hunter-gatherer diet have become detrimental to health when changing to a diet of store bought foods, which are high in refined starches, sugars, and saturated fats. The effects of this diet change, along with other risk factors associated with modernity, have caused the recent change in morbidity pattern due to non-communicable diseases, such as non-insulin-dependent diabetes mellitus, cardiovascular disease, and cancer.

The leading cause behind the escalation of NCDs in the hunter-gatherer population include biochemical reasons causing health problems from the recent drastic change of diet according to the article, although other NCD risk factors are included as factors of the recent change in the morbidity pattern. The hunter-gatherer diet consists mainly of nuts, seeds, green leafy vegetables, and fish and wildlife as a protein source (Russel). The shift from hunting-foraging to domestic meats results in a drastic increase in saturated fatty acid intake because domestic animals contain a significant amount of more fat than fish or wildlife. The increase in saturated fatty acid intake paired with a reduced consumption of seeds, nuts, fish, and leafy vegetables causing a vitamin E deficiency, a lipoprotein antioxidant, resulted in the increase of cardiovascular disease in the Inuit and North American Indian hunter-gatherers (Russel). Also, the shift in diet from natural foods taken directly from the environment to processed foods resulted in the exposure to many carcinogens. The article stated, “Industrialization has exposed Inuit and other hunter-foragers to a wide range of novel toxic and carcinogenic materials, while removing many of the protective nutrients from their diets.” (Russel).Previously, this group received little to no exposure to carcinogens because of their hunter-forager diet consisting of all natural foods taken directly from the environment. When they switched to a modern diet of processed foods, in particular processed meat, they began to be exposed to carcinogens that their bodies were not accustomed to causing an increase in cancer rates. Finally, the recent diet change led to a significant increase in occurrence of non-insulin-dependent diabetes mellitus, NIDDM, in the hunter-forager community. Genetic factors have been proven to play an important role in the increasing rate of NIDDM cases in the hunter-forager population. For instance, the article mentioned a “gene locus governing rates of IRF synthesis and iron uptake is linked with the expression of gene loci involved in glucose and lipid metabolism.” (Russel). The frequency of this allele proved beneficial for the customary hunter-forager diet. When the change to a low-iron and high density store-bought food diet occurred, the rates of NIDDM and anemia significantly increased due to the genetic predisposition to favor the hunter-forager diet. Clearly, the recent change in diet triggered the change in morbidity pattern due to the genetics of the Inuit and North American Indian hunter-gatherers.

Although many biochemical reasons in the change in diet can explain the change in morbidity pattern in this group, the author made a point to mention that other risk factors for NCDs have also increased recently in this group and have also contributed to the problem. The health impacts of dietary change have also been aggravated by behavioral factors resulting in the escalation of NCDs and thus the increase in morbidity. Behaviors such as alcohol and tobacco use and reduced physical activity are also risk factors for NCDs and have played a role in the recent change in morbidity. The increase in alcohol use amongst this group has been theorized to be caused by “modernization” which introduces new status symbols, such as alcohol consumption (Russel). The increase in alcohol intake and tobacco use have already been clearly identified as NCD risk factors, therefore the increase in these behaviors in the hunter-forager community also contributed to the increase in NCD occurrences.

The causes behind the increase in morbidity in the Inuit and North American Indian hunter-gatherer population require complex research and analysis to gain a complete and accurate understanding. The holistic approach used by the anthropologist of this article explores all possible causes, including cultural, scientific, and historical reasons for the problem. This same holistic approach can be applied to other communities around the globe that also have experienced an increase in deaths caused by NCDs.

A medical anthropological perspective would frame this problem differently than the approach used by the World Health Statistics Report 2012. The World Health Statistics stated a clear approach to the solution in their 2012 report. The approach they outlined included the acknowledgement of the rising number of deaths caused by NCDs, especially in developing countries, and the problem’s contribution to poverty and hunger in developing countries. The plan of action shaped by the WHO comprised of developing “a comprehensive global monitoring framework and recommendations for a set of voluntary global targets for the prevention and control of NCDs” and “to collaborate with the Secretary-General of the United Nations in submitting a report to the United Nations General Assembly in 2012 on options for strengthening and facilitating multisectoral action for the prevention and control of NCDs through effective partnership.” (World Health Statistics). WHO plans to approach the problem by finding ways to reduce NCD risk factors, strengthen health systems to provide better treatment, and improve the monitoring of NCDs globally. The WHO regions will be individually monitored to watch the process of the individual regions in the hopeful reduction in the rates of NCDs over time. Their plan fails to include several aspects that a medical anthropologist would include when framing the problem.

A medical anthropological perspective would take a holistic approach to framing this problem, instead of looking at just the diseases and risk factors like the approach used by WHO. A medical anthropological perspective would include looking at all physical, social, and mental aspects of health, illness, and healing in order to frame the problem and find a solution. To do this, contextualization and comparisons would be used to help frame the problem. Instead of grouping the problem globally like the World Health Statistics, a medical anthropologist would contextualize the NCDs within the uniqueness of individual communities. The perception of the NCDs varies greatly based on the culture and the health belief systems of each individual community. When grouping individual cultures and communities into the large WHO regions, the varying cultures within those large regions are ignored in the World Health Statistics approach. A medical anthropological perspective would frame the problem by individually studying the communities where NCD rates are particularly high to create a complete understanding of the diseases and the reasons for the escalating occurrences of NCDs within that culture. The studying of the individual cultures would be performed through participant observation in order to interact fully with the community and gain a thorough understanding of the issue within a particular culture. Then, to interpret the data from the participant observation, comparisons to other cultures will be used to link the details from the immersion to the big picture meaning. Finally, from the thorough research described, a medical anthropologist could frame the problem and determine a unique solution to the rising rates of NCDs within each particular community.

Several medical anthropology concepts addressed in class can be used to shed light on new aspects of this problem allowing for further analysis and possibly finding a solution. First, the importance of ethnographic studies can be used to redefine the problem and create a better understanding of the rising NCD rates within particular communities. Ethnographic studies by medical anthropologists can help shed light onto the causes of the rise in number of deaths caused by NCDs and the reasons why the NCD risk factors are increasing within specific communities. The health systems of communities depend heavily on their culture, therefore to understand the health system of a community an understanding of the community from participant observation and ethnographic work is vital. Health systems can be very complex and vary greatly from culture to culture. They consist of healers, therapies, sufferers, and a health belief system. The health belief system of a community is important to understand because it consists of the etiology, diagnosis, and prescription or treatment of a disease. The health belief system thus determines what governs a disease and what the treatment of a disease requires. In some cultures, the etiologies behind diseases such as cancer or cardiovascular disease may not fully be understood resulting in the people of those communities not reducing risk factors for those diseases. For instance, if their health belief system’s etiology for lung cancer does not include smoking, they will not know to reduce or stop smoking in order to lower their risk of getting lung cancer. Understanding the health belief system of a community will help shed light on how to solve this problem by learning how to reduce the NCD risk factors within that community.

The prescription, or treatment, and diagnosis of a disease are both determined by the health belief system of a community. Treatment and diagnosis are key to reducing the global death rates caused by NCDs. Early diagnosis of NCDs correlates with a higher survival rate for most NCDs, therefore it is important that the health systems of a community understand the early signs and symptoms of a disease. Certain signs and symptoms have different symbols or meanings within a culture, which can also affect whether a disease is properly diagnosed. In order to understand these symbols, cultural understanding must exist in order to educate the community in proper diagnosis and treatment. The treatment of NCDs can also vary greatly from culture to culture because the treatment is also determined by the unique health belief system of a culture. Medical pluralism exists in most communities creating a complex and dynamic treatment process for diseases and adding yet another important factor to consider. Cultural awareness through ethnographic research plays an important role in finding a solution to reduce NCD risk factors and improve the treatment of NCDs within a community. The previously mentioned example of the hunter-forager community exemplifies the importance of cultural context when addressing this problem and attempting to find a solution.

After applying these medical anthropology concepts to this global health problem, I have a much more thorough understanding of the concepts and their applications. I now clearly understand how the health belief system of a culture determines the outcome and the treatment of a disease in a community. The unique culture of a community includes their health belief system, which is important to understand in order to understand a disease within a community. After seeing the application of the importance of ethnographic work through participant observation, contextualization, and comparisons for my selected problem, I have a thorough understanding of the steps taken by a medical anthropologist when researching a problem within a particular community. Also, I noticed the significance of in-depth and detailed ethnographic work when trying to determine the complex causes of a problem within a community when reading my chosen article about the Inuit and North American Indian hunter-forager population.

When addressing the increasing occurrences of NCDs from a medical anthropological perspective, this global health problem is re-defined and new light is shed on how to address this problem. A medical anthropological perspective exemplifies the importance of how cultural understanding of individual cultures plays a crucial role in addressing global health problems, including my chosen problem. Instead of grouping large regions of the world and attempting to fix the problem in these large regions through monitoring NCD rates and strengthening health systems of a large and diverse area, a medical anthropological perspective pays attention to specific cultures within the large regions. The medical anthropological perspective uses ethnographical studies and medical anthropology tools to understand the problem within a culture. It addresses the problem within an individual culture rather than trying to tackle the problem in a diverse region. When the causes of the problem are analyzed within a particular culture, a solution specific to that community can be found that will produce the most beneficial results.

The rising death rate due to NCDs has already been determined a major global health problem of the twenty-first century. Deaths caused by NCDs already make up a much larger number of global deaths than infectious diseases, and the deaths from NCDs are only expected to rise in the future. A solution to this problem needs to be found in order to help reduce the annually increasing deaths from NCDs, especially since some can be prevented through decreasing NCD risk factors. From the example of the rising number of deaths within the hunter-forager community in the article, the importance of contextualization and cultural understanding when addressing this problem can clearly be seen. In order to prevent the predicted increase in deaths caused by NCDs, a medical anthropological perspective needs to be used to analyze the problem within individual cultures to create a valuable and unique solution for the individual communities and an overall global reduction in the deaths cause by NCDs.

-Allison Binkerd

Bibliography

Russel, Lawrence Barsh (1999): Chronic health effects of dispossession and dietary change: Lessons from North American hunter‐gatherers, Medical Anthropology: Cross-Cultural   Studies in Health and Illness, 18:2, 135-161

"World Health Statistics 2012." WHO. World Health Organization, 2012. Web.             <http://www.who.int/gho/publications/world_health_statistics/EN_WH S2012_Full.pdf>.