Non-communicable diseases (NCDs) are conditions that are not transmissible. This definition captures a wide range of conditions. However, in most cases, whether in research, funding, programs and/or policies, the focus is on the ‘Big Four’ NCDs i.e. cardiovascular diseases, diabetes, cancers and chronic respiratory diseases 1. Mental health disorders which are also termed as NCDs, notably receive inadequate attention making it seem like a less significant condition. Considering that mental health represents the leading cause of years lived with disability worldwide 2, it is important to identify where the 450 million people suffering from mental health disorders are placed in the NCD agenda 3. It is of concern now especially with target 3.4 of the UN Sustainable Development Goal 3 being: ‘To reduce premature deaths from NCDs by one third by 2030 and promote mental health and wellbeing’ 4.
Evidence shows that mental health and the ‘Big Four’ are closely linked in terms of the features they have: they are all long-standing in nature, require prolonged management, affected by multiple risk factors and associated with functional impairment or disability. Additionally, they also share common risk factors such as harmful use of alcohol, low socioeconomic status, stress, sedentary behavior and unhealthy diets. Moreover, studies show the rate of depression is higher in patients with physical diseases than without. This has been illustrated whereby the prevalence of depression is 29% in hypertensives, 22% in myocardial infarction patients, 27% in diabetics and 33% in cancer patients 5. Furthermore, the global cost of mental health conditions was estimated at US$ 2.5 trillion in 2010, which is expected to double in the subsequent 20 years 6. The rising incidence of mental health conditions and the massive economic and health gains we face to loss demonstrates the urgent need to put mental health disorders forward into the global health agenda.
Moreover, recognizing the shared commonalities between mental health conditions and other NCDs illustrates the significance of utilizing collaborative care models where NCD care and mental health care are integrated and provided in primary care settings 5. This approach facilitates the move from the common psychiatric hospital approach to mental health care to a prevention-based and locally responsive primary health care approach. It further proposes a restructuring of the roles of health care providers and the introduction of team-based approaches to management of chronic complex medical conditions. Granted, such an approach requires a cultural shift in norms and roles of health care providers, it provides an opportunity to create synergies, reduce redundancies and identify existing policy and program gaps. Therefore, with evidence of high prevalence of co-morbidities and shared risk factors, not integrating mental health care into the overall NCD care will be less effective and more costly in the long run.
With increasing commitment globally and nationally towards addressing the prevention and control of NCDs, this presents an opportune moment to put into action mental health interventions that are community-based, locally responsive and that take into account the different entry points for mental health service delivery within the health systems.
No one-size intervention fits all, thus demonstrating the efforts that need to be put in by countries, in order to establish a high quality, affordable, accessible and acceptable national to local mental health promotion and prevention programmes and policies.
Meggie Mwikali Mwoka
Dr. Meggie Mwoka serves as a Medical Officer of the Government of Kenya. She has experience in global health and is an advocate for sexual and reproductive health rights. Her passion for youth engagement has led her to volunteer and leadership opportunities at international and national youth-led organizations. She serves as an active member in several organizations where she often provides consultation, especially on youth and health issues. She is currently pursuing her Master of Global Health at the Barcelona Institute for Global Health. As an aspiring global health specialist, she hopes to close the inequality gap within her country and globally; through collaboration and provision of equal access, opportunities, and rights across all social and economic spheres.
- O’Neil, A., Jacka, F.N, Quirk, S.E., Cocker, F., Taylor, C.B., Oldenburg, B. & Berk, M. (2015). A shared framework for the common mental disorders and Non-Communicable Disease: key considerations for disease prevention and control. BMC Psychiatry, 15(15). Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342822/pdf/12888_2015_Article_394.pdf>.
- Pryor, L., Da Silva, M.A., Melchior, M. (2017). Mental health and global strategies to reduce NCDs and premature mortality. The Lancet, 2(8), e350-e351. Available at: <https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30140-8/fulltext?code=lancet-site>.
- World Health Organization (2001). The World Health Report. Mental Health: New Understanding, New Hope. Geneva: WHO. Available at: <http://www.who.int/whr/2001/en/whr01_en.pdf?ua=1>.
- The United Nations (2017). Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages. Available at: <https://sustainabledevelopment.un.org/?menu=1300>.
- Ngo, V.K., Rubinstein, A., Ganju, V., Kanellis, P., Loza, N., Rabadan-Diehl, C., Daar, A.S. (2013). Grand Challenges: Integrating Mental Health Care into the Non-Communicable Disease Agenda. PLoS Medicine, 15(5). Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653779/>
- Bloom, D.E., Cafiero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl, A.B., Gaziano, T., Mowafi, M., Pandya, A., Prettner, K., Rosenberg, L., Seligman, B., Stein, A.Z., & Weinstein, C. (2011). The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum. Available at: <http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf>.
Cover picture from Pixabay. Available at: https://pixabay.com/fi/mielenterveys-abstrakti-anatomia-3285634/