Noncommunicable Diseases Still Underestimated, Only 59% View Diabetes As Very Harmful

Is it possible to underestimate the biggest killer in the world? In a word, yes. In two words, unfortunately yes.

As you may have heard, noncommunicable diseases (NCDs) have become the leading cause of death globally. That’s because NCDs kill on average around a whopping 41 million people each year, which comprises about 74% of all deaths around the world, according the World Health Organization (WHO). Yet, a new Gallup survey commissioned by the WHO and Bloomberg Philanthropies found that substantial percentages of people still may not consider the five biggest NCDs to be “very harmful.” That’s a noteworthy disconnect because death is kind of a very harmful thing.

For the survey, Gallup interviewed adults 18 years and older from five different countries: the U.S., Colombia, India, Jordan, and Tanzania. In many cases, Gallup folks didn’t exactly get “killer” responses, so to speak. For example, only 83% of those interviewed considered cancer to be “very harmful.” That percentage dropped to 72% for heart disease and stroke. And the numbers for diabetes and lung disease were even lower at 59% and 51%, respectively.

In fact, in Jordan, where diabetes is the third-leading cause of death, just 36% indicated that diabetes is “very harmful.” Similarly, only 49% of those surveyed in Tanzania, 44% of those in the U.S., and 36% of those in Jordan had a “very harmful” perception of lung diseases, despite lung diseases killing over four million people each year. Flip all of these percentages around and you’re talking about potentially millions and millions of people in each country underestimating how bad NCDs really are.

“There was some variation by country,” Kelly Henning, MD, Public Health Program Lead for Bloomberg Philanthropies, emphasized. “This kind of granularity of data has not been collected before.” Henning pointed out that the results show that not everyone has enough awareness of NCDs and their risk factors and that such awareness will be important to help prevent and control NCDs.

Of course, survey results don’t always exactly reflect what everyone in a population is actually thinking. Naturally, the Gallup staff didn’t interview every single person in the the U.S., Colombia, India, Jordan, and Tanzania. That would have taken a really, really long time. Instead, the Gallup team selected probability-based and nationally representative random samples of adults in each of the five countries. Specifically, the samples consisted of 1,028 adults in the U.S., 1,000 in Colombia, 1,001 in Jordan, 1,000 in Tanzania, and 3,000 in India. The interviews in the U.S. were done via phone, whereas the interviews in the other four countries were in-person, conducted from November 2021 through January 2022. While the results may not represent the exact percentages of people in each country who may feel a certain way, statistical tests did suggest that all of the results were probably within several percentage points of the true percentages. Suffice it to say that too many people still don’t realize how bad to the bone—and bad to the heart, lungs, kidneys, brain, eyes, and other body parts that you really like—NCDs can be.

So why is there this disconnect between the reality and perception of NCDs? Have NCDs simply hired a really good publicist? Well, NCDs are kind of tricky. They don’t brandish knives or ray guns or say really threatening things on Twitter. They aren’t like a gigantic telepathic starfish destroying a city as Starro the Conqueror did in the movie The Suicide Squad. Instead, NCDs can be much more silent killers at least at the beginning. They can quietly sneak up on you like hair growing out of your ears or your YouTube watching habit. For example, diabetes initially may seem like no more than a “your blood sugar levels are off” thing. It can take time for problems with your heart, kidney, eyes, nerves, feet, kidneys, and other parts of your body to emerge and become life-threatening. Similarly, lung diseases early on in their courses can appear to be just a little out of breath thing, sort of like when you see something amazing like a really large plate of nachos.

Then there’s also the age-old misconception about NCDs. “Many people may think of non-communicable diseases as diseases of the elderly,” explained Henning. “But it’s not just about the extreme elderly. They affect many working-age adults.” For example, a Centers for Disease Control and Prevention (CDC) website indicates that “Type 2 diabetes most often develops in people over age 45, but more and more children, teens, and young adults are also developing it.” Oh, and 45 isn’t exactly a time-to-withdraw-your-401k age. Heck lots of Hollywood actors turned 45 last year and some are still going to be squeezing themselves into super-tight red spandex suits and saying words like “butt cheeks” way too often in the coming years.

There can also be the incorrect perception that NCDs are a natural part of getting older rather than things that are preventable. Studies have shown how many types of cancers, heart disease, strokes, diabetes, and lung disease are eminently preventable. And even if you can’t prevent the diagnoses of these five major NCDs, you can prevent or at least slow the progression of them. Now if you think that NCDs are a everyone-person-for-himself-or-herself-and-everything-is-a-personal-choice thing, you’d be wrong, wrong as a bathroom gong. Many risk factors for NCDs lay in the systems that surround people such as their social, political, and physical environments. For example, if the air around you is polluted, you can’t simply choose not to breathe. Similarly, if all the food around you has too much salt, then you can’t simply remove each salt granule one-by-one by hand. Moreover, regardless how often your life coach tells you that “you are your own person,” you are actually influenced in many ways, often subtle ways, by the people and things around you. So to really prevent and control NCDs, the will and cooperation of the public and governments around the world are needed.

This brings us to the positive findings from the Gallup interviews: that a majority of adults in all five countries support policy measures that can help fight NCDs. For example, 69%, 66%, and 59% of those interviewed supported higher taxes on alcohol, tobacco products, and high-sugar drinks, respectively. Such results go against the narrative advanced by some politicians that people don’t want to pay more taxes at all, period.

There was even greater support for laws that restrict or ban smoking in public (a country average of 69% favored this), the advertising of high-sugar foods and drinks to children (72% said go for it), and companies from promoting unhealthy products (72% were alright, alright, alright with this). These findings go against the political narrative that people do not want restrictions, that people want the freedom to do whatever they want.

Support jumped above 90 percent for conducting media campaigns to promote healthy behaviors (91%), increasing access to healthcare services (93%), and creating spaces to support a healthier lifestyle like public parks or safe walking routes (95%). It kind of makes you wonder who the seven percent are who don’t want more access to healthcare services. But oh well.

All in all, this is a not-so-great-news yet promising news at the same time situation. While there probably isn’t enough awareness of NCD badness yet, the “support for more policies is there,” in Henning’s words. Henning went on to say that there are opportunities to overcome what she considers the two main obstacles to better controlling NCDs: relative lack of awareness and political will. In fact the timing may be right for even larger pushes against NCDs in the coming years. Earlier this year, the WHO identified 16 “best-buy” interventions to tackle NCDs, as I covered for Forbes in February. These are interventions that will not only save lives but also are very affordable and in some cases can pay for themselves. At the same time, there have been increasing efforts underway to raise awareness and enact policies, especially in low-and middle-income countries where the NCD burden has been rapidly increasing. Oh, and if you’ve kept up with the news over the past couple years, there’s been this little thing called the Covid-19 pandemic happening. “The pandemic has shone a light how important it is to have healthy populations,” Henning added. “Those with NCDs have been more likely to do worse. It makes a strong case for doing more to control NCDs.”

If there can be indeed more efforts to raise awareness and better prevent and control NCDs then that could be a “killer” result, meaning that it would be a totally excellent thing to be able to thwart the world’s leading killers.