Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda

Abstract

Five Sustainable Development Goals (SDGs) set targets that relate to the reduction of health inequalities nationally and worldwide. These targets are poverty reduction, health and wellbeing for all, equitable education, gender equality, and reduction of inequalities within and between countries. The interaction between inequalities and health is complex: better economic and educational outcomes for households enhance health, low socioeconomic status leads to chronic ill health, and non-communicable diseases (NCDs) reduce income status of households. NCDs account for most causes of early death and disability worldwide, so it is alarming that strong scientific evidence suggests an increase in the clustering of non-communicable conditions with low socioeconomic status in low-income and middle-income countries since 2000, as previously seen in high-income settings. These conditions include tobacco use, obesity, hypertension, cancer, and diabetes. Strong evidence from 283 studies overwhelmingly supports a positive association between low-income, low socioeconomic status, or low educational status and NCDs. The associations have been differentiated by sex in only four studies. Health is a key driver in the SDGs, and reduction of health inequalities and NCDs should become key in the promotion of the overall SDG agenda. A sustained reduction of general inequalities in income status, education, and gender within and between countries would enhance worldwide equality in health. To end poverty through elimination of its causes, NCD programmes should be included in the development agenda. National programmes should mitigate social and health shocks to protect the poor from events that worsen their frail socioeconomic condition and health status. Programmes related to universal health coverage of NCDs should specifically target susceptible populations, such as elderly people, who are most at risk. Growing inequalities in access to resources for prevention and treatment need to be addressed through improved international regulations across jurisdictions that eliminate the legal and practical barriers in the implementation of non-communicable disease control.

Education and gastric cancer risk—An individual participant data meta‐analysis in the StoP project consortium

“…36 Low education corresponds to ISCED 0-1, Intermediate education to ISCED 2-4 and High education to ISCED 5-6. 1 Adjusted for age, sex, alcohol drinking, tobacco smoking, race/ethnicity, fruit and vegetable consumption and study center (for multicenter studies).…”

“…National and international agencies are implementing strategies to guarantee health and wellbeing for all people by targeting sustainable development goals like education, gender equality and poverty reduction. 1 Worldwide, there is increasing awareness and evidence that low socioeconomic position (SEP) is a strong determinant of morbidity and premature mortality from selected noncommunicable diseases, including several cancers. 2,3 SEP reflects the availability of cultural, material and social resources that translate into advantages in terms of decision making, social network, lifestyle habits and also access to health services.…”

Identifying a human rights–based approach to obesity for States and civil society

“…Once viewed as chronic diseases of aging populations, obesity and its comorbidities are increasingly affecting younger populations who are politically active, engaged in the workforce, and have dependants. As with HIV, there are complex linkages between low socio‐economic status and NCDs and their risk factors, including obesity, in some countries . In both cases, effective public policy responses risk becoming derailed by an excessive focus on individual behaviour and personal responsibility, rather than health systems that exclude large numbers of people, and health‐harming and exploitative environments.…”

“…As with HIV, there are complex linkages between low socio-economic status and NCDs and their risk factors, including obesity, in some countries. 34,35 In both cases, effective public policy responses risk becoming derailed by an excessive focus on individual behaviour and personal responsibility, rather than health systems that exclude large numbers of people, and health-harming and exploitative environments. There is no magic bullet in sight-an HIV vaccine and a cure for AIDS remain elusive, while treatments for diabetes mellitus, cardiovascular disease, cancer, osteoarthritis, hypertension, and stroke are often expensive and offer no promise of a lifetime cure.…”

Taxes on alcohol, tobacco, and soft drinks are fair and produce health gains, review finds

“…The review,1 published by the Lancet ’s taskforce on non-communicable diseases and economics, showed that the burden of preventable non-communicable diseases associated with tobacco, alcohol, and obesity is itself regressive.…”