Non-communicable diseases: Children and adolescents Commonwealth Health Partnerships 2015 95 Non-communicable diseases (NCDs) have a significant impact on children and adolescents. Approximately 1.2 million deaths from NCDs occur each year in people under the age of 20 – more than 13 per cent of all NCD mortality (NCD Child, 2013). Furthermore, while child mortality rates have recently decreased, mortality in adolescents has only marginally improved. Children die from treatable NCDs, such as rheumatic heart disease, type one diabetes, asthma and leukemia. Prenatal and childhood exposure to tobacco and alcohol, prematurity and low birth-weight, malnutrition and obesity, and diabetes have long-term impacts on health and development, including increased risk of adult cardiovascular disease, diabetes, and other social and medical problems later in life. In much of the world, road traffic and other injuries are the leading cause of death for those aged five to 15 years (Marquez and Farrington, 2013). Many of the behaviors that lead to adult NCDs start during childhood and adolescence. Over half of all NCDrelated deaths each year are associated with behaviours attained in youth: • More than 25 per cent of obese adolescents have signs of diabetes by the age of 15 years • Despite improvements in survival for some childhood cancers, survival is much lower in resource-poor countries • Ninety per cent of the one million children born each year with congenital heart disease live in areas without adequate medical care • Tobacco smoke exposure causes asthma, otitis and respiratory infections in children • Mental health disorders, motor vehicle trauma, homicide and suicide cause significant morbidity and mortality in youth Globally, 100,000 young people start smoking each day, and more than 90 per cent of adults who smoke started smoking as children or adolescents. Teenage alcohol consumption is common, risking impaired brain development, higher rates of non-intentional injury and violence, and alcohol dependence in adulthood. Being overweight and obese is increasing in both high-income, and lowand middle-income countries (LMICs), thus also increasing the risk of diabetes and cardiovascular disease. Whether congenital or acquired, childhood NCDs lead to disabilities that follow into adulthood. While asthma is often the most common NCD in industrialised countries, childhood disability is increasing and emotional, behavioural and neurological disabilities are more prevalent than many physical impairments. In the USA, for example, more than one in five families have at least one child with special or extraordinary health care needs, and many children and adolescents with special health care needs do not receive all the services they need. Both prevention and treatment interventions for children and teenagers are effective strategies for reducing the global social and economic burden of NCDs. Addressing the global burden of NCDs through a life-course approach can reduce both rates of NCDs, and can greatly improve the lives of those living with illness. Youth and family voices, and civil society and professional organisations’ inclusion in countries’ discussions will help lead to optimal solutions. Countries have an opportunity to include the needs of children and adolescents affected by and/or at risk of developing NCDs as part of their NCD plans, and in addressing the impact of NCDs on post-2015 Sustainable Development Goals. Commonwealth diversity Fully 30 per cent of the people of the Commonwealth are younger than 30 years old, and this group is guaranteed to stay relatively young for the next few decades, as African and some Asian populations continue to grow. Likewise, as emerging economies develop, with improved social, economic and environmental characteristics, there will be significant shifts in the incidence and impact of NCDs among children and adolescents in these nations. The diversity seen in the demographic factors above are reflected in the diversity of legislation, policies, budgeting, financing, knowledge, attitudes, behaviour, research and monitoring of NCDs, particularly with regard to children and adolescents. Prevention, provision of care and treatment, and mechanisms to support those affected by NCDs – at home, at school, at work and in society generally – vary across and within countries, with social and economic ‘minorities’ (poor, uneducated, inner-city and rural, very young and very old, female and disabled) disproportionately affected. The principal determinants of health, namely the social and economic environment, physical environment, and individual characteristics and behaviours, are interlinked and interdependent. Shifts occur over the lifecycle and generations, and vary across a range of demographic factors. The Commonwealth has the opportunity to have an impact on the situation of NCDs in children and adolescents in each country, and to serve as a model for the rest of the world to learn from. Any progress made among NCD Child Authors: Jonathan D. Klein (corresponding author, USA), Terrell Carter (USA), Kate Armstrong (Australia), Swati Bhave (India), HRH Dina Mired (Jordan), Amy Eussen (The Netherlands), Mychelle Farmer (USA), Zeina Massanat (Jordan), Jamal Raza (Pakistan), Barbara Reynolds (Guyana) and R. Jamie Rodas (Canada).
Commonwealth Health Partnerships 2015
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