IN view of my last two columns, I think it is pertinent to delve into the state of the people of Pakistan with regard to the epidemiology of non-communicable diseases (NCDs).

Up until 2010, communicable diseases, spread through virus, bacteria and other organisms and from one person to another, were affecting us more than NCDs, which affect our body’s organs and systems due to the choices we make (behavioral factors) and due to environmental factors (for example, air pollution) and not due to any intermediary organisms. NCDs were gradually increasing, but in 2010, they surpassed communicable diseases in terms of the cause of death. To be exact, 681,003 deaths were estimated due to NCDs in 2010 as opposed to 675,332 deaths due to communicable diseases, and since then the gap between the two has been widening.

Looking at the trends over 30 years, deaths due to NCDs in 1990 were estimated to be 426,809, which jumped to 830,172 in 2019. The burden of NCDs including mental health problems, which was 29.9 per cent of the total burden in 2000, has increased its share to 43.7pc in 2019 and is on the rise.

Pakistan represents a global phenomenon interms of the rise of the NCDs epidemic — 74pc (41 million) of the number of annual deaths globally are due to NCDs, out of which 86pc occur in low- and middle-income countries. Of the total deaths due to NCDs, 41pc of people die under the age of 70 years. The attendant economic losses have been estimated to be humongous. Eighty per cent of global deaths take place due to four diseases: cardiovascular, cancers, chronic respiratory disorders and diabetes.

What is the reason for these horrific figures and trends? The answer: our lifestyle choices and our environment, and there is some overlap between the two.

The risks to our health stem from three sources: our behaviour as individuals, the environment around us, and genetics. A lot of research has taken place to study the effects of these risks, their interplay and subsequent risk management.

The epidemiology of NCDs in Pakistan is horrific.

Our behaviour — the choices we make — is the most important. Wrong choices take us downhill fast, while the right ones not only improve our health and quality of life but may also have a positive impact on the other two groups of risks. Let’s discuss how.

Smoking is a personal choice. Some of us choose to smoke while most of us choose not to. So, first and foremost, it is our own decision to choose this behaviour. It is indeed high-risk behaviour with definite negative consequences. The WHO estimates that smoking is the leading cause of lung cancer, responsible for approximately 85pc of all cases. It contains more than 7,000 toxic chemicals and affects almost all organs of the body. It is a risk factor for all NCDs. A lifetime of smoking subtracts an average 10 years from life.

Despite knowing this, some people still make the choice to adopt such high-risk behaviour. I have yet to meet a smoker who says that smoking is good for our health! So, when we smoke, we actually make a choice to expose our body to harm. It is this behaviour that is likely to take us towards cardiovascular diseases, diabetes, cancers, etc. And, if we choose not to smoke, we remove a major risk factor. It is our decision to take.

In 2021, the prevalence of tobacco smoking among people above the age of 15 years in Pakistan was estimated by the WHO to be 31.7pc in males and 7.3pc among females. A very high rate of prevalence indeed.

Applying the same example to environmental risks — risks which exist beyond our own control — we can focus on second-hand smoke, which occurs when people around an active smoker inhale exhaled tobacco fumes. An AKU team of researchers discovered the presence of SHS in an alarming 95pc of children in Pakistan and Bangladesh. SHS also causes all the aforementioned NCDs and related problems an active smoker is likely to develop. Adopting behaviour that avoids SHS and other environmental risks to health can have a positive impact, but only to a limited extent. For this, intersectoral collaboration and larger regulatory and educational interventions are required.

Genetic predisposition is also a risk (for example, if both parents are diabetic, there is a higher chance of their children developing diabetes). This problem is aggravated by the high occurrence rate of cousin marriages in Pakistan. However, the emerging field of epigenetics shows how better and sustainable behavioral choices and environmental control can effectively regulate the effect of genes.

Due to shortsighted behavioral choices, today, every fourth adult above the age of 20 years has type II diabetes and every third adult above 45 has elevated blood pressure in Pakistan; a precursor to a plethora of cardiovascular diseases which are also being increasingly recorded among the younger age groups. One in nine women in Pakistan is likely to be diagnosed with breast cancer at some point in her life.

Interestingly, smoking, unhealthy diets, physical inactivity and air pollution are common risk factors for developing cardiovascular diseases, diabetes, cancers and chronic respiratory disorders. Many a time, these risk factors coexist and their synergistic effect is lethal. By implication, effectively controlling these risk factors would help control all major NCDs.

The avalanche of NCDs in Pakistan demands our attention to effectively implement preventative policies, regulatory, managerial, educational interventions and reliable health services to manage NCDs. It requires the stern control of tobacco and fast-food industries that promote unhealthy behaviours, alongside heavy and sustained investments in the education of health professionals and the public in adopting healthy lifestyles choices.

NCDs are chronic, so the interventions to address them should be too.

The writer is a former health minister and currently a professor of health systems & population health at the Shifa Tameer-i-Millat University.

Published in Dawn, May 2nd, 2025