Journal of developmental origins of health and diseaseSeema Lal-Kumar, Anand Marya, Bob Williams, Metua Bates, Abiola Adeniyi
The Developmental Origins of Health and Disease (DOHaD) paradigm has transformed our understanding of how early-life biological and social environments shape lifelong health trajectories. While DOHaD research across Oceania has focused primarily on metabolic, cardiovascular, and nutritional outcomes, oral health, particularly early childhood caries (ECC), remains largely absent from life course research and policy despite its early onset, shared risk factors with childhood obesity and other noncommunicable diseases (NCDs), and strong social and intergenerational patterning. This conceptual paper synthesises the DOHaD paradigm, First 1000 Days approaches, common risk factor theory, and Pacific relational worldviews to propose a Pacific-centred framework that explicitly integrates oral health. Using the Cook Islands as a regional exemplar, the paper demonstrates how oral health can be aligned with existing maternal and child health, nutrition, and NCD policy priorities. The proposed framework reframes ECC as both a biologically embedded developmental outcome and an early indicator of broader NCD risk trajectories. It highlights the interconnected influence of biological, family, community, health system, and policy environments on oral health across the life course. Integrating oral health within a Pacific centred DOHaD framework addresses an important gap in research and policy and provides a culturally grounded and policy relevant model to strengthen early-life prevention, improve health equity, and guide future research and implementation across Oceania.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsCatherine Helenna Mulyadi, Lisa Hui, Heng Jiang, Mari de Leon, J C Nacpil, Yichao Wang, Jason Choi, Suzanne Mavoa, Melvin Barrientos Marzan
ISSUE ADDRESSED: Non-communicable disorders (NCDs) in women of reproductive age (WRA) shape maternal and intergenerational outcomes, yet their area-level socio-environmental drivers remain unclear. We examined correlations between socio-environmental factors and NCDs in WRA. METHODS: We linked 2021 Australian Census sociodemographic and health variables with postcode-level environmental exposures, including air pollutants (PM2.5, NO2, CO, SO2, formaldehyde and ozone), land surface temperature and greenness. The NCDs (asthma, diabetes, cancer, mental health and cardio-renal disease) were expressed per 1000 WRA. Spatial clustering (Moran's I) and socioeconomic gradients (Wagstaff Concentration Index) were assessed, alongside geospatial regression and clustering analyses. RESULTS: NCDs among WRA showed strong socioeconomic patterning. Most disadvantaged postcodes recorded the highest composite NCD burden (323.0 and 227.3 per 1000 in the most disadvantaged and advantaged postcodes respectively), with the steepest inequality for diabetes (Wagstaff = -0.16). Environmental exposures demonstrated spatial clustering but weak associations with health outcomes. Notably, peri-urban and fringe postcodes experienced higher heat exposure coinciding with socioeconomic disadvantage. Inner Melbourne (with lower heat exposure and more socioeconomic advantage) showed lower NCD burden despite elevated NO2 and PM2.5. CONCLUSION: NCDs among WRA in Victoria are strongly patterned by socioeconomic disadvantage with geographic clustering by environmental exposures. These inequities persist even where most air quality measures remain within regulatory limits, underscoring the disproportionate burden faced by disadvantaged areas. SO WHAT: Health promotion should prioritise disadvantaged peri-urban and regional communities through proactive, place-based policies that address both environmental conditions and the social systems that influence how and for whom those conditions become harmful.
Mymensingh medical journal : MMJS B Proma, M M Hasan, A H Chowdhury, N Islam, A K Saha, T M S Islam, A H M Rahman, A Zaman
In recent times, non-communicable diseases (NCDs) have emerged as a significant global public health challenge. Particularly impact in middle- and low-income countries, NCDs is responsible for 74.0% of global deaths, with South Asia, including Bangladesh, experiencing a mortality rate of 77.0%. Amidst an epidemiological transition, Bangladesh is witnessing a shift from infectious to chronic diseases. This study aims to explore the burden of NCDs in a tertiary care setting, offering insights to inform public health interventions and policies. A cross-sectional descriptive study was conducted at Sir Salimullah Medical College Mitford Hospital, Dhaka, involving 6698 patients admitted in 2022 (1st January 2022 to 31st December 2022). Data were collected retrospectively from medical records, focusing on patients above 14 years with NCDs. Statistical analyses were performed using SPSS 24.0. Among 6698 admissions, 42.05% were attributed to NCDs. Females exhibited a higher prevalence (56.37%) than males (43.63%). The age group 41-60 years demonstrated the highest NCD prevalence (37.20%). Major NCDs included hypertension (33.22%), diabetes (25.34%), stroke (17.85%) and cardiovascular diseases (12.14%). NCDs contributed to 88.41% of 164 total deaths, with cardiovascular diseases, stroke, chronic respiratory diseases and malignancies as primary causes. In brief, this study sheds light on the critical challenge posed by non-communicable diseases (NCDs) in Bangladesh. With a significant proportion of hospital admissions attributed to NCDs, urgent and targeted interventions are warranted. The observed prominence of NCDs and tha alarming rate of attributed deaths necessitates a shift in healthcare focus. This study's findings emphasize the imperative for innovative approaches, increased resource allocation and heightened awareness campaigns to effectively address the escalating impact of NCDs on both individuals and communities.
British dental journalHabib Benzian, Sudeshni Naidoo
Global political declarations play a growing role in shaping health priorities, yet the diplomatic processes through which they are negotiated remain poorly understood across much of the health community. The 4th United Nations High-Level Meeting on non-communicable diseases (NCDs) and its political declaration provide a revealing illustration of how global health diplomacy operates under contemporary political constraint. Oral diseases entered the declaration through a negotiated process in which technical evidence, existing policy frameworks, and advocacy interacted with discretion, political feasibility, and geopolitical context. The failure to secure consensus on adoption in September 2025, followed by adoption by majority vote in December, underscores both the fragility of multilateral agreement and the willingness of Member States to defend negotiated commitments. Oral diseases have achieved durable political recognition within the global NCD agenda, yet this recognition has yet to be fully translated into corresponding responsibility for financing, delivery, or accountability. Political declarations function primarily as instruments of alignment that stabilise expectations and signal collective intent, while leaving the work of implementation to national health systems. Understanding these dynamics is critical for navigating the space between global commitment and practical change in oral health policy.
Swiss medical weeklyLara Güntert, Jan Taeymans, Heiner Baur, Marcus Van Dyck, Nathanael Lutz
UNLABELLED: BACKGROUND: Physical inactivity is a major risk factor for noncommunicable diseases, contributing to both substantial morbidity and premature mortality. In Switzerland, the prevalence of physical inactivity varies across language regions. This study aimed to quantify differences across Swiss language regions in the physical inactivity-attributable burden of disease, expressed as Years Lived with Disability (YLD) and Years of Life Lost (YLL) for 2022. The analysis focuses on YLD and YLL attributable to physical inactivity across 15 physical inactivity-associated diseases. METHODS: This study employed the Population Attributable Fraction approach to estimate the proportion of YLD and YLL attributable to physical inactivity in Switzerland. The analysis included individuals aged >20 years and was stratified by disease, age, sex and language region (German-, French- and Italian-speaking). Physical inactivity was defined according to WHO guidelines as not meeting at least 150 minutes of moderate or 75 minutes of vigorous physical activity per week. Prevalence data on physical inactivity were derived from the 2022 Swiss Health Survey. Prevalences were combined with relative risks (RR) of corresponding diseases, identified through a systematic literature search to derive Population Attributable Fractions. Estimates of YLD and YLL for Switzerland for 2022 were derived from the Global Burden of Disease study. YLD and YLL estimates attributable to physical inactivity are presented as rates per 100,000 people aged >20 years. Uncertainty was assessed using parametric bootstrapping. RESULTS: Overall, the physical inactivity-attributable burden of disease was estimated at 227.08 (95% CI: 214.74-240.08) YLD and 424.23 (95% CI: 383.15-479.23) YLL per 100,000 people aged >20 years. This corresponds to approximately 2% of total DALYs in Switzerland in 2022. Clear regional differences were observed. Estimated physical inactivity-attributable YLD rates were highest in the Italian-speaking region (134.90; 95% CI: 122.04-148.25) followed by the French-speaking region (130.72; 95% CI: 120.78-141.50) and German-speaking region (96.26; 95% CI: 88.81-104.01). Similarly, estimated YLL rates attributable to physical inactivity were highest in the Italian-speaking region (287.74; 95% CI: 245.82-349.99), followed by the French-speaking region (221.56; 95% CI: 192.54-264.55) and German-speaking region (186.67; 95% CI: 162.64-222.27). Disease-specific analysis indicated that depression (93.38; 95% CI: 85.46-101.80) and low back pain (52.01; 95% CI: 45.90-58.47) contributed most to physical inactivity-attributable YLD rates, whereas coronary heart disease (132.12; 95% CI: 115.60-149.55) and Alzheimer's disease and dementia (83.61; 95% CI: 51.90-134.97) were the main contributors to physical inactivity-attributable YLL rates. Women showed consistently higher burden of disease than men, with physical inactivity-attributable YLD rates of 286.06 (95% CI: 264.58-308.90) versus 166.32 (95% CI: 155.06-178.44) and physical inactivity-attributable YLL rates of 475.23 (95% CI: 404.85-577.64) versus 371.69 (95% CI: 337.50-414.96). CONCLUSION: Results of this analysis suggest that physical inactivity significantly contributes to YLD and YLL rates in Switzerland, with pronounced regional and sex-specific disparities. The higher burden of disease observed in the Italian- and French-speaking regions highlights the need for regionally tailored prevention strategies that address cultural and contextual differences.
Frontiers in public healthNiraksha Jithoo, Nomathemba Chandiwana, Oludoyinmola Ojifinni, Jeffery Wing
BACKGROUND: The COVID-19 pandemic underscored the relationship between infectious diseases and non-communicable diseases (NCDs), highlighting increased risks for people with pre-existing chronic conditions. This study piloted an integrated care model for NCD and infectious disease screening in healthcare settings. The aim of this study is to show that integrating NCD screening into existing HIV clinics and COVID-19 vaccine delivery clinics leads to better pandemic preparedness. METHODS: From October 2023 to December 2023, we conducted a cross sectional prospective, low interventional study involving 461 participants from two health care clinics in Johannesburg, South Africa using convenience sampling. Screening included blood pressure, body mass index (BMI), HbA1c, lipid profile, glucose, and kidney function assessments. Data were analyzed to identify NCD prevalence and key risk factors. RESULTS: Newly diagnosed NCDs were found in 73.9% of participants. The most common were kidney disease (31.7%), obesity (28.9%), and dyslipidaemia (25.8%). Modifiable cardiovascular disease (CVD) risk factors, including obesity (63.9%) and alcohol use (50%), were widespread. CONCLUSION: Integrating NCD screening into HIV and COVID-19 services is achievable, offers a valuable opportunity for early detection and intervention. Scaling such models could strengthen health systems in resource-limited settings.
Proceedings of the National Academy of Sciences of the United States of AmericaMartin Stocker, Claus Klingenberg, John A Rogers, Neil Patel, Davide Morgillo, Andrea Peitler, Martin Christmann, Ferdinand von Meyenn, Magnus Domellöf, Shuai …
Noncommunicable chronic diseases (NCDs) are on the rise in high-income countries, leading to substantial morbidity and mortality and contributing to increased resource demands and healthcare costs. Early-life exposures can initiate trajectories that culminate in NCDs later in life. Examples include the metabolic-endocrine pathway to obesity, diabetes, and cardiovascular diseases; the immune-mediated pathway to asthma and allergies; or the neurodevelopmental-psychological pathway to mental health problems. The interconnected trajectories involving microbiome composition, epigenetic signatures, nutrition, and psychological factors in early life can establish a basis for long-term health. While universal vaccination programs are in place to prevent infectious diseases, a coordinated effort to mitigate the rise of NCDs is missing. Examples of how to balance short- and long-term effects in early life include the use of appropriate medications, balanced healthcare interventions, optimized nutrition, and a nurturing care in early life. While these examples will not provide simple answers, they may stimulate important discussions and research into the overarching question: How can we deliver care in early life that achieves optimal short-term outcomes while promoting long-term health trajectories and well-being? While it is imperative to underscore the significance of subsequent periods to circumvent a deterministic conceptualization of a singular period as the primary catalyst for the development of physical and mental health, early life remains an underexploited window of opportunity fostering long-term health and mitigating the growing resource challenges faced by healthcare systems.
NutrientsElandia Aparecida Dos Santos, Jacqueline Isaura Alvarez-Leite
Background/Objectives: Dietary bioactive compounds (BCs) modulate multiple cellular pathways involved in inflammation, oxidative stress, energy metabolism, and tissue homeostasis. This narrative review aimed to synthesize the mechanistic roles and therapeutic relevance of major dietary BC classes, including polyphenols, carotenoids, organosulfur compounds, and polyunsaturated fatty acids, in chronic non-communicable diseases. Methods: We conducted a narrative review to integrate current evidence on the classification, bioavailability, molecular targets, microbiota interactions, and clinical relevance of dietary BCs. The literature considered experimental, observational, and clinical studies addressing key signaling pathways, including NF-κB, Nrf2, AMPK, mTOR, SIRT1, PPARs, and the NLRP3 inflammasome, as well as the diet-microbiota-host axis. Results: The literature indicates that BCs exert pleiotropic effects through the coordinated modulation of transcription factors, metabolic sensors, nuclear receptors, and inflammatory mediators. Their biological activity is also shaped by bioavailability, food matrix effects, host metabolism, and gut microbial transformation into bioactive metabolites. Across obesity, type 2 diabetes, cardiovascular disease, inflammatory bowel disease, and neurodegenerative conditions, BCs appear associated with improved inflammatory, metabolic, and redox regulation. However, findings remain limited by heterogeneity in study design, intervention duration, and compound characterization. Conclusions: Dietary BCs show therapeutic potential as modulators of molecular and microbial pathways relevant to chronic diseases. However, greater standardization in study design and longer-term human trials are needed to support robust evidence-based recommendations.
MedicineSeungjae Byun, Kyeongeun Kim, Min Seong Kim, Guillaume Fond, Laurent Boyer, Guillermo F López Sánchez, Jiseung Kang, Dong Keon Yon
Health-related quality of life (HRQoL) is a key indicator of population health, but its association with noncommunicable diseases (NCDs) has not been fully clarified. This study aimed to clarify the association between NCDs and HRQoL in South Korea, focusing on differences by sex, age, and household income. Under Strengthening the Reporting of Observational Studies in Epidemiology guidelines, this study examined the association between HRQoL and NCDs using data from Korean adults aged ≥19 years in the Korea National Health and Nutrition Examination Survey between 2010 and 2023. HRQoL was assessed using the European Quality of Life 5 Dimensions 3 Level (for mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and the presence of 10 major NCDs, including hypertension, myocardial infarction, stroke, dyslipidemia, kidney disease, diabetes mellitus, osteoarthritis, allergic rhinitis, asthma, and atopic dermatitis, was determined by self-reported physician diagnoses. Weighted multivariate logistic regression models were used to estimate weighted odds ratios with 95% confidence intervals for the association between HRQoL and NCDs. Among 40,985 adults (56.57% females) in the Korea National Health and Nutrition Examination Survey from 2010 to 2023, lower HRQoL was consistently associated with higher odds of NCDs, with the strongest associations observed for stroke (weighted odds ratio, 1.32 [95% confidence interval, 1.27-1.38]) and osteoarthritis (1.37 [1.33-1.42]). No significant sex differences were observed across NCDs except for stroke, for which the association with reduced HRQoL was stronger in males (1.74 [1.63-1.86]) than in females. Stratified results indicated stronger associations among younger adults, particularly those aged 30 to 39 years, with the highest odds observed for hypertension (1.37 [1.09-1.72]), myocardial infarction (2.05 [1.48-2.83]), diabetes mellitus (1.77 [1.35-2.32]), allergic rhinitis (1.31 [1.18-1.46]), and asthma (1.31 [1.18-1.46]). Inverse socioeconomic gradients were observed for osteoarthritis (2.24 [2.04-2.45]) and myocardial infarction (1.59 [1.42-1.77]), with the strongest associations found in the second-highest income quartile. Decreased HRQoL was associated with higher odds of NCDs across ten conditions in Korean adults, with the strongest associations in younger and higher-income groups. These findings underscore HRQoL as a valuable indicator for NCD management and the need for policies addressing emerging health disparities.
BMJ openBonan Chen, Chaisiri Angkurawaranon, Iliatha Papachristou Nadal
OBJECTIVE: Non-communicable diseases (NCDs) are major contributors to morbidity and mortality in Thailand, yet the effectiveness of lifestyle counselling within routine practice is underexplored. This rapid realist review examined how, for whom and under what circumstances lifestyle counselling supports behaviour change among Thai adults. DESIGN: Rapid realist review following guidance from the Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES). SETTING: Lifestyle counselling and health-coaching interventions for NCD prevention and management delivered in Thai primary care, community settings or digitally supported programmes. DATA SOURCES: Six international and Thai databases (Scopus, Google Scholar, ProQuest, PubMed, EMBASE (Ovid) and ThaiJo) were searched for studies published between 2005 and 2025. ELIGIBILITY CRITERIA: Empirical studies involving adults (≥18 years) in Thailand that described lifestyle counselling or coaching interventions for NCD-related prevention or management and reported outcomes. DATA EXTRACTION AND SYNTHESIS: Data were extracted to identify contexts (C), mechanisms (M), outcomes (O) and equity considerations. These were synthesised into context-mechanism-outcome configurations (CMOCs) and helped to form programme theories. RESULTS: 16 studies were included. 19 explanatory configurations were identified across six mechanisms: self-efficacy, social support, motivation, accountability, emotional resilience and relevance and engagement. These mechanisms and programme theories (PTs) were supported by family-centred education, routine self-monitoring with feedback, culturally or literacy-tailored materials and brief stress-regulation strategies. Barriers included low health and digital literacy, conflicting norms, short programme duration and rural workforce constraints. Facilitators included plain-language materials, low-tech or hybrid follow-up, co-designed dietary strategies and task-sharing with village health volunteers and family members. CONCLUSIONS: This rapid realist review identified six PTs, suggesting that the operation of lifestyle counselling interventions for non-communicable diseases in Thailand may be influenced by cultural norms, family and community support, village health volunteers and health service capacity. The findings highlight the potential importance of sustained follow-up, cultural and literacy tailoring and accessible modes of delivery in supporting behaviour change and self-management across different contexts. These PTs provide insight into how lifestyle counselling may operate in Thailand and may inform future research and the refinement of lifestyle counselling interventions.
Frontiers in public healthAndrea Schaller, Lena Katharina Spanio, Martin Lange
INTRODUCTION: The prevalence of non-communicable diseases (NCD) is rising and increasingly affects people of working age. Thereby, NCD burden those affected and challenge society, welfare systems and companies in many different ways. Workplace Health Promotion (WHP) is considered promising to improve and maintain employee health and physical activity (PA)-related WHP programs constitute a main area of action. This study aimed to better understand the needs employees with NCD have with regard to PA related WHP programs. METHODS: In an exploratory approach, qualitative partly structured interviews were conducted with 15 employees with NCD. The interviews were analyzed using structuring content analysis with concurrent deductive and inductive main categories, dimensions and expressions. RESULTS: Based on the interviews, four main categories were identified: "subjective health concept", "workplace-related health challenges and coping strategies", "experiences with WHP" and "wishes and needs in terms of PA-related WHP". "Subjective health concept" comprised the personal definition and the personal relevance of health. "Workplace-related health challenges and coping strategies" could be divided into physical and psychological demands and reported strategies were physical activity, nutrition, a supportive social environment and relaxing activities. The "experiences with WHP" comprised type of program, reasons for participation, access channels and subjective evaluation. The "wishes and needs in terms of PA-related WHP" referred to specific PA-content, structural aspects and psychosocial aspects. DISCUSSION: The findings provide insights into the experiences and needs of employees with NCD regarding PA-related WHP and provides recommendations for the further development of WHP tailored to specific target groups. Thereby, WHP for employees with NCD must not only be consistently adapted to the target group's work-related environment, but also take into account their mental, physical, and social limitations.
It remains unclear whether prehypertension combined with noncommunicable diseases (NCDs) is associate with higher risks of cardiovascular diseases (CVD) and all-cause mortality. The study aimed to investigate the associations of prehypertension with CVD and all-cause mortality in individuals with or without NCDs. The prospective cohort study included 56 114 participants from the Kailuan Study. Participants were divided into four groups: optimal blood pressure (BP) without NCDs, prehypertension without NCDs, optimal BP with NCDs and prehypertension with NCDs. CVD events and all-cause mortality were followed up until December 31, 2018. Cox proportional hazards models and Kaplan-Meier survival curves were used to assess the associations of prehypertension with the risk of CVD and all-cause mortality among patients with or without NCDs. Sensitivity and stratified analysis were performed to verify the robustness of the results. During a median follow-up of 9.04 years, 3367 CVD events and 5754 all-cause mortality had occurred. Compared with optimal BP alone, the multivariable adjusted hazard ratios (HRs) and 95% confidence interval (CI) for CVD were 1.36(1.23-1.51) for prehypertension alone, 1.82(1.55-2.14) for optimal BP and NCDs and 2.33(2.10-2.58) for prehypertension and NCDs (all P < 0.001). For all-cause mortality, the corresponding HRs (95%CI) were 1.13(1.04-1.21), 2.07(1.85-2.32) and 1.85(1.72-2.00) (all P < 0.001). Results were consistent in sensitivity and stratified analysis. Notably, females with prehypertension and NCDs showed the highest all-cause mortality risk. Prehypertension significantly increased CVD risk in patients with NCDs. However, a paradoxical all-cause mortality association was seen, with higher risk among NCDs patients with optimal BP versus prehypertension.
Non-communicable diseases (NCDs) account for more than 81% of all deaths in Iran and impose a substantial burden on the national health system. Although Iran has implemented multiple initiatives, including the World Health Organization's STEPwise Approach to NCD Risk Factor Surveillance (STEPS), to monitor NCD risk factors, critical gaps remain in longitudinal outcome assessment, particularly in the post-COVID-19 period, for which national data are limited. Moreover, in the context of declining fertility rates and demographic challenges in Iran, emerging evidence suggests that metabolic and lifestyle-related NCD risk factors are associated with impaired reproductive health, fertility potential, and childbearing behaviors. Therefore, the assessment of reproductive outcomes within population-based NCD surveillance frameworks addresses an important knowledge gap in Iran. The Iran STEPS Follow-Up Cohort (ISFUC) is established to evaluate mortality, health outcomes related to NCD risk factors, and fertility related outcomes using population-based data from the 2021 STEPS survey. The ISFUC is a population-based cohort study established through follow-up of participants from the nationally representative 2021 Iranian STEPS survey. The 2021 STEPS survey constitutes the baseline assessment, whereas ISFUC represents the subsequent follow-up phase. Baseline assessments were collected through interviewer-administered questionnaires, standardized physical measurements, and laboratory analyses of blood and urine biomarkers. Follow-up began in 4 April 2025, a five-years interval after baseline, and is ongoing. It will be conducted through structured telephone interviews by trained staff after renewed verbal consent. Study outcomes include all-cause mortality, healthcare utilization, injuries, reproductive health indicators, fertility-related behaviors and attitudes, and use of governmental childbearing support policies. Mortality outcomes are validated through linkage with the national death registry. Questionnaire validity was ensured using expert review, the Content Validity Ratio, and the Content Validity Index methods. By linking comprehensive 2021 STEPS baseline data with follow-up information on health, healthcare utilization, mortality, and reproductive outcomes, ISFUC provides a national platform for investigating Iran's evolving epidemiological and demographic health challenges.
Globalization and healthDarshen Naidoo, Nosiphiwo Nzimande, Susan Goldstein, Sameera Mahomedy
BACKGROUND: Non-communicable diseases (NCDs) are rising rapidly in South Africa, prompting the introduction of the Health Promotion Levy (HPL) in 2018 to reduce the consumption of sugar-sweetened beverages. However, the levy remains below the rate recommended by the World Health Organization. One of the central institutions involved in the policy process leading up to and following the introduction of the HPL was the National Economic Development and Labour Council (NEDLAC), a statutory body designed to promote dialogue between government, business, labour, and community constituencies. This study examined NEDLAC's mandate and its actual role in the HPL process, with particular attention to the inclusivity and transparency of its deliberations. RESULTS: Using an exploratory case study design, the research drew on qualitative content analysis of documents obtained through an access to information request made under South Africa's Promotion of Access to Information Act 2 of 2000. The findings indicate that NEDLAC's engagement with the HPL process fell short of its mandate to advance social equity and inclusive participation in economic decision-making. Community representatives, one of NEDLAC's four official constituencies, were absent from all deliberations on the levy. In contrast, business representatives dominated the discussions, often advancing arguments aligned with the interests of the sugar industry and emphasising potential job losses despite limited supporting evidence. Moreover, the process lacked transparency, particularly regarding the authorship of NEDLAC's HPL Report and the presentation of evidence used to support its conclusions. CONCLUSIONS: NEDLAC's handling of the HPL illustrates how participatory governance structures may, in practice, enable industry influence and weaken public health objectives. To enhance the integrity and effectiveness of policy dialogue on health-related fiscal measures, NEDLAC should adopt clearer procedural guidelines to ensure inclusive representation, strengthen transparency through public access to documentation, and institutionalise the role of civil society in its processes. Such reforms are essential to align participatory mechanisms with public health goals and to safeguard them from corporate capture.
Population aging and the rising burden of non-communicable diseases (NCDs) place sustained pressure on health systems. In this perspective, I argue that muscle health-muscle mass, strength, and physical function-should be recognized as an explicit and prognostically distinct target within policies for healthy aging and NCD prevention. Two arguments distinguish this from generic physical activity promotion: muscle strength predicts mortality, regardless of activity level, and the most significant gains are produced by resistance and multicomponent training rather than by aerobic activity alone. I summarize randomized evidence, including trials with follow-up to 36 months, highlighting that the benefits are more pronounced among individuals with demonstrable functional impairment-a finding that strengthens, rather than weakens, the policy case. I identify three recurring policy gaps: the limited use of feasible assessment tools in primary care, fragmented prevention efforts that under-prioritize resistance training, and the near absence of functional capacity in global NCD frameworks. Drawing on experiences from Japan, Europe, North America, and Brazil, I propose five operational priorities and examine the practical constraints on delivery-equipment, financing, workforce, cultural barriers, and long-term adherence-alongside the limits of the economic evidence, so that policy ambition is matched to the strength of the data.
Frontiers in public healthWenyu Ye, Li Shi, Sha Ye, Yuanqian Wen, Jiayi Gong, Wei Qian, Li Zhang, Lili Lu
INTRODUCTION: Childhood overweight and obesity are increasing worldwide, yet their population-level associations with a broad range of non-communicable diseases (NCDs) among children aged 5-9 years remain insufficiently characterized. This study examined the country-level associations between overweight/obesity and NCDs prevalence and explored whether these association patterns differed by sex. METHODS: This ecological study included 2022 national-level data from 174 countries. The prevalence of NCDs among children aged 5-9 years was obtained from the Global Burden of Disease (GBD), while overweight and obesity prevalence estimates were obtained from the World Health Organization Global Health Observatory (GHO). We utilized Spearman's correlation analysis to assess correlations and Random Forest to explore predictive importance, while generating forest plots and importance summary plots as independent visualization tools for the results. RESULTS: Significant global disparities in childhood overweight/obesity existed, with high prevalence in the Americas/Europe and low in Africa/Southeast Asia. Both were significantly positively correlated with multiple NCDs (p < 0.05). For overweight and obesity, the strongest correlations were with neoplastic disease, digestive and urinary system disease, neurological and psychiatric disease, as well as cardiovascular disease. After Benjamini-Hochberg false discovery rate (FDR) correction, multiple positive associations remained significant in the overall and boys' analyses, including associations with skin-related diseases among boys, whereas no positive associations remained significant among girls. CONCLUSION: This study provides epidemiological evidence on robust positive associations between childhood overweight/obesity and a broad spectrum of NCDs. Governments and global health systems should implement preventive measures against childhood weight abnormalities.
PloS oneMd Golam Kibria, Russell Kabir, Ali Davod Parsa, Mst Nasrin Jebin, Sonali Akter, Md Abu Raihan, Taslima Islam
BACKGROUND: Tobacco cessation services are recognised as an effective strategy for curbing tobacco consumption. However, data regarding these services in Bangladesh are limited. This study aimed to assess the levels of knowledge of and willingness to use tobacco cessation services and to identify associated factors among patients with NCDs who were current tobacco users in Bangladesh. METHODS: A cross-sectional study was conducted among 660 consecutively selected patients with NCDs aged ≥18 years visiting selected government sub-district hospitals in Bangladesh. Data were collected using a structured questionnaire from May 26-14 June, 2025. Multivariable logistic regression analyses were performed to identify the factors associated with overall knowledge of and willingness to use cessation services. RESULTS: Only 10.5% of participants reported moderate to high levels of overall knowledge on cessation services, while 65.3% expressed willingness to use them. In the multivariable ordinal logistic regression with partial proportional odds model (PPOM), higher knowledge of cessation services was associated with secondary education (adjusted odds ratio [aOR]: 1.9, 95% CI: 1.08-3.31) and higher secondary education and above (aOR: 4.3, 95% CI: 2.21-8.51). Similarly, the multivariable binary logistic regression analysis shows that willingness to use cessation services was associated with secondary education (aOR: 1.8, 95% CI: 1.12-2.83), higher secondary education and above (aOR: 2.2, 95% CI: 1.13-4.68), > 10 hospital visits (aOR: 2.5, 95% CI: 1.59-3.88), and moderate to high levels of overall knowledge of cessation services (aOR: 3.5, 95% CI: 1.73-7.99). CONCLUSIONS: Despite low levels of knowledge, willingness to use cessation services was high among participants in Bangladesh. Educational attainment was a key determinant of knowledge, while greater knowledge, higher education, and more frequent hospital visits were associated with willingness. These findings highlight the need to improve patient awareness and integrate cessation support into routine care to increase service use among tobacco users.
PLoS medicineEmma Whitfield, Becky White, Matthew E Barclay, Meena Rafiq, Nadine Zakkak, Marta Berglund, Hardeep Singh, Sean McPhail, Spiros Denaxas, Georgios Lyratzopoulos
BACKGROUND: In patients with cancer, diagnosis through or soon after the use of emergency hospital care ('emergency diagnosis') is associated with advanced disease and poor prognosis. The varied and complex reasons for emergency diagnoses-including rapid disease progression, patient factors, and system delays-are unlikely to be unique to cancer. However, little is known about the frequency and prognostic outcomes of emergency diagnosis in other conditions. We aimed to document the frequency of emergency diagnoses across various non-neoplastic conditions and examine the association of emergency diagnosis with clinical outcomes. METHODS AND FINDINGS: We analysed records from linked primary care, secondary care, and death data (Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics, Office for National Statistics) for 1,701,154 patients with one of 13 exemplar conditions (axial spondyloarthritis, coeliac disease, coronary/ischaemic heart disease, chronic obstructive pulmonary disease (COPD), inflammatory bowel disease (IBD), Lyme disease, multiple sclerosis (MS), Parkinson's disease, polycystic ovary syndrome, rheumatoid arthritis, schizophrenia, subacute bacterial endocarditis, and tuberculosis) in England between 1999 and 2019. We examined the percentage of patients diagnosed as an emergency and compared their mortality and time in hospital in the year post-diagnosis with patients who were not diagnosed as an emergency. Emergency diagnosis occurred in at least 20% of patients for 9 out of 13 conditions in our sample, including more than 30% of patients with Parkinson's disease and 35% of patients with COPD. For 9 out of 13 conditions, there was a substantial increase (at least +10% difference) in 1-year mortality in patients diagnosed as an emergency versus patients who were not diagnosed as an emergency. After adjusting for age and year of diagnosis, deprivation, comorbidity burden, and the healthcare setting in which the diagnosis was made, patients diagnosed as an emergency were typically much more likely to die within one year. This association held even in conditions with generally good prognosis, such as coeliac disease (adjusted odds ratio 7.53, 95% CI [5.64, 10.1], women) and IBD (adjusted odds ratio 5.99, 95% CI [5.30, 6.78], men). Similarly large differences were observed for time in hospital in the year post-diagnosis by emergency diagnosis status. For example, adjusted rate ratios of 8.76 (95% CI [6.52, 11.8]) for men with coeliac disease, and 5.59 (95%CI [2.57, 12.2]) for women diagnosed with Lyme disease. The findings were consistent across two subsets of CPRD data (Aurum, GOLD). Analyses of patients with five supplementary cancer sites (brain, colon, lung, pancreas, and ovary) produced findings concordant with prior literature, supporting the validity of the study methods. The main study limitation is the assumption of accurate recording of diagnoses in health records. CONCLUSIONS: Emergency diagnosis is common and associated with worse clinical outcomes in a wide range of conditions with diverse aetiology. Further research and investment to reduce the number of emergency diagnoses is needed, particularly for diseases where diagnosis in community settings should be expected (e.g., rheumatoid arthritis and COPD), and conditions such as coeliac disease, IBD, and MS, where emergency diagnosis is associated with particularly poor outcomes.
BACKGROUND: Among low- and middle-income countries, noncommunicable diseases (NCDs) are a significant health burden among the elderly. Mobile health interventions provide resource-constrained health education that is scalable. AIMS: Determine the viability, acceptability, and preliminary effects of culturally adapted Short Message Service (SMS)-based nutrition and lifestyle change on the knowledge, attitudes, and practices (KAP) of older adults in Jordan towards prevention of noncommunicable diseases (NCDs). METHOD AND MATERIALS: A total of 79 older adults (mean age 57.33 ± 9.37 years) with NCDs received 30 culturally tailored SMS messages daily for one month. Messages were based on Social Cognitive Theory and addressed dietary habits, physical activity, and NCD risk reduction. A validated Arabic-adapted KAP questionnaire was administered pre- and post-intervention. STATISTICAL ANALYSIS: Paired-samples t-tests were used to compare pre- and post-KAPs. Effect sizes were calculated using Cohen's d. Sociodemographic factors associated with KAP improvement were examined through multiple linear regression (p ≤ 0.05). RESULTS: Significant improvements occurred in knowledge (mean difference = 40.62, p ≤ 0.001; Cohen's d = 3.29) and attitudes (mean difference = 24.43, p ≤ 0.001; Cohen's d = 1.77). There was no significant change in practice scores (p = 0.175). Overall KAP improved significantly (p ≤ 0.001; Cohen's d = 2.15), driven primarily by gains in knowledge and attitudes; practice scores did not change significantly. Greater improvement in KAP was associated with higher education (β = 0.379, p ≤ 0.001), younger age (β = - 0.646, p ≤ 0.001), female sex (β = - 0.067, p = 0.007), and living alone (β = 0.150, p = 0.031). CONCLUSIONS: The pilot study indicates that culturally adapted SMS messaging among older adults with NCDs is feasible and acceptable in Jordan, and its early impacts on knowledge and attitudes are promising. These results provide preliminary evidence and effect size estimates needed to design a fully powered randomized controlled trial to determine effectiveness.
Frontiers in public healthFabrizio Carinci, Stephen Fava, Iztok Štotl, Nicholas Nicholson
BACKGROUND: The growing burden of non-communicable diseases (NCDs) in Europe has intensified the need for timely, comparable, and policy-relevant health indicators derived from increasingly heterogeneous health data ecosystems. The European Health Data Space (EHDS) represents a major policy initiative to facilitate the secondary use of health data while preserving privacy, security, and national data sovereignty. In this context, federated analytics can foster international comparisons without requiring the transfer of person-level data. OBJECTIVES: This scoping review aimed to map federated analytical approaches relevant to the production of NCD indicators within the EHDS and to develop a conceptual framework linking distributed statistical methods, privacy-preserving infrastructures, and policy-oriented surveillance requirements. MATERIALS AND METHODS: A scoping review was conducted following the PRISMA Extension for Scoping Reviews. Searches were structured into three complementary conceptual domains: (a) federated analytical approaches, (b) distributed statistical inference methods, and (c) governance and health-data infrastructures relevant to the EHDS. Searches were performed in PubMed, Scopus, and IEEE Xplore, for studies published between 2010-26. Records were exported with abstracts and full bibliographic metadata. Deduplication and metadata-aware merging were conducted across databases using DOI and normalized-title matching. RESULTS: We retrieved a total of 2,362 records, of which 1,285 were unique records and 104 were finally retained. The literature revealed a heterogeneous but rapidly expanding ecosystem of distributed analytical approaches. We identified three major domains: (1) distributed regression; (2) federated or distributed analytical infrastructures; and (3) privacy-preserving federated epidemiological analysis. DISCUSSION: An increasing range of solutions for federated analytics is available for policy-grade NCD indicators. Longitudinal and survival models remain methodologically complex because of covariance structures and globally coupled risk sets. A modular approach is needed to incorporate public-health intelligence and a dynamic set of interoperable tools in the EHDS, with the active support of a decentralized network of active stakeholders. CONCLUSION: Federated analytics is shifting the paradigm from centralized data pooling to computation-to-data architectures. The successful implementation of NCD surveillance in the EHDS require integrating statistics with legal, IT, policy and governance mechanisms. The review outlined a conceptual framework that can couple technical innovation with the best architecture for public-health knowledge production.
Bulletin of the World Health OrganizationNicole Rendell, Habib Benzian, Richard G Watt, Leanne Riley, Eugenio Beltrán, Eduardo Bernabe, Jonathan Broadbent, Moréniké O Foláyan, Heba Fouad, Nicolas Gira…
The World Health Organization (WHO) Global strategy and action plan on oral health 2023-2030 emphasizes the need to strengthen oral health information systems, including surveillance, to support public health action. Objective 5 of the Global strategy and action plan on oral health 2023-2030 calls for reliable, timely and policy-relevant data to inform decision-making, promote accountability and monitor progress, in other words, surveillance of oral diseases. However, most countries face challenges in identifying and applying practical tools to generate such population-level data. Until recently, the WHO STEPwise approach to noncommunicable disease risk factor surveillance (STEPS) included an oral health module that relied on self-reported data on perceived oral health and oral health-seeking behaviour. However, this module is outdated. In response to growing global demand and policy needs, the new STEPS oral health module updated the self-reported questionnaire and added a clinical assessment component that can be done by oral or non-oral care workers after a short training. This paper presents the rationale, development process, structure and policy implications of the updated module. The paper provides an outline of the updated module and evidence to support this new approach as a practical, scalable and aligned solution to one of the most persistent gaps in noncommunicable disease surveillance. As countries move towards universal health coverage and integration of oral health into broader noncommunicable disease strategies, the updated WHO STEPS oral health module is a timely and necessary improvement in surveillance of noncommunicable diseases and their risk factors.
International journal of population data scienceKatie McBain, Samuel Kasjan, Ryan Taylor, Dorothea Dumuid, Susan Clifford, Timothy Olds, Melissa Wake
INTRODUCTION: The life course phenotypic pathways leading to noncommunicable diseases (NCDs) provide information needed to plan and test preventive interventions. However, most NCD-relevant phenotypes are not routinely measured until diagnosis and their pre-clinical trajectories are therefore not in linked population datasets. OBJECTIVES: In the context of planning phenotypic collection waves in an Australian early and pre-midlife mega-cohort, we aimed to undertake (1) a scoping review to identify knowledge availability and gaps and (2) a comparative map of trajectories from available data. METHODS: We searched PubMed and MEDLINE (September 2024) for trajectory studies on phenotypes underlying NCDs with the highest late life disease burden (excluding cancer and back pain, with no clear precursor phenotypes): cardiovascular, chronic obstructive pulmonary and kidney diseases, diabetes, falls, hearing and vision loss, and dementia. Eligible studies had ≥3 timepoints spanning ≥5 years in childhood or ≥10 years in adulthood. Using the R ggplot package, we fitted loess curves to create lifetime trajectory visualisations in absolute values and units standardised for comparison. RESULTS: From 3770 abstracts, we included 36 studies. Most (n == 19) examined cardiovascular trajectories, collectively spanning ages 5-105 years for blood pressure. Ten studies reported cognition trajectories, but could not be synthesised due to measurement diversity. Twelve studies mapped lung, glucose, kidney or musculoskeletal phenotypes but with discontinuities at varying life stages. No studies tracked vision or hearing trajectories. Our syntheses confirmed some known trajectory patterns, such as peaking of musculoskeletal phenotypes in early adulthood and the rise in cardiovascular and glucose markers beyond healthy ranges from midlife. CONCLUSIONS: Our mapping confirmed expected patterns for some phenotypes, but highlighted significant gaps for others on pathways to high-burden NCDs. If long-running population cohorts collectively tracked all major phenotypes over time, embedded real-world or simulated trials could accelerate progress in prevention and treatment across all major NCDs.
OBJECTIVES: To assess the impact of non-communicable diseases (NCDs) by number and pattern on productivity loss costs (PLCs) and health-related quality of life (HRQoL) in a large working-age population in Japan. DESIGN: Cross-sectional analysis of linked claims-survey data with sex-stratified multivariable regression. SETTING: Employment-Based Health Insurance Associations in Japan. Administrative claims using International Classification of Diseases, Tenth Revision codes were linked to an online questionnaire (November 2022). PARTICIPANTS: Insured workers and families aged 18-65 years who completed the survey (n=18 236; mean age 48.7 years; 66.2% men). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary: PLC, estimated from the Work Productivity and Activity Impairment instrument using the Human Capital Method (annual US$). SECONDARY: HRQoL measured using the EuroQoL 5-Dimension 5-Level index. Exposures were NCD categories, multimorbidity counts and high-impact disease combinations. Models adjusted for sex, age and the number of other conditions. RESULTS: Multimorbidity (≥2 conditions) was present in 58.4% (56.3% men; 62.5% women); 29.3% had ≥5 conditions. Women had higher NCD prevalence (76.9% vs 70.0%), higher median PLC (US$3683 vs US$117) and lower median HRQoL (0.89 vs 1.00) than men. In adjusted analyses, neuropsychiatric conditions were associated with higher PLC in both sexes (men: US$2393 (95% CI 1966 to 2820); women: US$2097 (US$1442 to US$2751)). Musculoskeletal disorders were statistically significant in men but not in women (US$809 (US$381 to US$1236)), whereas genitourinary disorders were statistically significant in women but not in men (US$701 (US$121 to US$1282)). Neuropsychiatric disorders were associated with lower HRQoL in both sexes (men: -0.040 (-0.045 to -0.034); women: -0.044 (-0.053 to -0.035)); musculoskeletal disorders showed similar decrements (men: -0.031 (-0.037 to -0.025); women: -0.040 (-0.049 to -0.031)). Combinations involving sleep and neuropsychiatric disorders produced the highest PLC (eg, depressive episode and sleep disorder: men: US$5219.9 (US$3646.4 to US$6793.4); women: US$5858.5 (US$2634.4 to US$9082.5)). Each additional condition was independently associated with higher PLC and lower HRQoL. CONCLUSIONS: In this cross-sectional study of Japanese workers, specific combinations of chronic conditions, particularly neuropsychiatric conditions co-occurring with sleep disorders and musculoskeletal disorders, were associated with greater productivity loss and lower HRQoL than predicted by the number of co-occurring diseases alone. These findings suggest that workplace health strategies addressing high-impact disease combinations may warrant further investigation in longitudinal studies.
Inquiry : a journal of medical care organization, provision and financingFuhmei Wang, Tsefu Ting, Kuang-Liang Chang
IntroductionNoncommunicable diseases (NCDs) are associated with a less healthy workforce, higher medical expenditures, and worse on-the-job performance. The allocation of limited health resources between prevention and treatment is therefore critical, as it could influence both NCDs-related mortality risk and on-the-job productivity.MethodsUsing panel data from 38 OECD countries over the period 2000 to 2023, this study applies the system generalized method of moments (GMM) to examine (a) the nexus of prevention-cure-NCDs death probability, and (b) the possible roles of preventive and curative health services on the path of saving the economy's production loss attributable to the risk of NCDs death for the population aged 30 to 70.ResultsIntegrating preventive and curative health services is associated with improvements in health outcomes and economic productivity. If prevention is maintained at the current level (0.27% of GDP) and curative health spending is continually allocated at a GDP ratio of 10.2%, the probability of dying from NCDs could decrease from the current 13.94% to 13.84%. Annual earnings per worker are estimated to increase from USD 49,036.52 to USD 49,515.49, while GDP per worker is projected to rise from USD 101,727.7 to USD 103,980.ConclusionsGender disparities in NCDs mortality risk persist. The findings underscore the importance of aligning investments in both preventive and curative health interventions to address the burden of noncommunicable diseases.
Nature communicationsFinn Stürenburg, Kerstin Forster, Nicolas Banholzer, Malte Toetzke, Kenneth Harttgen, Stefan Feuerriegel
Reducing the global burden of disease is crucial for improving health outcomes. However, misalignment between health aid and country-level disease burden leaves vulnerable populations without the necessary support for major health challenges, particularly in the least developed countries. Here, we develop a machine learning pipeline using large language models to track flows in official development assistance (ODA) earmarked for health and identify aid-burden misalignment. We classified 3.7 million development aid projects from 2000 to 2022 (USD ~ 332 billion) into 17 major categories of communicable, maternal, neonatal, and nutritional diseases (CMNNDs) and non-communicable diseases (NCDs). We compared the rank of per capita ODA disbursement against the rank of disease burden, measured in disability-adjusted life years (DALYs). We interpret DALY-based alignment as a policy-relevant heuristic rather than a prescriptive allocation criterion. Although funding and disease burden are significantly correlated for many diseases, there are notable disparities. For example, NCDs account for 59.5% of global DALYs but received only 2.5% of health-related ODA over the study period. This is concerning because low- and middle-income countries face an increasing double burden from both CMNNDs and NCDs. Our results show aid-burden misalignment across multiple diseases in several regions, including Central Africa and parts of South Asia and West Africa. Overall, our results identify health disparities to potentially inform policy decisions on development assistance and support targeted allocation of health aid.
Global health actionYanhua Liu, Mengxue Zeng, Xingwen Luo, Oratanasataporn Soonthree
Non-communicable diseases (NCDs), including cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, represent a growing inpatient burden worldwide. Yet hospital-based cross-national mixed-methods comparisons remain scarce, and the factors shaping inpatient NCD care are poorly understood. This protocol describes an explanatory sequential mixed-methods study examining inpatient NCD characteristics, disease patterns and hospitalisation indicators in tertiary hospitals in New Zealand and China, and exploring multilevel influences on NCD care. Guided by the Social Ecological Model, the study will be conducted at Waikato Hospital and the Third People's Hospital of Yibin. In the quantitative phase, de-identified discharge records of adult inpatients aged ≥ 16 years with a primary diagnosis of one of the major NCDs will be extracted for 2023-2025. Analyses will be stratified by NCD category, and multivariable regression models with site as a fixed effect will examine variations in hospitalisation outcomes. In the qualitative phase, semi-structured interviews will be conducted with approximately 30-40 healthcare professionals across both settings. Interview data will be analysed thematically and integrated with quantitative findings using joint displays. To our knowledge, this is the first mixed-methods comparison of inpatient NCD care between tertiary hospitals in China and New Zealand. Findings are expected to support cross-cultural learning and inform evidence-based strategies to improve inpatient NCD management across diverse healthcare systems. This protocol is reported in accordance with the GRAMMS, STROBE and COREQ guidelines.
BACKGROUND: Non-communicable diseases (NCDs) account for a large and growing share of global mortality, with the highest burden in low- and middle-income countries (LMICs). The World Health Organization and global partners emphasise strengthening primary health care (PHC) as a central pathway toward universal health coverage (UHC). The WHO Package of Essential Noncommunicable Disease Interventions (PEN) for PHC explicitly positions "integration of NCD management into primary health care" as an important step, particularly in LMICs. Despite the wide policy endorsement, evidence suggests there are ongoing gaps in integrating essential NCD care into PHC across Africa. METHODS: This protocol follows PRISMA-P guidance for systematic review protocols. The review will include peer-reviewed and grey literature (English) from 1 January 1990 to 31 December 2025 that focuses on implementation strategies for integrating NCD care into PHC in sub-Saharan Africa (SSA). Narrative synthesis will be conducted using established guidance for narrative synthesis and SWiM reporting, where meta-analysis is not feasible. Study quality will be appraised using the Mixed Methods Appraisal Tool (MMAT) to accommodate heterogeneous designs. ETHICS AND DISSEMINATION: Ethical approval is not required because the review will use publicly available data only. Findings will be disseminated through peer-reviewed publications and conference presentations. REGISTRATION: This protocol was registered with PROSPERO (CRD420261354803). https://www.crd.york.ac.uk/PROSPERO/view/CRD420261354803. PROTOCOL REPORTING STANDARD: This protocol is prepared in accordance with PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) 2015, which provides a minimum set of items for transparent reporting of systematic review protocols. AMENDMENTS: Any protocol amendments (e.g., eligibility criteria refinements or database additions) will be documented with date, rationale, and impact on methods, and updated in the PROSPERO record and the final manuscript.
INTRODUCTION: Health literacy is a multidimensional concept that encompasses a range of skills people need to function effectively and efficiently in a healthcare environment. This study, aims to fill the gap in knowledge about health literacy regarding noncommunicable disease prevention practices in the Ethiopian context. METHODS: A descriptive qualitative study was conducted to investigate health literacy-oriented noncommunicable disease prevention behaviors in the Amhara Region of Northwest Ethiopia. The study used focus group discussions and in-depth interviews with a purposive sample of 51 diverse participants from the community and health system. To further understand participants' health literacy on common noncommunicable diseases, a thematic analysis approach was employed. Atlas TI. 9.1.3.0 software was used for data analysis. RESULTS: Four themes emerged regarding how health literacy relates to the prevention and control of noncommunicable diseases. Factors contributing to low level of preventive behavior for noncommunicable diseases include the level of health literacy, lack of isolated comprehensive preventive health services room, a carefree attitude towards health, operational failures, knowledge gaps, and motivational variables. CONCLUSION: Participants demonstrated inadequate health literacy and held misconceptions about non-communicable diseases and their associated risk factors. To reduce the growing burden of noncommunicable diseases, this study highlights the need to address the diverse health literacy needs of adults-including the knowledge and skills required to recognize and act on these conditions or behaviors, and the ability to understand and respond to health requirements by implementing context specific health literacy improvement strategies for noncommunicable disease literacy.
Environmental monitoring and assessmentAmadou Barrow, Lamin M Ceesay, Elizabeth O Oloruntoba, Rex A Kuye
Agricultural systems are major sources of methane emissions, contributing to climate change with potential downstream effects on population health. West Africa faces a growing burden of non-communicable diseases (NCDs) alongside agricultural intensification, yet the relationship between agricultural emissions and NCD mortality remains unexplored. We examined whether changes in agricultural methane emissions were associated with NCD mortality trends across West African countries. We conducted an ecological panel study of 11 West African countries from 2015 to 2020 using World Bank World Development Indicators data. The exposure was agricultural methane emissions, measured in carbon dioxide equivalents (Mt CO₂e). The primary outcome was the probability (%) of dying from NCDs between exact ages 30 and 70 for both sexes combined; sex-stratified outcomes for women and men were examined as secondary analyses. We classified countries by emission trajectory: decreasing (> 5% reduction), stable, or increasing (> 10% increase). For each outcome we estimated associations using pooled ordinary least squares, within-country fixed effects, mixed effects models with random intercepts, and a descriptive group-by-period comparison of NCD mortality trajectories between The Gambia (largest emission reduction: -28.3%) and other countries. Sensitivity analyses assessed robustness to influential observations, functional form, and temporal specification. For both sexes combined, pooled analysis suggested an inverse cross-sectional association between agricultural methane and NCD mortality (β = -0.085; 95% CI: -0.126 to -0.043; p < 0.001). However, within-country fixed effects models showed no association (β = 0.027; 95% CI: -0.081 to 0.134; p = 0.62), indicating confounding by time-invariant country characteristics. The intraclass correlation coefficient was 0.984, indicating 98.4% of variance occurred between countries. A descriptive group-by-period comparison found no differential change for The Gambia versus other countries (0.62 percentage points; 95% CI: -0.78 to 2.03; p = 0.39). Sex-stratified analyses were consistent: the pooled inverse association was present for both women (β = -0.077; p = 0.001) and men (β = -0.096; p = 0.004) but was eliminated under fixed effects (women p = 0.27; men p = 0.88), and excluding Nigeria reversed the pooled association (both sexes β = + 0.091, p = 0.014), confirming it was driven by a single influential country. Agricultural methane emission reductions were not associated with short-term changes in NCD mortality in West Africa. The high between-country clustering suggests that stable country-level factors including health system capacity, socioeconomic development, and baseline disease burden are more strongly associated with NCD mortality patterns. Longer follow-up periods and individual-level studies are needed to evaluate potential health co-benefits of agricultural emission reductions.
Frontiers in public healthZoha Imtiaz Malik, Shaheer Ellahi Khan, Abdul Momin Rizwan Ahmad, Saleh A Alsanie
BACKGROUND: Employed females such as school teachers form a particularly vulnerable and overlooked population group, in terms of non-communicable diseases (NCDs), and despite their higher risk, research on female school teachers remains limited. OBJECTIVE: The current study aimed to assess NCDs related risk factors, and their knowledge in female secondary school teachers. METHODS: A cross-sectional baseline survey was conducted for a quasi-experimental mixed methods study on 130 female secondary school teachers, selected using two stage sampling, with the first stage involving purposive selection of 08 secondary federal government public schools of Islamabad, and the second stage involving simple random selection of female teachers employed at these schools. Data was collected using pre-validated questionnaires and analyzed using SPSS version 27. Chi-square/Fisher exact test and binary logistic regression were applied to determine associations between variables. RESULTS: Out of the 130 participants, 63.8% were aged 41-45 years age group, 89.2% had a post-graduate degree, and 90% participants earned more than 150,000 PKR per month. About 38.5% consumed fruits every 3-4 days, 88.5% claimed they did not know how many servings of fruits and vegetables they consumed, and 16.2% participants said they often add salt to their foods before or while eating. About 63.8% participants said they walk for at least 30 min per day, while 31.5% spent more than 6 h while sitting or lying down. The mean BMI was reported to be 27.09 ± 4.94, mean waist circumference (WC) was 95.01 ± 10.05, while mean WtHR was 0.88 ± 0.04. The percentage of participants with moderate level of HTN, CVDs, and DM were 61.5, 76.9, and 64.6%, respectively. Household income (p = 0.022), servings of fruits and vegetables (p < 0.001), and moderate physical activity (p = 0.041) were significantly associated with DM. CONCLUSION: This study's findings reflected high levels of moderate NCDs knowledge, however, participants exhibited increased behavioral and anthropometric NCDs risk factors. This reflects a lack of translational knowledge despite general NCDs awareness in the target population.
Cadernos de saude publicaGederson Santos Rigoni, Andrea Sobral, Jonas Eduardo Monteiro Dos Santos, Andre Reynaldo Santos Périssé
This study compared the possible impacts caused by the Samarco dam collapse (Minas Gerais State, Brazil) and municipalities with a similar profile to analyze the morbidity and mortality patterns due to chronic noncommunicable diseases in the affected municipalities. This ecological study was based on publicly available secondary data (SIA/SUS, SIH/SUS, and SIM) from 2008 to 2023. The analyses were carried out by disease chapters and groups (circulatory, diabetes, respiratory, neoplasms, and mental disorders) and population strata. Rates per 100,000 inhabitants, percentage differences, and relative risk were calculated with 95% confidence intervals. The "post-collapse" period (2016-2019) was compared to the "before the collapse" (2008-2015) and "post-COVID-19" (2020-2023) ones. An increase in the rates of outpatient care occurred in the affected municipalities in relation to the comparison municipalities, especially regarding diabetes (strata 1, 2, 3, and 5), respiratory diseases (strata 1, 3, 4, and 5), mental disorders (strata 4 and 5), and neoplasms (strata 1, 2, 3, and 4). In hospitalizations, slight increases due to respiratory problems occurred in stratum 4 and due to neoplasms in strata 3, 4, and 5. Regarding mortality, this study found an increase in the rates of mental disorders in strata 2 and 4. These findings suggest changes in care patterns in the affected municipalities with possible post-disaster overload and reinforce the importance of surveillance and integration between health, environmental, and risk management policies.
Global health actionMohammad Amin Kharaghani, Safdar Masoumi, Arash Bagherian Ghotbi, Yosra Azizpour, Mina Mirzad, Sepehr Khosravi, Mostafa Moghimi Kheirabady, Moez Shaabanian, Na…
BACKGROUND: Noncommunicable diseases (NCDs) are the leading cause of mortality in Iran, driven by behavioral and metabolic risk factors that frequently co-occur. OBJECTIVE: To identify patterns of co-occurring behavioral and metabolic NCD risk factors among Iranian adults and characterize their demographic and socioeconomic correlates. METHODS: This cross-sectional study analyzed data from 16,618 adults aged ≥25 years who participated in Iran's 2021 nationally representative STEPS survey. Thirteen behavioral and metabolic variables, including physical activity, nutrition score, smoking frequency, alcohol intake, salt intake, body mass index, blood pressure, fasting plasma glucose, and lipid markers, were entered into a K-means clustering analysis. Clusters were characterized by their risk profiles and demographic/socioeconomic attributes. Multinomial logistic regression examined associations between cluster membership and sociodemographic factors. RESULTS: Five distinct behavioral-metabolic clusters emerged. The smokers-drinkers (SD) cluster (3.1%) comprised mostly older, less-educated men with high smoking and alcohol use. The healthy-low-risk (HLR) cluster (40.3%) showed favorable profiles and included younger, more educated individuals. The physically active (PA) cluster (6.6%) was characterized mainly by younger men with markedly high physical activity levels. The dyslipidemic (DLP) cluster (26.0%) exhibited high dyslipidemia and overweight prevalence, while the hypertensive-diabetic (HTD) cluster (24.0%) had the highest obesity, hypertension, and diabetes rates, common among older urban adults. CONCLUSION: Behavioral and metabolic NCD risk factors in Iran formed five distinct co-occurrence patterns. Nearly half of adults belonged to metabolically high-risk clusters, highlighting the need for targeted prevention strategies that combine lifestyle interventions with screening and management of obesity, hypertension, diabetes, and dyslipidemia.
Journal of global healthKurubaran Ganasegeran, Mohd Kamarulariffin Kamarudin, Shameni Sunasundram, Mohd Rizal Abdul Manaf, Erwin Jiayuan Khoo
Non-communicable diseases (NCDs) account for a growing proportion of morbidity and disability among children and adolescents worldwide. Contemporary NCD preventive strategies are predominantly adult-centric, resulting in delayed prevention and widening inequities, particularly in low- and middle-income countries. This neglect reflects a deeper structural and ethical failure, sustained by fragmented financing, siloed governance, commercial determinants of health, and short-term political priorities. Drawing on life-course theory, systems thinking, and principles of global health justice, childhood and adolescent NCD neglect can be understood as a systematic gap in long-term health governance that undermines human capital formation and entrenches socioeconomic disadvantage. A policy reorientation that positions early-life NCD prevention as a strategic investment in sustainable development is required. Priority reforms include embedding paediatric NCD services within universal health coverage, strengthening age-disaggregated surveillance systems, institutionalising intersectoral governance mechanisms, and establishing global accountability frameworks. Protecting children and adolescents from preventable NCDs constitutes not only a public health necessity but a moral, economic, and political imperative.
European journal of public healthAnna Vera J Pallesen, Jochen O Mierau, Laust H Mortensen
Individual socioeconomic position is known to affect the progression of disease and mortality after disease onset. Existing studies generally focus on single diseases, making it unclear whether this is a universal pattern or a common characteristic across disease classes. The objective of this study is to examine educational and income inequalities in life expectancy after diagnosis of noncommunicable diseases. Based on full population Danish registers (N = 4 420 226), we created multistate models for 64 noncommunicable diseases according to education, income, age and sex. Transition probabilities from healthy to sick and deceased were estimated with a multinomial logit model and used for the construction of life tables from which we estimated life expectancy after diagnosis. We observed education and income inequalities in life expectancy after diagnosis across all noncommunicable diseases studied for both men and women. For example, a woman diagnosed with cirrhosis of the liver at age 50, has a life expectancy of almost 17 years if she has a high education and 14 years if she has a low education. For men, life expectancy after diagnosis of cirrhosis is 13 years for the high educated and 10 years for the low educated. Our findings show that socioeconomic inequalities in life expectancy after disease onset are consistent across a wide range of noncommunicable diseases. In terms of policy, our study highlights the need for interventions that reduce the accumulation of risk before individuals become patients, and strengthen the healthcare system's ability to mitigate inequalities.
Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassitEfat Mohamadi, Amirhossein Takian, Fateme Yaftian, Alireza Olyaeemanesh, Ali Sheidaei, Fatemeh Ghavidel, Ramin Heshmat, Ardeshir Khosravi, Gita Shafiee
BACKGROUND: Limited evidence on the socioeconomic inequalities in mortality due to noncommunicable disease hampers the development and implementation of policies to improve health equity in Islamic Republic of Iran. AIM: To assess the socioeconomic inequalities in mortality caused by major noncommunicable diseases across provinces and districts in Islamic Republic of Iran. METHODS: We obtained data for all deaths attributed to noncommunicable disease (1 105 000) for the period 2016-2018 across 429 districts in 31 provinces of Islamic Republic of Iran. We also obtained aggregated household income and expenditure data from the statistical centre. We analysed the data with R version 4.5.1, using the index of disparity to measure inequality and regression-based relative index of inequality to measure socioeconomic inequalities in noncommunicable disease mortality. RESULTS: The average noncommunicable disease mortality ranged from 36.02 per 100 000 population in Kohgiluyeh and Boyer-Ahmad to 73.06 per 100 000 in Golestan. The index of disparity was >40% in Chaharmahal and Bakhtiari, Sistan and Baluchestan, and Kohgiluyeh and Boyer-Ahmad, and <20% in Semnan and Qazvin. Cardiovascular disease mortality showed the highest difference between adjacent socioeconomic groups, decreasing from 144.1 to 118.5 per 100 000 population between the first and second groups. CONCLUSION: Noncommunicable disease mortality varied across provinces and socioeconomic groups, particularly for cardiovascular disease mortality. To reduce inequalities in mortality due to noncommunicable disease within and between the provinces, there is a need to strengthen health inequality monitoring using evidence on the causes of death, risk factors and the social determinants of health.
Non-communicable diseases (NCDs) account for a major share of global mortality and disability, while their development and outcomes reflect interactions among behavioral, metabolic, socioeconomic, environmental, infectious, and non-modifiable factors. This issue of the Biomedical Journal highlights the breadth of contemporary research across NCD epidemiology, mechanisms, diagnosis, prevention, and treatment. A study from northern Peninsular Malaysia examines age- and sex-specific patterns in the burden of cardiovascular disease, respiratory disease, and diabetes, while a review considers the complex association between diabetes, vascular complications, and dementia. Further reviews address strategies to improve glioblastoma vaccines through enhanced antigen presentation and combination immunotherapy, as well as ultrasound-guided interventions for adhesive capsulitis, including stage-specific and structure-oriented approaches to pain relief and functional recovery. The original articles explore a single-dose, non-waiting neoadjuvant immunotherapy strategy for resectable hepatocellular carcinoma; emerging evidence on problematic ChatGPT use; genomic surveillance following an outbreak of carbapenem-resistant Serratia marcescens; the stage-specific role of miR-7974 in colorectal cancer; and the potential diagnostic relevance of DEC-1 in ischemic stroke. Other contributions investigate extracorporeal shockwave therapy as a means of reducing inflammation in experimental psoriasis and Fu's subcutaneous needling as a potential modulator of mitochondrial quality control and inflammatory signaling in a rat model of sciatica. A correspondence exchange on molecular diagnostic platforms for primary mitochondrial diseases discusses the validation, sensitivity, terminology, clinical practicality, and particular advantages of long-read nanopore sequencing.
Bioinformatics (Oxford, England)Donghee Choi, Yajie Gu, Kai Qi Zong, Antoine D Lain, Dimitrios Zaikis, Thomas Rowlands, Marek Rei, CoDiet Consortium, Tim Beck, Joram M Posma
Diet plays a critical role in human health, with growing evidence linking dietary habits to disease outcomes. However, extracting structured dietary knowledge from biomedical literature remains challenging due to the lack of dedicated relation extraction datasets. To address this gap, we introduce RECoDe, a novel relation extraction (RE) dataset designed specifically for diet, disease, and related biomedical entities. RECoDe captures a diverse set of relation types, including a broad spectrum of positive association patterns and explicit negative examples, with over 5000 human-annotated instances validated by up to five independent annotators. Furthermore, we benchmark various natural language processing (NLP) RE models, including BERT-based architectures and enhanced prompting techniques with locally deployed large language models (LLMs) to improve classification performance on underrepresented relation types. The best performing model was gpt-oss-20B, a locally-deployed open-weight LLM, achieving an F1-score of 61% (macro) for multi-class classification and 89% for binary classification using a hierarchical prompting strategy with a separate reflection step built in. To demonstrate the practical utility of RECoDe, we introduce the Contextual Co-occurrence Summarisation (CoCoS) framework, which aggregates sentence-level relation extractions into document-level summaries and further integrates evidence across multiple documents. CoCoS produces effect estimates consistent with established dietary knowledge, demonstrating its validity as a general framework for systematic evidence synthesis. Availability: The code, models, and dataset are publicly available at https://github.com/omicsNLP/RECoDe.
Journal of medical Internet researchSerine Sahakyan, Selai Akseer, Lusine Abrahamyan, Olivia Metcalf, Sara Allin, Richard Chenhall, Emily Seto
BACKGROUND: Digital health technologies (DHTs) have the potential to improve care delivery and outcomes for patients with noncommunicable diseases. Yet their implementation in rural settings remains uneven, and the factors influencing uptake are not well understood. OBJECTIVE: This mixed methods systematic review aimed to identify barriers and facilitators influencing the implementation and use of DHTs for remote management of noncommunicable diseases in rural areas. METHODS: We searched Medline, Embase, and CINAHL from inception to February 12, 2026, using terms related to digital health, noncommunicable diseases, and rural settings. Following the Joanna Briggs Institute methodology for mixed-method systematic review, we synthesized quantitative and qualitative studies. Barriers and facilitators were categorized using the Consolidated Framework for Implementation Research, and study quality was appraised using the Mixed Methods Appraisal Tool. RESULTS: From the initial 1491 records, 14 studies met the inclusion criteria, with most conducted in high-income countries (n=11). Key barriers included technical challenges (software instability and hardware issues), poor internet connectivity, financial constraints, and workforce constraints, such as staff shortages and heavy workloads. Key facilitators included user-friendly technology design, strong leadership, effective teamwork, and ongoing communication. Evidence was predominantly qualitative, with only limited quantitative data available. CONCLUSIONS: DHTs show promise for improving access and continuity of care for cardiovascular disease, hypertension, and diabetes in rural settings; however, their impact is constrained by structural inequities, including limited broadband access, workforce shortages, and financial fragility. These findings highlight important implications for research, policy, and practice, including the need for rigorous mixed methods evaluations sensitive to rural contexts, long-term equity-oriented financing mechanisms, and strengthened organizational readiness to support effective DHT uptake.
Infectious diseases of povertyJiao-Jiao Li, Mei-Lan Fu, Lingyun-Fei Kong, Zi-Yu Zhao, Okugbe Ebiotubo Ohore, Robert Bergquist, Marcel Tanner, Guo-Jing Yang
BACKGROUND: Evidence increasingly shows close, bidirectional links between infectious diseases (IDs) and non-communicable diseases (NCDs). However, research, health policy, and prevention practices still largely address them in separate frameworks. This scoping review summarises the current evidence on the interconnections between IDs and NCDs and explores integrated strategies for their prevention and management. METHODS: This scoping review systematically searched PubMed, Web of Science, and Scopus for English-language systematic reviews and meta-analyses published between Jan 1, 2000, and April 20, 2026. Two reviewers independently screened eligible studies and extracted effect estimates for associations between IDs and NCDs. Evidence was grouped into two themes: associations between infectious agents and cancer, and the effects of NCDs on susceptibility to or severity of IDs. RESULTS: From 5799 records identified, 41 meta-analyses or systematic reviews met the inclusion criteria. The included reviews showed associations between pathogen infections and specific cancers, including hepatitis B and C virus infections with liver cancer, human papillomavirus infection with cervical cancer, and Helicobacter pylori infection with gastric cancer. IDs were also associated with an increased risk or burden of NCDs, as illustrated by the association between tuberculosis and chronic obstructive pulmonary disease. Conversely, NCDs could affect susceptibility to and outcomes of IDs; patients with diabetes or cardiovascular disease had higher risks of severe disease or adverse outcomes following tuberculosis, influenza, or COVID-19 infection. CONCLUSION: IDs and NCDs can interact through shared mechanisms, overlapping risk factors, and bidirectional pathways, underscoring the need for integrated strategies that combine prevention, early detection, treatment, and long-term management. At the public health level, this calls for health policies and financing mechanisms to move beyond disease-specific silos towards systemic frameworks that support integrated prevention and control, coordinated management, and cross-sectoral action.
Global health actionGudani G Mukoma, Lisa K Micklesfield, Estelle D Watson, Shane A Norris
BACKGROUND: Non-communicable diseases (NCDs) disproportionately affect rural South Africans due to limited healthcare access and delayed diagnoses. Biokineticists, experts in clinical exercise therapy, can aid in the early detection and prevention of NCDs, but their integration into primary healthcare remains limited. OBJECTIVE: To explore Biokineticists' perspectives on their role in early NCD detection and prevention in rural South Africa, along with health-system factors affecting their integration into public primary healthcare. METHODS: An interpretivist qualitative study using semi-structured interviews was conducted with 10 purposively selected Health Professions Council of South Africa (HPCSA)-registered Biokineticists (6 female, 4 male; median age 34; median 10 years' practice experience). Interviews explored screening, health promotion, referrals, interprofessional collaboration, and systemic barriers. Sessions were recorded, transcribed, and analysed using Braun and Clarke's thematic analysis. RESULTS: Four interconnected domains were identified: (1) professional identity and recognition, (2) screening and early-detection practices, (3) community-based prevention and management, and (4) structural barriers and integration opportunities. Participants conducted screenings, exercise-based interventions, and health promotion activities, but faced fragmented referral pathways, low awareness of Biokinetics, limited visibility, and financial and geographic barriers affecting rural access. While participants viewed Biokineticists as capable contributors to NCD prevention and early detection, systemic issues, including weak integration into primary healthcare and the National Health Insurance framework (NHI), hindered continuity of care. Conclusion: Biokineticists are an underused allied-health resource with the potential to strengthen early detection and prevention of NCDs in rural primary care settings; addressing structural and policy barriers is crucial for their integration into primary care.