CONTRIBUTORS: Jenny Proimos, MB BS, MPH, FRACP,a,b and Jonathan D.
Klein, MD, MPH, FAAPc,d
a
Department of Pediatrics, University of Melbourne, Centre for Adolescent
Health, Royal Children’s Hospital, Parkville, Victoria, Australia; bVictoria
Department of Education and Early Childhood Development, Victoria, Australia;
c
American Academy of Pediatrics, Elk Grove Village, Illinois; and dUniversity of
Rochester School of Medicine, Rochester, New York
Dr Proimos is a member and Dr Klein is chair of the International Pediatric
Association Technical Advisory Group on Noncommunicable Diseases. The
International Pediatric Association is a nongovernmental organization of 144
national, regional, and international specialty pediatric societies.
Accepted for publication Jun 4, 2012
ABBREVIATION
NCD—noncommunicable disease
doi:10.1542/peds.2012-1475
Noncommunicable Diseases in Children and
Adolescents
We have made great progress in
preventing and managing communicable diseases worldwide. Noncommunicable diseases (NCDs), which
result from noninfectious and nontransmissible factors, are often
caused by factors that are modifiable.
Children are the frequent victims of
air pollution and behaviors such as
tobacco use, physical inactivity, and
unhealthy diets leading to the development of the NCDs discussed in
this global health perspectives commentary. The worldwide burden of
NCDs is enormous, actually accounting for the majority of all deaths.
Risk factors such as high blood
pressure, raised cholesterol, tobacco
use, alcohol consumption, and overweight coupled with poor economic
and social conditions create a perfect storm for many of the world’s
chronic illnesses diseases. Drs Proimos
and Klein bring new focus to
the pediatric perspective and suggest an approach to developing
strategies internationally to combat
PEDIATRICS Volume 130, Number 3, September 2012
these most common health issues of
our time.
—Jay E. Berkelhamer, MD
Editor, Global Health Perspectives
Recent global attention has focused on
NCDs and their impact on global morbidity and mortality. NCDs are medical
conditions or diseases that are nontransmissible and often enduring. Of
the 57 million deaths worldwide in 2008,
NCDs accounted for 36 million, mainly
due to cardiovascular disease, cancers,
diabetes, and chronic lung diseases.1
Eighty percent of NCD deaths occur in
low and middle income countries.2
NCDs often result from modifiable lifestyle risk factors, such as tobacco use,
problem alcohol use, unhealthy diet, and
lack of physical activity, leading to
overweight, raised blood pressure, and
cholesterol. Left unchecked, NCDs will
continue to lower global productivity,
threaten quality of life, and cost trillions
of dollars.3 Systematic efforts to prevent
NCDs, and ameliorate their burden, are
now part of a global health strategy.4
In September 2011, the United Nations
General Assembly declaration on prevention and control of NCDs first acknowledged the increasing impact of
NCDs on children and adolescents and
recognized the need to protect them
from NCDs.5
CHILDREN AND ADOLESCENTS ARE
HEAVILY IMPACTED BY NCDS
• 1.2 million children and youth under
age 20 died of NCDs in 20026
• More than 25% of obese adolescents
have signs of diabetes by age 157
• Despite improvements in survival for
some childhood cancers,8 survival is
much lower in resource-poor countries
• 90% of the 1 million children born
each year with congenital heart disease live in areas without adequate
medical care9
• Tobacco smoke causes asthma, otitis, and respiratory infections in
children10
379
• Mental health disorders,11 motor
vehicle trauma, homicide, and suicide12 cause significant morbidity
and mortality in children and
youth
RISK FACTORS AND BEHAVIORS
LEADING TO ADULT NCDS START IN
CHILDHOOD
Prenatal exposure to tobacco and alcohol, prematurity and low birth weight,
nutritional deficiency, 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.13 It is important to focus
on prenatal care, healthy nutrition in
pregnancy, and breastfeeding. Safe
deliveries, effective resuscitation, and
postnatal care with adequate immunizations and safe, smoke-free environments also help prevent the burden of
chronic care for children and their
families.
The onset of risk behaviors predisposing to NCDs often occurs in children and adolescents. Globally, 100 000
young people start smoking each
day,14 and over 90% of adults who
smoke started as children or youth.15
Adolescent alcohol consumption is common, risking brain development, nonintentional injury and violence, and alcohol
dependence in adulthood.16,17 Overweight
and obesity are increasing in high-income
countries and in low- and middleincome countries,10,18 with increased
risk of diabetes and cardiovascular
disease.19
A life course approach to preventive
efforts addressing NCDs and their risk
factors and behaviors will improve
child and adolescent health but also
decrease lifetime health care costs.20
This approach recognizes that adult
health and disease risk develops early
in life and can affect disease states
and risks across generations.20 Vaccinepreventable NCD programs (eg, human
380
PROIMOS and KLEIN
papilloma virus and hepatitis B) are
examples of effective primary prevention that have successfully mobilized international resources to help
the world’s poorest countries.21 NCD
efforts must collaborate with maternal,
newborn, and child health systems
to achieve efficiency and effectiveness and must also address the
social determinants of health and
disease. This includes promoting education, which benefits both lifestyle
choices and health outcomes, and
also community productivity and
social stability.22 Living conditions, air
and water pollution, and adequate
sanitation and open spaces all should
be considered by governments in
developing policies to promote child
health.
Strengthening child and adolescent
health systems is essential if low- and
middle-income countries are to develop comprehensive approaches
to prevention and management of
NCDs. Comprehensive family centered
“medical home” based care systems
(www.medicalhomeinfo.org), integrating primary care for children and
youth with community public health
systems, are a useful model for a
comprehensive, multilevel approach to
NCD prevention and management. Increasingly, young people themselves
have also been engaged as active participants in promoting community
health and social services that meet
their needs.23
The United Nations global strategy
calls for comprehensive monitoring of
trends and progress in implementation
of national plans and recommendations
for voluntary global targets for prevention and control of NCDs.24,25 Monitoring is crucial to inform policy;
however, many countries do not collect comparable mortality and NCD
data.26 Only one-third of the world’s
population lives in areas where births
and deaths are accurately registered.
Advocacy for child and adolescent
NCD efforts must encourage countries to develop and implement effective monitoring and surveillance
systems. Advocacy is also needed to
ensure that child and adolescent
health targets are included in the
monitoring framework and targets
being set by the United Nations for
NCDs. The International Pediatric Association, American Academy of Pediatrics, and other national pediatric
societies have called on countries to
pay specific attention to children and
adolescents in developing national tobacco, alcohol, mental health, chronic
illness, nutrition and physical activity,
and reproductive health goals. A broad
coalition of family advocates and clinical groups, the NCD Child Network,
has also called on the global community to (1) focus attention on NCDs
in children and adolescents, (2) advance policies and interventions that
ensure maternal and child health systems become engaged in development
of NCD prevention and management,
and (3) assist nations in addressing a
life-course approach to the prevention
and management of NCDs among children and adolescents at all levels of
the health care system.27
CONCLUSIONS
Childhood and adolescence are crucial
times for the prevention of NCDs. A lifecourse approach to prevention, diagnosis, and management may result
in significant gains in health outcomes,
global productivity, and health care
savings. Measuring progress in health
outcome trends is a first step to being
able to monitor the impact of NCD
prevention. Advocacy by child health
leaders for equitable inclusion of
children and adolescents in NCD goals
by countries is critically needed to
ensure that countries’ NCD efforts include support for child and adolescent health.
PEDIATRICS PERSPECTIVES
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FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
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