In today’s world, non-communicable diseases (NCDs) such as cancers, heart and respiratory disease, diabetes, and Alzheimer’s — to name just a few — have quietly emerged as a pandemic of silent killers to collectively become the leading cause of death worldwide. Overall according to the World Health Organization (WHO), NCDs are responsible for more than 38 million deaths a year — more than all other causes combined.

Dr. Christine Ngaruiya, an assistant professor in the section of global health and international emergency medicine at the Yale School of Medicine, is taking a leadership role to combat the grave dangers of NCDs worldwide. She was recently among a team of 25 researchers, in collaboration with the Kenya Ministry of Health, to publish a series of 10 research papers from a study on the topic. Conducted in 2015 in Kenya, the study used the WHO STEPwise tool. The publications were funded by the International Development Research Centre and facilitated by the African Population and Health Research Center (APHRC).

The papers were recently published by BMC Public Health, an open access, peer-reviewed journal that covers all aspects of public health. The study, recommended by WHO for member nations, was the first focused on NCDs in Kenya. Ngaruiya was the sole senior faculty contributor from the United States, co-authoring four of the 10 papers. 

Gladwell Gathecha, an executive from the Division of NCD in the Ministry of Health in Kenya, said undertaking the STEPS survey was a critical milestone for Kenya and forms an important part of the government’s efforts to address the increasing burden of the NCD and injuries epidemic currently affecting this nation. 

“The survey paves the way for the establishment of an NCD surveillance platform that collects baseline indicators on determinants of NCD and their risk factors for policy and planning purposes,” said Gathecha. “The collaborative efforts towards publishing the findings played an integral part in ensuring effective translation of evidence to policy and achievement of a wider audience reach.”

Catherine Kyobutungi, executive director of the APHRC agrees with Gathecha, stating that the survey was a critical first step in understanding the magnitude of NCDs in the country, providing guidance on what Kenya needs to prioritize in NCD prevention.

“We are pleased to have participated in publishing academic papers from the first-ever national STEPs survey in Kenya,” said Kyobutungi. “Kenya has been a leader in developing comprehensive NCD prevention policies, and strategies in the region and the results from the STEPs survey provide a baseline on which we can assess progress a few years from now.”

Kybobutungi said publishing these papers ensures that the world is more aware of the challenge posed by NCDs and will help ensure that organizations like APHRC respond with the urgency needed to tackle the epidemic.

“It was an honor and a privilege to be able to work with Kenya’s ministry of health and other prominent public health leaders on this critically important research study,” said Ngaruiya. “It’s only through close partnership and collaborative networking with leading organizations and experts around the world to produce studies like this that meaningful strides can be made toward forging an effective global response to the dire threat posed by NCDs.”

Ngaruiya says the vast majority of deaths from NCDs take place in low- to middle-income countries, and if drastic countermeasures aren’t taken then advances recently made to counter other public health challenges, such as the effects of communicable diseases, may be forfeited. She says in addition to the tragic personal loss, the economic loss to countries and the world overall is sure to be staggering. The United Nations has estimated that the cumulative loss NCDs pose to the global economy could surpass $47 trillion by 2030 if it doesn’t soon become a top priority for countries worldwide to tackle.

“Most NCDs affect people under the age of 60, nearly all of whom are still economically active,” said Ngaruiya. “Losing those in societies who are still making a significant contribution is simply not something most economies can afford.”

It is for this reason that Ngaruiya chose to devote so much time and effort to the study. The four papers she contributed include the following:

• Tobacco use and its determinants in the 2015 Kenya WHO STEPS survey
• Prevalence and determinants of heavy episodic drinking among adults in Kenya: analysis of the STEPwise survey, 2015
• Prevalence and predictors of injuries in Kenya: findings from the national STEPs survey
• Individual and household level factors associated with presence of multiple non-communicable disease risk factors in Kenyan adults

Ngaruiya says that in societies today the dangers posed by NCDs are often overlooked or not considered as great a priority as communicable diseases such as HIV, hepatitis, or the flu, which typically get more attention from policy makers, public health officials, and the general public.

She says the reason for this is that NCDs are inherently chronic, so the effects of interventions targeting them require a prolonged period of time before tangible positive outcomes can be seen. In many instances, even when interventions are successful, they still don’t make the diseases go away, and so it is often challenging to convince donors and politicians to invest in NCD treatment programs due to the seemingly nebulous return on investment.

“There is no such thing as a quick fix for treating NCDs, and continuous investment is necessary to make a meaningful long-term positive impact,” said Ngaruiya. “All these factors make it especially challenging to convince others to consider it a priority and to commit to the cause.”

Ngaruiya says another unique challenge posed by NCDs is that because such diseases are so slow to develop they often go unnoticed until complications arise, and it is too late or extremely costly to administer effective treatment.

Also, societal trends further complicate and compound the challenges posed by NCDs. In particular, urbanization significantly contributes to the growth of NCDs. Urbanization occurs when people increasingly move from rural areas into cities and towns where they have a better chance of finding employment, which is increasingly the case in developing nations like Kenya.  This trend contributes to the rise in NCDs because people are exposed more frequently to richer, potentially unhealthy food and diets, and have fewer opportunities for exercise and physical activity. These lifestyle changes are made worse by increased exposure to pollution in cities, and harmful work environments, all of which expedite progression to the development of NCDs.

Being Kenyan-American, with most of her extended family still living in East Africa, Ngaruiya has experienced firsthand the devastating effects NCDs have on families. In the past decade, she has lost two family members to diabetes, a grandmother to heart disease, and a close friend to brain cancer, and her mother is a two-time cancer survivor.

“It’s simply devastating to lose close friends and family to any disease, but especially diseases that can be defeated through early prevention and treatment,” said Ngaruiya. “What makes it even worse, beyond the emotional trauma of losing loved ones, is the tremendous economic impact it poses to society and the world overall.”

It is for this reason that international organizations have increasingly stepped up to prioritize NCDs and highlight the devastating effects changes aren’t made. At the forefront of these efforts is WHO, an organization that has hosted several high-level meetings focused on NCDs over the past decade. The third most recent meeting happened in 2018 under the new leadership of Dr. Tedros Adhanom Ghebreyesus, the current director-general of the WHO.

Immediately following the 2018 NCD meeting, Tedros quickly convened a new independent high-level commission on NCDs, comprising government leaders and global public health experts from around the world whose mandate is to identify bold recommendations to combat and curb the danger NCDs pose to the world. One of the first actions taken by the group was to commission “Time to Deliver,” a report providing recommendations on how countries can prevent and treat NCDs to promote enhanced mental health and well-being worldwide.

Still another effort undertaken to combat NCDs is WHO’s establishment of “Sustainable Development Goals; 17 Goals to Transform our World (SDGs).”  The SDGs call for all countries to partner to protect the world by implementing strategies to address a wide range of social needs and challenges including combating NCDs.

 “The work of this study highlights the importance of a strong academic push in the Kenya/ African setting with primary data,” said Ngaruiya. “Only when scientists perform such studies can public health can be advanced and meaningful change realized.”

Go here to access all 10 of the research papers comprising the Kenya WHO STEPS 2015 study.