Opinion – Saúde em Público: Looking to the future: the impact of the pandemic on non-communicable chronic diseases

Worldwide, according to the World Health Organization (WHO), 7 out of 10 deaths are caused by chronic noncommunicable diseases (NCDs) such as cancer, diabetes, cardiovascular and chronic respiratory diseases. These diseases represent one of the main public health challenges in many countries around the world. It is no different in Brazil: around 70% of deaths are caused by CNCDs and their complications.

The Covid-19 pandemic had a significant impact on the NCD scenario in the country. According to the findings of Covitel (Telephone Survey of Risk Factors for Chronic Noncommunicable Diseases in Times of Pandemic) the global health crisis has contributed to an increase in unhealthy habits in the Brazilian population, worsening several indicators related to risk factors for DCNT.

The survey, developed by Vital Strategies, a global public health organization, and by the Federal University of Pelotas (UFPel), based on the articulation and financing of Umane and co-financing of the Ibirapitanga Institute, reveals an increase in some risk behaviors among Brazilian men and women . Between the pre-pandemic period and the first quarter of 2022, consumption of vegetables fell by 12.5% ​​in the general population. What also declined was the practice of physical activity, with a 21.4% reduction in the proportion of people who meet the WHO recommendation (150 minutes per week).

Covitel also found that 20.6% of Brazilians had consumed alcohol abusively in the month prior to the survey (four doses or more for women and five doses or more for men on a single occasion). And, moreover, it attested that other indices that had been improving in recent years, such as smoking, had their positive trend interrupted, remaining stagnant.

In a context in which many habits of the population have deteriorated, the survey showed that there was no statistically significant increase in medical diagnoses of hypertension and diabetes in the period of analysis. But, contrary to what it may seem, this is not necessarily positive news. This stability may be linked to lower access to medical diagnosis during the period of social isolation. With attention directed towards health emergencies, care for non-communicable chronic diseases was less prioritized, increasing the difficulties in accessing new diagnoses and timely treatments.

These data show the legacy that the pandemic has left for chronic noncommunicable diseases, bringing a double challenge: 1) the reversal of the worsening of the population’s habits, demanding investment in health promotion policies and actions; 2) the system’s ability to proactively deal with a pent-up demand for diagnoses and treatments for hypertension and diabetes that were not delivered in a timely manner.

And these two priorities have to go hand in hand. The relationship between unhealthy habits and hypertension, for example, becomes even clearer when we delve deeper into Covitel data: of those diagnosed with hypertension, 22.7% smoked in the 1st quarter of 2022, while in the general population this prevalence is 12.5%. When talking about a healthy eating marker, 25.7% of people with hypertension reported consuming vegetables five or more times a week, against 39.5% of the total population. Indicators related to physical activity, alcohol consumption and prevalence of obesity are also worse in the population with hypertension. And those who also go hand in hand are the NCDs themselves: 68.1% of people with hypertension also have a diagnosis of diabetes, that is, seven times more than that seen in the total population (9.3%).

Just as health promotion actions are urgent, it is essential that the health system is structurally and financially prepared to deal with these patients who have not received adequate diagnosis and treatment, and may often arrive with greater complications at the health services. . A recent study shows that currently, the economic costs generated by CNCDs are already very heavy. The costs attributed to overweight and obesity in the Unified Health System (SUS) reach US$ 654 million. Cardiovascular diseases had the highest attributable costs (US$ 289 million), followed by chronic respiratory diseases, with a cost of US$ 110 million.

Most NCDs are preventable. They are directly related to people’s living conditions, determined by access to public goods and services, guarantee of rights, access to information, employment and income, and possibilities to make choices favorable to health. Therefore, to facilitate and encourage individual changes in the habits of many Brazilian men and women, it is extremely important that there are public policies that facilitate the reduction of physical inactivity, lead to a decrease in the consumption of foods rich in sodium, sugar and fats and hinder habits such as smoking and alcohol consumption. One option to reinforce this change is to increase taxation of unhealthy foods and tobacco as a way of curbing the consumption and adoption of unfavorable habits for coping with NCDs.

To reverse the impacts imposed by the pandemic on the scenario of CNCDs in Brazil and guarantee a healthier future for our population, which is even aging and will soon be mostly elderly, governments, more than ever, need to invest in building a country where healthy alternatives are facilitated in the environments where people live and coexist, making them standard choices for the population across the country.