The Role of Healthy Lifestyle Promotion, Counseling, and Follow-up in Noncommunicable Diseases Prevention

In recent years, various factors, including economy, education, food security and access to proper healthcare and immunization programs, have led to unhealthy behaviours, inappropriate diets and a sedentary lifestyle, which have favored the development of noncommunicable diseases (NCDs). This term, often also referred to as “chronic diseases”, describes medical conditions or diseases that are noninfectious, of long duration, generally characterized by slow progression (Pop et al., 2019) and are the result of a combination of genetic, physiological, environmental and behavioural factors (WHO, 2014). The World Health Organization (WHO) statistics report that NCDs kill 41 million people each year, equivalent to 71% of all deaths globally (WHO, 2014).

The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes. Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.0 million), respiratory diseases (3.9 million), and diabetes (1.6 million) (WHO, 2014).

Modifiable behaviours, such as tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol, all increase the risk of NCDs (WHO, 2014). Metabolic risk factors contribute to four key metabolic changes that increase the risk of NCDs: hypertension, overweight/obesity, hyperglycemia and hyperlipidemia. In terms of attributable deaths, the leading metabolic risk factor globally is elevated blood pressure, followed by overweight and obesity and raised blood glucose (WHO, 2014).

Although NCDs have their major impact on global mortality and morbidity in adulthood, statistics show a significant impact of NCDs on children and adolescent. This is the main reason why the working group on social pediatrics and public health of the European Paediatric Association, the Union of National European Paediatric Societies and Associations, is actively engaged in contrasting the expansion of NCDs through the promotion of preventive program. The object is to further raise the attention of healthcare professionals worldwide about the importance of healthy lifestyle promotion, counseling, and follow-up in the prevention of NCDs during developmental years (Pop et al., 2019).

Children are particularly vulnerable to NCDs. The causes of obesity are complex and based on several elements, including genetic and physiological factors, eating and physical activity habits, and growth patterns in early life, all influenced by a variety of social determinants. Well-designed and planned preventive programs are the primary measures to combat overweight and obesity, through targeting their related risk factors in children and adolescents. Alcohol, drug abuse, and tobacco are also also widely recognized to be important risk factors exposing children to NCDs. Most people who smoke or use tobacco products began at young age, and teens who use tobacco and/or alcohol are more likely to use drugs (Pop et al., 2019). It is thought that parental tobacco and alcohol use compromises the physical and mental health of children in three ways: 1) direct exposure to the substances; 2) living with parents who may become ill from using these substances; and 3) children’s modeling of parental substance use. All these aspects are of great relevance for their implications for prevention, intervention, and public education (Richter et al., 2001). Health education aimed at school aged children is considered the most effective way of implementing healthy style behaviour and to decrease the risk of NCDs in adulthood (Pop et al., 2019). As a matter of fact, integrating health education efforts within core curricula classes can lead to favorable outcomes (Rajan et al., 2017).

Different adverse occurrences or conditions that children may have to face include poverty, maltreatment, chronic illness, needs of individuals from cultural minorities, or children and adolescents at risk for behavioral problems and substance abuse. Several studies have assessed children’s ability to manage their well-being and develop resilience to adapt and cope with unfavorable events. The process of developing resilience, that is the ability to cope with stressful events, in children and adolescents has progressively become of particular interest to healthcare professionals and families because of its implications for the health of children and adolescents they care for. It is in fact important for pediatric healthcare systems and structures to exhibit absorptive, adaptive, or transformational capacity in the face of challenges related to children’s health. With the combined support of healthcare professionals, families, and other social connections, including friends and the school environment, children and adolescents can appropriately overcome a condition of distress and prospectively stabilize emotionally and physiologically (Pettoello-Mantovani et al., 2019).

Some authors proposed to change the term NCDs in socially transmitted conditions (Allen et al., 2017). Most governments focus on individual lifestyle choices, and only a minority of developing countries have implemented WHO “best buys” such as tobacco taxation, salt reduction, and elimination of trans fats. It is important not to absolve individuals of all responsibility for their own health and lifestyle choices, while highlighting the fact that our changing social environment strongly influences the set of choices available. The term “socially transmitted” shifts the implied locus of action upstream. This term also provides clarity by describing the core uniting characteristic of the disease group (Allen et al., 2017).

References
Allen LN, Feigl AB. Reframing non-communicable diseases as socially transmitted conditions. Lancet Glob Health, 2017;5(7):e644–e646.
Pettoello-Mantovani M, Pop TL, Mestrovic J, et al. Fostering Resilience in Children: The Essential Role of Healthcare Professionals and Families. J Pediatr. 2019;205:298–299.e1.
Pop TL, Namazova-Baranova L, Mestrovic J, et al. The Role of Healthy Lifestyle Promotion, Counseling, and Follow-up in Noncommunicable Diseases Prevention. J Pediatr, 2019 Nov 15 [Epub ahead of print].
Rajan S, Roberts KJ, Guerra L, Pirsch M, Morrell E. Integrating Health Education in Core Curriculum Classrooms: Successes, Challenges, and Implications for Urban Middle Schools. J Sch Health, 2017;87(12):949–957.
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WHO global status report on noncommunicabile disease, 2014, 2014. Geneva: World Health Organization, 2014. https://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases . Accessed January 2020.