NCDs vs. Infectious Disease: It's not always one or the other...

Last week in class we discussed non-communicable and communicable diseases and at several points compared which was more threatening and which was harder to deal with globally.  While it may seem easy to lump the two into separate categories, we must not forget that “health” is no simple topic; the interdependence of morbidities, geographies, and lifestyles cannot be ignored. 

A very poignant and current example of what I am talking about is the threat of a new multi-drug resistant mycobacterium infection that poses a deadly threat to cystic fibrosis (CF) patients.  I actually heard about this outbreak because a childhood friend of mine who suffers from CF posted it to her Facebook wall.  CF is a devastating hereditary chronic disease affecting the linings of mucus membranes, leading to complications with the lungs, gastrointestinal tract, liver, and more; life expectancy is now close to 40 years, but as recently as the 1950’s children rarely lived past age 7-8 (www.cff.org).  Living to the age of 40 with CF is accomplished with a regiment of breathing treatments, nutritional supplements, and other medications, but infection can take a devastating toll, especially because of the thickened mucus inside the lungs that can harbor life-threatening bacteria, as is the case with this new outbreak.  Emerging research shows that patient-to-patient transmission is occurring (previously thought to be only environment-to-patient), which is very dangerous for the CF community who seek treatment at shared facilities dedicated to the disease; this strain is especially concerning because it is transmissible through infected surfaces and air, leading to some CF treatment facilities adopting plans for controlled air management systems (www.cam.ac.uk).  And to make matters worse, global spread appears to have begun with cases in Northern Europe, the United States, and Australia (parts of the world where CF is most common).  This spread speaks to the importance of horizontal germ governance in many epidemics of the developed world, because even though hospital treatment would be available to most people who contract the infection, its multi-drug resistance means that even when treatment is available it may not be enough – only 1 in 3 cases is treated successfully, and this requires 18 months of a rigorous antibiotic regimen (www.cam.ac.uk).  Comparatively, vertical germ governance seems to apply more in situations where local systems require significant strengthening to be able to properly handle easier-to-treat infections, as well as NCDs. 

So the discussion is not really NCDs vs infectious disease.  As I mentioned in class last week, there may be an infectious component to the spread of lifestyles leading to NCDs, and as this particular mycobacterial infection indicates, patients do not suffer from one or the other; CF and some other NCDs can increase risk of infectious disease, too.  Health must be approached holistically; how do environment, pathogens, lifestyle, SES, geography, and other risk factors all combine to contribute to international health issues, and how can we seek to mitigate their impact?  The wide range of topics covered in this class is really helping me put all of this together and see not a set of health problems but rather a web of factors capable of influencing, and being influenced by, each other.

Sources:

http://www.cam.ac.uk/research/news/multi-drug-resistant-infection-spreading-globally-among-cystic-fibrosis-patients

https://www.cff.org/What-is-CF/About-Cystic-Fibrosis/