The Basics: The Paradox of the Dual Burden – NCDs and CDs

Here’s a fictional allegory:

Thelma lives in a rural area in Tanzania. At age 5, she contracted malaria. Due to broadened availability of health services, Thelma received an artemisinin based treatment and, unlike many before her, she survived. In fact, she lived a long, healthy life.

Long enough to reach the age of 55; at which point she developed hypertension and was later diagnosed with Type 2 Diabetes Mellitus.


I write this fictional tale here, far removed from the fictional life of Thelma, at my oh-so-trendy standing desk. But fiction or not, it is a scenario that is far too real in many middle and low-income nations. The dual burden of communicable and non-communicable diseases is very real.

Communicable Diseases (CDs): An infectious disease; one transmitted from person to person. e.g. Tuberculosis

Non-Communicable Diseases (NCDs): Diseases that are not transmitted from person to person and generally bare closer relation to lifestyle factors than CDs. e.g. Coronary Heart Disease

Globally, four of the top 5 causes of death are non-communicable diseases; and the vast majority of the global population lives in low and middle-income nations. But make no mistake, the burden of malaria, HIV and other communicable and tropical diseases remains a force to be reckoned with for many national and regional health systems.

Nonetheless, the fact that four of the top 5 global causes of death are all non-communicable illnesses  is a success. It is a success because it is my opinion that the aim of improving global health is increasing the number of healthy life years for the greatest number of people.

Thus, the fact that the majority of the world’s population, including Thelma, now live long enough to develop these arguably lifestyle influenced diseases that occur both later in life and towards the end of an individuals most economically productive years, is a success.

It is vital, however, to understand that none of this is an accident. Cholera, malaria, measles and even polio have not ceased to exist, or occur. It is through consistent, vigilant monitoring, financial investment in the refinement of systems on the part of national governments and associated actors that have kept communicable diseases at bay: they occur, but they do not result in death at the same scale as they did 30 years ago.

Meanwhile, due to globalization and urbanization, amongst the advent of other factors, lifestyles have changed world over. Globally, on average, we are ALL walking less, driving more, consuming a diet higher in saturated fat, sodium and sugar, and living more sedentary lifestyles. These are just some of the many risk factors for NCDs such as Coronary Heart Disease and Type 2 Diabetes (which will no doubt be discussed at length in a future post).

Thus, the emergence of the dual burden. Malaria endemic regions need to remain vigilant in their fight against malaria and despite encouraging numbers, need to maintain funding to maintain progress. Nonetheless, this dual risk and burden mean that investment need also be made in the prevention of NCDs as well as their treatment.

Developing countries today are facing a greater burden than that faced by Europe 100 years ago with regards to Tuberculosis in Sweden and Cholera in England, for example. Today low and middle-income countries are dealing with both old and new; the ailments of the ‘poor’ and the ailments of the ‘rich’, simultaneously. Furthermore, they are dealing with larger populations, different technologies, and regulatory restrictions that the developed world didn’t have to deal with in their fight against widespread NCDs, decades ago.


It won’t be easy, but with collaboration, dedication and understanding, it will be done.


– Christiana


  1. […] these are steadily on the decrease. Indeed, in many regions, health services are dealing with the dual burdens of both communicable and non-communicable diseases. In my opinion, the threat of disease associated with inactivity is real; and with mean life […]



  2. […] I have discussed this topic at length. South Africa is a perfect example of a nation facing the dual burden of communicable and non-communicable diseases. No, malaria has been fully eradicated. But Tuberculosis is a real and verifiable risk and diabetes and COPD are equally so. […]



Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: