NCD in South Asia(cont...)

Figure 1.6 Age-adjusted prevalence of current smoking of any tobacco product among men and women 15 years old and above, South Asia

Figure 1.7 Prevalence of current smoking of any tobacco product among youth 13–15 years old, South Asia

The poor face multiple obstacles in preventing NCDs. Tobacco use rates tend to be higher among men with less or no education and tobacco expenditure among the poor frequently crowds out spending on food and education (John 2008a). Furthermore, it is among the poor where NCD risk factors (tobacco use) and infectious diseases (tuberculosis) are more common leading to worse outcomes, as already noted. For example, the risk of dying from tuberculosis is 2.3 times as high for smokers than for nonsmokers (Gupta et al. 2005; Jha et al. 2008).

Another risk factor for NCDs is low birth weight, still common in South Asia. The fetal origins hypothesis of adult diseases postulates that fetal undernutrition, as reflected by low birth weight, is associated with susceptibility to development of IHD and other chronic NCDs in later life (Barker et al. 1989). Breastfeeding practices may contribute to an increase in NCDs. A recent meta-analysis of the world’s iterature by WHO examined breastfeeding practices associated with important NCD outcomes. Allowing for methodological difficulties, this review concluded that infants who were breastfed had lower mean blood pressure and cholesterol, and better performance on intelligence tests later in life.

This regional pattern of a similar NCD risk factor burden with a variable country disease burden occurs for two related reasons. First, the period between risk factor exposure and its related morbidity/mortality is long, especially compared to most infectious diseases. Second, in some countries people die from other causes (infectious diseases) at younger ages before the full impact of exposure to NCD risk factors has occurred. Thus in countries where infectious diseases remain a significant cause of mortality, smokers may succumb to other causes before tobacco’s ill effects manifest themselves. By contrast, in countries with longer life expectancies and where smokers smoke for many years, the ill effects of tobacco use may ultimately cause significant morbidity or even death.