Non-communicable diseases and risk factors

Doc Brown's Biology Revision Notes

Suitable for GCSE/IGCSE/O level Biology/Science courses or equivalent

 This page will help you answer questions such as ...

 What is a non-communicable disease?

 Describe some examples on non-communicable diseases.

 Explain some life-style risk factors associated with cancer.

 See also communicable diseases  and  plant diseases

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Introduction to non-communicable diseases

Health is the state of an organism's well-being - physical or mental, but ill health is where there is a problem including suffering from some disease.

The World Health Organisation defines heath as "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity".

So, even if you are a very fit person, you are not necessarily healthy e.g. if you had mental health issues and/or lonely.

A disease is a medical condition where part of an organism (plant or animal) isn't functioning properly - in some way the organism is not as it should be.

The disease may take the form of cell damage to the host (plant or animal) which in some way impairs the healthy ('normal') structures or functions of the organism.

Most organisms, including ourselves, experience ill health at some point in their life.

If you have an increased chance of contracting a disease you are described as susceptible.

There are many causes of ill health in plants and animals e.g.

infection from a pathogen eg flue, malaria, salmonella,

mutation in an organism's genes (DNA) eg cancers,

an organism might suffer some deficiency eg lack of vitamins in human diet, lack of light on plant growth

an organism may experience mental or physical trauma triggered by some event eg depression, bereavement, serious accident,

the lifestyle of an organism can have consequences on your health eg links between: smoking and lung cancer, too much sugary/fatty food and obesity and/or diabetes,

All diseases show symptoms at some point in their development.

Symptoms are indications of disease in an organism - usually observable eg cough, rash, diarrhoea, leaf discolouration etc.

Sometimes symptoms do not show up immediately after infection - the virus or bacteria may multiply for days or weeks when sufficient of the pathogen is present to create visible symptoms.

This period of infection without symptoms is called the incubation period and may last hours, days, weeks or months - which is a bit scary, because you can't apply medical treatment to a medical condition you don't know you've got!

There are two sorts of diseases - communicable and non-communicable.

Communicable diseases are spread between individual organisms - animals and people or person to person.

See  communicable diseases  and  plant diseases

Non-communicable diseases cannot be transmitted between individual organisms e.g. cancer, diabetes, heart diseases (eg cardiovascular) or respiratory diseases of the lung.

These cannot be spread from person to person or between animals and people.

They tend to last for a long time and slowly get worse over time, in the case of 'humans' they can be often linked to our lifestyles.

Examples are asthma, cancer and heart diseases.

If you are suffering from one disease, your bodies defences may be weakened by it making you more susceptible to another disease - a 'knock on' effect reducing your body's ability to fight off a second disease.


Examples of risk factors for non-communicable diseases and how different types of disease can interact

Just a few general points as a 2nd introduction to non-communicable diseases - including when diseases coincide and cause other medical situations - physical conditions or mental health issues.

Risk factors are anything that can be associated with an increase in likelihood of developing a non-communicable disease, but that doesn't been you will automatically contract the disease!

They can be often related to a person's lifestyle or whether they are exposed to a pollutant in the environment or place of work - air pollution has always been linked with bronchial and lung diseases including asthma.

Age or gender

Certain medical conditions become more likely to older you get - e.g. arthritis or Alzheimer's disease - these are unavoidable as the body ages, but susceptibility varies from one individual to another.

Males and females have different susceptibilities to certain non-communicable diseases.

Alcohol - a lifestyle choice

Too much a in your alcohol in your diet can cause liver damage e.g. cirrhosis of the liver (scarring of the live). This happens because alcohol is broken down by enzymes in the liver and some of the products of this process are toxic. With excessive drinking over a long period time results in permanent liver damage - in some cases a liver transplant is required to keep the person alive - needs a donor - may not be available.

Heavy drinking can affect brain function, nerve cells are damaged and brain volume decreases.

When pregnant women drink to much alcohol there is an increased risk of health problems for an unborn baby.

Genetics

Quite a few diseases can be linked to genetic factors - what we become from our inherited genes.

Unfortunately, you can inherit faulty genes that make a person more susceptible to cancer.

e.g. mutations to the BRCA genes have been linked to increased chance of women developing breast cancer or ovarian cancer.

Immune system responses

The presence of a pathogen infection in your body can trigger an allergic reaction from your immune system e.g. asthma sufferers experience more intense symptoms or skin rashes.

Lifestyle choices and your personal situation

Diet

Eating a good balanced healthy diet helps maintain your body in good shape and your immune system to fight communicable disease infections and reduce the risk of contracting non-communicable diseases such as cardiovascular disease and cancers.

The poorer you diet, the more susceptible you are to these kinds of diseases and mental health issues.

Eating a balanced nutritious diet, not too high in fats and sugars, plenty of minerals and vitamins from whole grains, fruit and vegetables.

Smoking - completely avoidable to reduce your chance of developing lung cancer.

BUT, smoking is now linked to (i) cardiovascular disease and (ii) lung diseases including cancer. Substances in tobacco smoke cause damage to

(i) Nicotine in cigarette smoke increases heart rate which increases blood pressure - increasing the chance of a heart attack, stroke or blood clot formation. Increased blood pressure damages the walls of arteries which contributes to the build up of fatty deposits on the walls of the arteries - leading to heart disease and circulation problems which further increase the risk of a stroke or heart attack.

(ii) the cells in the lining of the lungs can be coated in tar (which also contains carcinogens) - leading to various serious lung conditions - breathing problems Inefficient oxygen intake), mutations of lung cells to form tumours which can become cancerous.  

When pregnant women smoke there is an increased risk of health problems for an unborn baby.

Access to your needs?

Malnutrition means lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat.

Usually no problem in rich developed countries - your choices, BUT not so for people living in poorer underdeveloped countries.

e.g. to help prevent or reduce the risk of non-communicable diseases in the first place - an you afford to buy healthy food? Is 'healthy shopping' readily available?

If you have contracted a non-communicable disease, do you have access to appropriate medicines?

Perhaps surprisingly?, non-communicable diseases are more likely with people of higher income in developed countries because they can afford to buy richer food higher e.g. in saturated fats - obesity related.

However, ALSO, people from poorer areas are poor likely to have a poorer diet (not balanced) and exercise less. Therefore in deprived areas, you find higher rates of cardiovascular disease, obesity, type 2 diabetes due to less healthy lifestyles.

Statistics and a note of caution!

Medical scientist do their best correlate data connecting risk factors with disease incidence.

However, correlation doesn't simply mean you can relate incidence to cause.

Just because you eat a poor diet and have little exercise doesn't mean to say you automatically get e.g. cardiovascular disease (CVD).

Your diet and lack of exercise does not cause CVD directly. What these two factors cause is high blood pressure and increase in the blood levels of bad LDL cholesterol - and it is these which actually cause the CVD.

Mental health and stress

If can develop a mental health condition such as depression while enduring some physical health problem e.g. lack of mobility reducing your ability to participate fully in everyday life. If you are constantly under mental stress e.g. 'high-powered' job or caring for a very sick relative, then your physical well-being can be affected - ulcers can develop or a mental health condition like extreme anxiety - both of which are non-communicable.

Obesity

Poor diet and 'over-eating' lead to excess weight in the body - obesity!

This increases your susceptibility to type 2 diabetes when your body is less responsive to your own insulin and reduced control of blood sugar levels - which can be very dangerous.

Obesity can also affect your breathing - reduces your respiratory function.

Obesity is a risk factor in other non-communicable diseases e.g. cardiovascular disease and type 2 diabetes.

Viral infection

Some types of cancer are triggered by particular viral infections.

This is a communicable disease causing the development of a non-communicable disease.

 


Examples of non-communicable diseases and risk factors


Cardiovascular disease

I've discussed this in detail on

The human circulatory system - including the causes and treatment of cardiovascular disease


Cancer - many types and many risk factors!

What is cancer?

Cancer is caused by some genetic fault or change e.g. caused by a mutation, that leads to uncontrolled growth by cell division.

The extra mass of cells formed is called a tumour.

Tumours can be benign (non-cancerous) and not usually dangerous, or malignant (cancerous) which are potentially very harmful.

Benign tumours grow and fill the space available. The benign tumour stays in one place e.g. in a membrane and doesn't invade other tissues of the body. Benign tumours are not cancerous are not usually harmful or dangerous to the body.

Malignant tumours keep growing and spread to neighbouring healthy tissue. Malignant cells can break away and spread to other parts of the body in the bloodstream. The same malignant cells can then invade healthy tissue and form secondary tumours in other parts of the body. Therefore malignant tumours are highly dangerous forming potentially fatal cancers.

 

Risk factors associated with types of cancer

A large proportion of our ever increasing aging population will eventually suffer from cancer.

We can get a cancer at any stage in our life, though as we get older our defensive immune system does decline in response to threats.

Cancer survival rates are continually increasing, particularly in richer developed countries with their comprehensive health care services, including early diagnosis from screening programmes and improved anti-cancer treatments.

Carcinogens

A carcinogen is defined as a substance capable of causing cancer in living tissue - usually a chemical that promotes changes in the structure and working of cell DNA.

Sheets of the mineral asbestos were widely used in housing and factories for thermal insulation. Unfortunately, very fine asbestos fibres build up in the air passages of lungs. All forms of asbestos increase the risk of lung disease. The three types of asbestos-related lung disease are scarring (asbestosis), non-cancerous disease of the tissue of the lining of the surface of the lung (pleural disease), and lung cancer (of the lungs or their outer lining tissue - mesothelioma).

Several molecules in tobacco tar are carcinogenic, which you breathe down into your lungs when smoking.

Genetics - inheritance and mutations

Unfortunately, you can inherit faulty genes that make a person more susceptible to cancer. Mutations in the BRCA genes have been linked to increased chance of women developing breast cancer or ovarian cancer - a good reason and argument for cancer screening programmes e.g. cervical smear test for cervical cancer or x-ray screening for breast cancer.

Ionising radiation

Exposure to ionising radiation - uv, x-ray or gamma radiations, causes cell damage leading to cancer.

Ionising radiation is therefore described as carcinogenic.

Obesity

Obesity - being overweight, is now being linked to cancers of the bowel, kidney and liver.

Apparently, statistically, it is the 2nd biggest preventable cause of cancer, the 1st is smoking!

doc b oil notesSmoking (see also carcinogens)

Giving up smoking, is a lifestyle choice to reduce your chance of developing lung cancer.

Statistically, stopping smoking is the biggest preventable cause of cancer.

There is clear evidence of a link between smoking and contracting lung cancer.

(Its a 'no-brainer' for me, and admit to smoking cheap nasty cigarettes from the age of 11 to 27!).

However, that's not the only cancer risk from smoking - it is being linked cancers in the cervix, bowel, mouth and stomach.

Ultraviolet light (uv)

The more uv light you are exposed too, including bright sunlight, the greater the chance developing skin cancer - uv damages skin cells including burns or causing mutations in the skin cell DNA.

Frequent users of sun beds are also increasing their risk of skin damage - the lamps emit uv radiation which can cause DNA damage leading to cancer.

People who work outside or live in particularly sunny climates, are at higher risk - though evolution has allowed many people to have developed extra melanin in their skin to increase uv protection - that's why so many people in sunny areas like Africa have a much darker skin than many northern Europeans.

Fair-skinned should use sun-blockers to protect their skin in bright sunlight.

Virus

Some types of cancer are triggered by particular viral infections. This is a communicable disease causing an increase in the likelihood of developing a non-communicable disease.

The hepatitis virus (hepatitis B and C strains) causes long-term infections in the liver where it inhabits the cells. This gives you an increased chance of developing liver cancer.

The chance of becoming infected with this communicable disease can depend on your lifestyle e.g. contracting hepatitis during unprotected sex or drug users sharing a needle.

The human papillomavirus (HPV) is a virus that can infect the human reproductive system. It is thought that most cases of cervical cancer arise from HPV infections - one disease causes another.

 


AND, what are the human and financial costs of non-communicable diseases?

Millions of people die around the world every year from non-communicable diseases.

Non-communicable diseases decrease quality of life and life expectancy.

But, it isn't just the sufferers who are affected, but friends and family too.

There will be emotional strains and possibly financial strain too if the affected person is unable to work, reducing the family income. Homes may need to adapted if mobility is a problem.

There is also the extra burden and costs to health services - costs of providing the medical care and research into treating non-communicable medical conditions.

There are other costs too - if still in employment but unable to work properly for longer periods of time - the employer and ultimately the country has to bear the cost of reduced productivity in the workforce as a whole.

Millions of 'working days' are lost as a result of people with non-communicable diseases - and, as we have discussed, many of them are preventable, or there effects reduced, by thinking carefully and acting to adopt a more healthy lifestyle.

Non-communicable diseases are most common in the poorest areas, even in a rich developed country.

Here you find the greater levels of excessive alcohol consumption, obesity, poorer diet and smoking in the population. Not surprising in these same areas you find higher incidences of non-communicable diseases like cardiovascular diseases, liver disease or lung conditions.

This puts extra pressure on local health services.

 


Appendix 1 Measures of obesity  (one measure of healthiness and well-being)

Introduction

There is no such thing as the 'perfect weight', we come in all shapes and sizes, but there are limits within which we should be to be healthy!

In the medical profession, a doctor can't just simply that somebody is overweight, without reference to some kind of statistical index, usually by one/both of the ratios described below.

Equally healthy people can have quite different weights, but there are some reasonably good indicators as to when your weight is not what it should be 'ideally'.

In rich developed countries we are often dealing with 'overweight' people eating too much rich fatty food, but in poorer underdeveloped countries we are dealing 'underweight' people, particularly young children suffering from malnutrition.

Malnutrition means lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat.

The Body Mass Index

The body mass index is a 'rough' guide to help the medical profession decide whether is underweight, normal, overweight or obese.

The higher your BMI the more fat you are carrying - but not necessarily unhealthily.

Body Mass Index (BMI) = (body mass in kg) / (height in m)2

When measured, you then consult a table of BMI values to se where you fit in!

Table of BMI (values (from https://www.vertex42.com/ExcelTemplates/bmi-chart.html)

Body mass index Weight description
less than 18.5 underweight
18.5 to 24.9 normal
25.0 to 29.9 overweight
30.0 to 40.0 moderately obese
over 40.0 very obese

If you eat too much fatty sugary foods and don't take enough exercise, most people will put on weight and too much of it. You are taking in too much energy rich food for your daily needs.

The excess energy releasing food is stored as fat and gives you a raised BMI value.

Having a higher than normal BMI value increases your risk of developing type 2 diabetes.

Note of caution: Having a high BMI is not always unhealthy e.g. athletes train hard to build up extra muscle which is heavier than fat, so they will tend to have higher than 'normal' BMI values and would not be classed as overweight.

The waist-to-hip ratio

Comparing the circumferences of waist and hips is another measure of whether you are 'overweight' and concentrates around one area where we can accumulate to much fat.

waist-to-hip ratio = circumference of waist (cm) / circumference of hips (cm)

The higher your waist-to-hip ratio the more fatty tissue you are carrying around the middle of your body.

When measured, you then consult a table of BMI values to se where you fit in!

Table of   (from https://www.healthline.com/health/waist-to-hip-ratio)

Health risk waist-to-hip ratio (women) waist-to-hip ratio (men
low less than 0.81 less than 0.96
moderate 0.81 to 0.85 0.96 to 1.00
high (overweight) over 0.86 over 1.00

If you are female and your waist-to-hip ratio is over 0.86 you are classed as overweight.

If you are male and your waist-to-hip ratio is over 1.00 you are classed as overweight.

If you are above the moderate waist-to-hip ratio values you are carrying too much fat around your 'middle' - referred to as abdominal obesity.

Having a higher than normal waist-to-hip ratio increases your risk of developing type 2 diabetes.


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