Dr Aung Tun

 

1. The Deadliest Threat We Do Not See

Non-communicable diseases (NCDs) are often described as silent killers because they de­velop slowly, progress quietly, and frequently remain unde­tected until serious complica­tions arise. Unlike infectious diseases, they do not spread from person to person, yet they claim more lives every year than any other group of illnesses. Cardiovascular diseases, cancers, chronic respiratory diseases, and di­abetes together account for the majority of global deaths today.

 

Globally and in Myanmar, NCDs have overtaken com­municable diseases as the leading cause of mortality. They affect people across all age groups, including those in their most productive years, undermining national devel­opment and placing heavy so­cial and economic burdens on families and health systems. Addressing NCDs is therefore not only a health priority but also a development impera­tive.

 

2. Understanding Non-Com­municable Diseases

Non-communicable diseases are chronic conditions that tend to be of long duration and often require lifelong manage­ment rather than short-term treatment. The four major groups of NCDs are cardiovas­cular diseases, such as heart attacks and stroke, cancers, chronic respiratory diseases, including chronic obstructive pulmonary disease and asth­ma, and diabetes.

 

These diseases share com­mon risk factors. Unhealthy diets, physical inactivity, to­bacco use, harmful use of al­cohol, and exposure to air pol­lution contribute significantly to their development. Over time, such behaviours lead to metabolic changes including raised blood pressure, high blood glucose levels, abnormal blood lipids, and overweight or obesity, all of which greatly increase the risk of premature death.

 

3. The Global Burden of Silent Killers

Non-communicable diseases account for nearly three-quar­ters of all deaths worldwide. A particularly alarming feature of this burden is the high pro­portion of premature deaths occurring before the age of 70. Millions of people die each year during their most produc­tive years, resulting in major economic losses and social consequences.

 

Low- and middle-income countries carry the greatest share of the global NCD bur­den. Although NCDs were once considered diseases of affluent societies, nearly three-quarters of NCD-re­lated deaths now occur in developing regions. Rapid urbanization, ageing popula­tions, changing lifestyles, and limited access to preventive and curative health services have accelerated the NCD epidemic in these countries.

 

4. Myanmar’s Growing NCD Challenge

Myanmar is experiencing the same epidemiological transi­tion seen globally. Non- com­municable diseases now ac­count for approximately 70 per cent of all deaths in the coun­try. Cardiovascular diseases, particularly heart disease and stroke, are the leading causes of NCD mortality, followed by cancers, diabetes, and chronic respiratory diseases.

 

National risk factor data from the WHO STEPwise Approach to NCD Risk Factor Surveil­lance (STEPS) highlight the scale of the problem. The My­anmar STEPS Survey (2014), conducted among adults aged 25-64 years, reported that around one in four adults had raised blood pressure, while diabetes affected more than one in ten adults. Tobacco use remains widespread, particu­larly among men, with both smoked and smokeless tobac­co contributing to increased risks of heart disease, stroke, cancer, and chronic lung dis­ease. Harmful use of alcohol and rising levels of overweight and obesity, especially in ur­ban areas, further compound the NCD burden.

 

Importantly, NCDs in Myan­mar are not confined to older age groups. A significant pro­portion of deaths occur before the age of 70, resulting in pre­mature loss of life, reduced workforce productivity, and increased household poverty due to long-term health care costs.

 

5. Risk Factors: Behavioural, Metabolic and Environmen­tal

The major risk factors for NCDs can be grouped into behavioural, metabolic, and environmental categories. Be­havioural risk factors include tobacco use, unhealthy diets high in salt, sugar and un­healthy fats, harmful use of al­cohol, and insufficient physical activity. These behaviours are strongly influenced by social norms, commercial practices, and the physical environment.

 

Behavioural risks often lead to metabolic changes such as raised blood pressure, high blood glucose, abnormal cho­lesterol levels, and overweight or obesity. Among these, ele­vated blood pressure is one of the leading contributors to NCD-related deaths globally and in Myanmar.

 

Environmental factors also play a major role. Indoor and outdoor air pollution contrib­ute significantly to cardiovas­cular diseases, stroke, chronic respiratory diseases, and lung cancer. In Myanmar, exposure to household air pollution from solid fuel use, as well as in­creasing urban air pollution, remains a major public health concern.

 

6. Socioeconomic Impact and Development Consequences

Non-communicable diseas­es pose a serious threat to national development and the achievement of the Sus­tainable Development Goals. Chronic illness reduces pro­ductivity, increases absen­teeism, and places long-term financial strain on house­holds. Many families affected by NCDs face catastrophic health expenditures that can push them into poverty.

 

Vulnerable and socially dis­advantaged populations are disproportionately affected. Limited access to health services, lack of early detec­tion, and delayed treatment contribute to higher rates of complications and premature death. Without strong health systems and social protection mechanisms, the growing NCD burden risks reversing hard-won development gains.

 

7. Prevention and Control: From Policy to Personal Action

The good news is that many non-communicable diseases are preventable. Cost-effec­tive, evidence-based interven­tions exist to reduce exposure to major risk factors and to promote healthier lifestyles. Strong tobacco and alcohol control policies, promotion of healthy diets, encouragement of physical activity, and actions to reduce air pollution can sig­nificantly lower NCD risk at the population level.

 

8. Individual-Level Prevention: What Each Person Can Do

While government policies and health systems are criti­cal, individual actions remain central to preventing NCDs. Every person can take prac­tical steps to protect their health:

 

• Avoid all forms of tobacco use and protect family members from second-hand smoke. • Choose a healthy diet rich in fruits, vegetables, whole grains, and legumes, while reducing salt, sugar, and un­healthy fats. • Engage in reg­ular physical activity, such as walking or cycling, for at least 150 minutes per week. • Lim­it or avoid alcohol consump­tion. • Maintain a healthy body weight. • Check blood pressure, blood sugar, and cholesterol levels regularly, particularly after the age of 40. • Seek early medical advice and adhere to treatment if di­agnosed with hypertension, diabetes, or other chronic conditions.

 

Early detection and con­tinuous care are essential. Strengthening primary health care to provide screening, di­agnosis, and long-term man­agement of NCDs is a cost-ef­fective approach that saves lives and reduces the need for expensive hospital-based treatment.

 

9. Myanmar’s Response to the NCD Challenge

Myanmar has taken important institutional and policy steps to address the growing bur­den of non-communicable dis­eases. Within the Ministry of Health, a dedicated Non-Com­municable Disease (NCD) Unit was established under the Department of Public Health (DOPH) around 2015 to provide leadership in NCD prevention and control. The NCD Unit is responsible for developing and implementing national strategies, policies, and action plans aimed at re­ducing morbidity and mortal­ity from major NCDs.

 

A cornerstone of Myanmar’s response is the adoption and expansion of the World Health Organization’s Pack­age of Essential Noncommu­nicable Disease Interven­tions (PEN). Through PEN, cost-effective interventions for the prevention, early detec­tion, treatment, and referral of cardiovascular diseases, diabetes, chronic respirato­ry diseases, and related risk factors are delivered at the primary health care level. This approach strengthens early diagnosis, improves continuity of care, and promotes equita­ble access to essential NCD services across the country.

 

Myanmar’s NCD response also emphasizes surveillance and evidence-based planning. National risk factor data gen­erated through WHO STEPS surveys provide a foundation for monitoring trends in tobac­co use, harmful use of alco­hol, unhealthy diets, physical inactivity, hypertension, and diabetes. These data guide policy formulation, resource allocation, and programme prioritization.

 

Multi-sectoral collaboration is another key element of My­anmar’s response. The Minis­try of Health works with other government sectors, develop­ment partners, civil society organizations, and coordi­nating mechanisms such as the Myanmar Health Sector Coordinating Committee to address the social, commer­cial, and environmental de­terminants of NCDs. Together, these efforts aim to reduce preventable risk factors, im­prove service delivery, and strengthen health system capacity nationwide.

 

10. From Silent Killers to Visible Action

Non-communicable diseas­es may progress silently, but their consequences are profound and far-reaching. In Myanmar, as in the rest of the world, NCDs are now the leading cause of death and a major challenge to health sys­tems, economic productivity, and sustainable development.

 

Myanmar’s response — an­chored in strong institutional leadership, primary health­care-based interventions such as WHO PEN, improved surveillance through STEPS surveys, and multi- sectoral collaboration — demonstrates a clear commitment to tack­ling this growing epidemic. However, sustained political commitment, adequate invest­ment, and active community participation remain essential to translate policies into meas­urable health gains.

 

By combining effective nation­al programmes with individu­al responsibility for healthier lifestyles, Myanmar can move from reacting to silent killers toward preventing them. Mak­ing NCDs visible, preventable, and manageable is essential for protecting lives today and securing a healthier future for generations to come.

 

References

1. World Health Organization. Noncommunicable Diseases: Fact Sheet and Overview, 2024.

2. World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2030.

3. World Health Organization. WHO Global Status Report on Noncommunicable Diseases, 2022.

4. Institute for Health Metrics and Evaluation. Global Bur­den of Disease Study 2021 Results, published 2024.

5. World Health Organization South-East Asia Region. Noncommunicable Diseases Country Profile: Myanmar, 2018.

6. Ministry of Health and Sports, Myanmar & World Health Or­ganization. Myanmar STEPS Survey on NCD Risk Factors, 2014.

7. MOHS, National Strategic Plan for Prevention and Con­trol of NCDs(2017-2021)

Myanmar, 2017

8. United Nations. Transforming our World: The 2030 Agenda for Sustainable Development (SDG Target 3.4), 2015.