Addressing the high burden of noncommunicable diseases in Nigeria: a commentary

Purpose –The purpose of this study describes how individuals; healthcare providers and the government can reduce the burden of noncommunicable diseases (NCDs) in Nigeria. Design/methodology/approach – This commentary paper combines extensive literature searches and experience from public health physicians. Findings – Noncommunicable diseases are chronic diseases. They result from a combination of genetic, physiological, environmental and behavioral factors. NCDs are divided into four classes: cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Practical implications – Noncommunicable diseases are responsible for about a quarter of total deaths in Nigeria. These deaths are unnecessary asmost NCDs can be prevented if the risk factors are dealt with. Dealing Reducing burden of NCDS in Nigeria © Miracle Ayomikun Adesina, Ruth Ifeoluwa Oladele, Isaac Iyinoluwa Olufadewa, Ogheneruona Favour Onothoja, Damilola Remilekun Oladipo, Opeyemi Paul Iyiola, Marvelene Bassey Ekott, Pamela Chinenye Nwachukwu, Ararso Baru and Seyi John Akinloye. Published in Journal of Health Research. Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CCBY4.0) licence. Anyonemay reproduce, distribute, translate and create derivativeworks of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons. org/licences/by/4.0/legalcode Conflict of interest: The authors declare no conflict of interest. Funding: This Study was self-funded. The current issue and full text archive of this journal is available on Emerald Insight at: https://www.emerald.com/insight/2586-940X.htm Received 19 February 2020 Revised 13 April 2020 2 May 2020 Accepted 26 May 2020 Journal of Health Research Emerald Publishing Limited e-ISSN: 2586-940X p-ISSN: 0857-4421 DOI 10.1108/JHR-02-2020-0039 with these risk factors involves everyone (Individuals, government, interdisciplinary and multidisciplinary researchers, policymakers, government, etc.). Originality/value –Major risk factors for NCDs are tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity. The solution to NCDs, therefore, lies in dealing with these factors, which, fortunately, are modifiable since they have to do with lifestyle practices. There is evidence to support the claim that a reduction of the risks of NCDs can be achieved by engaging in healthy lifestyle practices.


Introduction
The World Health Organization (WHO) in 2011 stated obesity as a major risk factor for noncommunicable diseases (NCDs) [1]. Statistics from 2018 [2] showed that NCDs are responsible for the deaths of 41 million people annually, of which 15 million affected people are in the 30-and 69-year age group. It is reported that 50% of these premature deaths occurred in low-and middle-income countries [3]. Global Health Observatory data in 2018 predicted that deaths from NCDs would rise to about 52 million worldwide in the year 2030 [4] (See Figure 1).
NCDs account for about 24% of total deaths in Nigeria [5]. Recent data show an increase in statistics as represented in Figure 2.
The WHO reported that the probability of dying prematurely from NCDs in Nigeria is 20% [7]. The projected prevalence estimate of diabetes in Nigeria is 4.04% [8], it is also projected that in 2020, cancer incidence in Nigerian males will rise to 90.7/100,000 and 100.9/ 100,000 for females. According to the 2012 Globocan data, the top five cancers of the greatest burden in Nigeria are breast, cervix uteri, liver, prostate and colorectal cancers [9]. Workable and evidence-based solutions must be provided [10], to relieve the burden of NCDs in Nigeria which is the aim of this research article (See Figure 3).
One of the primary aims of the 2011 UN high-level meeting of the General Assembly was to reduce the level of exposure of individuals to modifiable risk factors of NCDs and their determinants while strengthening the capacity to make healthier choices and follow lifestyle patterns that foster good health [11] (See Figure 4).

Healthy lifestyle practices as a solution to NCD's in Nigeria
It was observed that small weight losses of 2-5% can decrease the risk of type 2 diabetes, and 15-30 min of brisk walking a day can reduce the risk of heart diseases by 10% [13].    Analysis of participants' lifestyle in a study conducted among traders in Sokoto, Nigeria [12] Reducing burden of NCDS in Nigeria Awareness of NCDs must be spread to imbibe healthy habits [14]. However, health literacy is not enough to make healthy lifestyle choices as illustrated in a study [15] where 54% of healthcare providers reported being obese.
The role of healthcare providers in ensuring ease of inculcating good health habits The USA proposed to have a new set of practitioners, identified as healthy lifestyle practitioners (HLPs) to help combat the NCD crisis [16]. In Nigeria, healthcare providers can do their best to deliver healthy lifestyle medicine while we await the emergence and intervention of HLPs. Healthcare providers can also take advanced courses and recommend technologies such as the Fitbit, [17] to the populace. The use of tailored and personalized messages via technology is shown to be effective in creating and sustaining healthy lifestyle practices [18].

Role of government and policymakers in ensuring that Nigerians imbibe healthy lifestyle practices
Creating a favorable environment Policies that allow the establishment of community parks, sidewalks, bike lanes, playgrounds or village square areas with beautiful landscapes where people can gather, jog, meet and play during leisure encourages people to participate in physical activity. It was observed in a study [19] that the presence of available space for a stroll contributed to longevity. Another study [20] revealed that walking reduced the risk of coronary artery disease among women. Once these structures exist, participation in physical activity becomes much easier and habitual.

Enacting policies
Other government policies should include a price increase through a tax increase and nonprice measures. Currently, Nigeria takes nonprice measures such as smoking bans in public places, banning tobacco advertising and promotion, and restriction of alcohol access to people aged below 18 years, but there is little implementation of these policies. The WHO [21] calculated that if all countries increased their taxes on cigarette packs by 50%, there would be 49 million fewer smokers and this would prevent 11 million deaths caused by smoking [22] (based on unpublished WHO simulations using 2012 data).

Role of individuals in imbibing healthy lifestyle practices
Nigerians must understand that healthy lifestyle practices are evidence-based solutions to reducing the burden of NCDs. They must agree with their health providers, cooperate with the government to make use of provided structures, and consciously develop self-motivation and cues for imbibing healthy lifestyle practices. Generally, individuals should avoid sedentary lifestyles, get vaccinated, consciously make time for regular medical screening and avoid patronizing herbal remedies that have no scientific evidence of efficacy.

Conclusion
The development of healthy lifestyle practices against the risk of NCDs should not be left to individual willpower alone. Habits stick best when there are structures, motivational support systems and national policies.

Recommendations
(1) Research in different fields should be conducted to unravel the cause of bad lifestyle practices and discover suitable cues for good lifestyle practices that the Nigerian population can engage in.
(2) Healthcare professionals in Nigeria should be trained in delivering healthy lifestyle medicine.