Non-Communicable Diseases (NCDs)

1. Key issue with NCDs is interruption of care
2. Cardiovascular events, diabetes, and hypertension are some of the most frequent health problems of newly arrived refugees and migrants
3. Risks of population movements increase risk of NCDs

WHO Europe migration and health outlines the key issues faced by new migrants. It points out there is no systematic association between migration and communicable diseases, but that non-communicable diseases (NCDs) often worsen.

The following information is taken from their advice, linked below.

NCDs cause preventable morbidity and mortality

The main NCDs are cardiovascular diseases, diabetes, cancer and chronic lung diseases. The prevalence of NCDs such as diabetes and hypertension in adults in certain low- and middle-income countries is as high as 25–35%.

Due to the conditions of their travel, refugees and migrants can be more susceptible to complications. The impact of psychosocial factors, including stress, as well as alcohol and tobacco use impact NCDs.

In addition, NCDs:

• require the provision of continuous care over a long time, often for life;
• often require regular treatment with a drug, a medical technique or an appliance;
• can be associated with acute complications that require medical care, incur health costs and may limit function, affect daily activities and reduce life expectancy;
• necessitate coordination of care provision and follow-up among various providers and settings; and
• may require palliative care.

In DOTW UK clinic, half of our patients had a long-term, chronic condition. The most frequently recorded health conditions were musculoskeletal (15%), followed by digestive (13%), psychological (12%) and circulatory (11%) (DOTW 2016).

These findings are supported by the Europe-wide MdM data published in the Observatory Report. The highest proportion of chronic pathologies were cardiovascular (19.9%; 1,945/9,774), followed by from musculoskeletal (13.2%; 1,293/9,774), from digestive (12.2%; 1,191/9,774), from endocrine, metabolic and nutritional (11.6%; 1,133/9,774), and from psychological (10.0%; 975/9,774). The report 'Falling Through the Cracks' is linked below.

Impact of Sudden Migration on NCDs

The conditions of migration, along with the conditions once arrived in the UK, can impact on NCDs. Children and elderly are the most at risk.

Complications can results from:

• physical injuries: factors such as secondary infections and poor control of glycaemia compromise management of acute traumatic injuries;
• forced displacement: loss of access to medication or devices, loss of prescriptions, lack of access to health care services leading to prolongation of disruption of treatment;
• degradation of living conditions: loss of shelter, shortages of water and regular food supplies and lack of income add to physical and psychological strain; and
• interruption of care: due to destruction of health infrastructure, disruption of medical supplies and the absence of health care providers who have been killed, injured or are unable to return to work; and
• interruption of power supplies or safe water, with life-threatening consequences, especially for people with end-stage renal failure who require dialysis.

NCDs need to be detected early, and managed according to guidance. Ensuring screening for NCDs is included in health checks can help with this, as well as encouraging access to healthcare.

Further information

• 

  WHO/Europe Migration and Health: Key Issues

  www.euro.who.int

• 

  Public Health England Migrant Health Guide: Non-Communicable Diseases

  www.gov.uk

• 

  Closing the Gaps in Healthcare Access: The United Kingdom

  migrant.health

• 

  Falling through the Cracks: The Failure of Universal Health Coverage in Europe

  migrant.health