Review Article

Ethical considerations in prevention and management of non-communicable diseases: a narrative review

Abstract

In recent years, alarming trends in non-communicable diseases (NCDs) have grown into some of the most important health concerns worldwide. The present research attempts to address the controversial approaches to the practical function of medical ethics while critically reviewing the main concepts of ethical considerations in NCD prevention literature. After refining the searched documents, we integrated related concepts and research, particularly emphasizing ethical considerations in NCD management. All four functional areas of NCD prevention (general health policymaking, social interventional, primary prevention, and secondary prevention) are affected by parallel associated factors of health determinants: environmental modification, lifestyle improvement and physiological characteristics, respectively. In addition to the practical aspects of implementing a response to NCDs, a variety of ethical considerations should be taken into account. For instance general policies, equity in care, interventional programs, and clinical/research data protection. A comprehensive, holistic approach considering all the involved parties can accommodate the wide spectrum of needs and continuum of management for NCDs.Creating an ethical procedure structure in public health systems can provide insight into managing the challenges posed by NCDs to health systems and assist in systematically confronting ethical problems in the management of NCDs.

Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2019 global survey. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. 2013;381(9867):670-9.

Boutayeb A, Boutayeb SJIjfeih. The burden of non communicable diseases in developing countries. 2005;4(1):1-8.

Nugent R, Bertram MY, Jan S, Niessen LW, Sassi F, Jamison DT, et al. Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals. The Lancet. 2018;391(10134):2029-35.

Schmidt H, Barnhill A. Equity and noncommunicable disease reduction under the sustainable development goals. PLoS medicine. 2015;12(9):e1001872.

Azadnajafabad S, Mohammadi E, Aminorroay a A, Fattahi N, Rezaei S, Haghshenas R, Rezaei N, Naderimagham S, Larijani B, Farzadfar F. Noncommunicable diseases' risk factors in Iran; a review of the present status and action plans. J Diabetes Metab Disord. 2021 Jan 22;23(2):1-9. doi: 10.1007/s40200-020-00709-8. Epub ahead of print. PMID: 33500879; PMCID: PMC7821170.

Peykari N, Hashemi H, Asghari G, Ayazi M, Janbabaei G, Malekzadeh R, et al. Scientometric study on non-communicable diseases in Iran: a review article. Iranian Journal of Public Health. 2018;47(7):936.

Kass NE. An Ethics Framework for Public Health. American Journal of Public Health. 2001;91(11):1776.

Schmidt H. Chronic Disease Prevention and Health Promotion. In: H. Barrett D, W. Ortmann L, Dawson A, Saenz C, Reis A, Bolan G, eds. Public Health Ethics: Cases Spanning the Globe. Cham (CH): Springer; April 13, 2016.137-176.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Systematic Reviews. 2021;10(1):89-.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003;327(7414):557-60.

Bausch FJ, Beran D, Hering H, Boulle P, Chappuis F, Dromer C, et al. Operational considerations for the management of non-communicable diseases in humanitarian emergencies. Conflict and health. 2021;15(1):9.

Zahedi F, Razavi S, Larijani B. A two-decade review of medical ethics in Iran. Iranian Journal of Public Health. 2009;38(Suppl. 1):40-6.

Venkatapuram S, McKee M, Stuckler D. Ethical tensions in dealing with noncommunicable diseases globally. Bulletin of the World Health Organization. 2012;90(3):241.

Organization WH. Commission on social determinants of health-CSDH. 2008.

Organization WJWH. Noncommunicable diseases progress monitor 2017. 2017.

Kickbusch I, Allen L, Franz C. The commercial determinants of health. The Lancet Global Health. 2016;4(12):e895-e6.

Organisation WH. WHO Director-General addresses health promotion conference. The 8th Global Conference on Health Promotion in Helsinki 2013 [Available from: https://www.who.int/director-general/speeches/detail/who-director-general-addresses-health-promotion-conference.]

Latapí Agudelo, M.A., Jóhannsdóttir, L. & Davídsdóttir, B. A literature review of the history and evolution of corporate social responsibility. Int J Corporate Soc Responsibility 4, 1 (2019). https://doi.org/10.1186/s40991-018-0039-y.

Khosravi Shadmani F, Farzadfar F, Larijani B, Mirzaei M, Haghdoost AA. Trend and projection of mortality rate due to non-communicable diseases in Iran: A modeling study. PloS one. 2019;14(2):e0211622.

Khajavi A, Pishgar F, Dehghani M, Naderimagham S. Socioeconomic inequalities in neonatal and postneonatal mortality: evidence from rural Iran, 1998–2013. International Journal for Equity in Health. 2017;16(1):1-11.

Di Cesare M, Khang Y-H, Asaria P, Blakely T, Cowan MJ, Farzadfar F, et al. Inequalities in non-communicable diseases and effective responses. The Lancet. 2013;381(9866):585-97.

AbdulRaheem Y. Unveiling the Significance and Challenges of Integrating Prevention Levels in Healthcare Practice. J Prim Care Community Health. 2023;14:21501319231186500.

Fowler T, Garr D, Mager NDP, Stanley J. Enhancing primary care and preventive services through Interprofessional practice and education. Isr J Health Policy Res. 2020;9(1):12.

Di Cesare M, Khang YH, Asaria P, Blakely T, Cowan MJ, Farzadfar F, et al. Inequalities in non-communicable diseases and effective responses. Lancet. 2013;381(9866):585-97.

Beran D, Pedersen HB, Robertson J. Noncommunicable diseases, access to essential medicines and universal health coverage. Glob Health Action. 2019;12(1):1670014.

Fisher M, Freeman T, Mackean T, Friel S, Baum F. Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare. Int J Health Policy Manag. 2022;11(5):690-700.

Biswas T, Islam MS, Linton N, Rawal LB. Socio-Economic Inequality of Chronic Non-Communicable Diseases in Bangladesh. PLOS ONE. 2016;11(11):e0167140.

Venkatapuram S, McKee M, Stuckler DJBotWHO. Ethical tensions in dealing with noncommunicable diseases globally. 2012;90(3):241-2.

CAPP S, SAVAGE S, CLARKE V. Exploring distributive justice in health care %J Australian Health Review. 2001;24(2):40-4.

Nugent R. A Chronology of Global Assistance Funding for NCD. Global heart. 2016;11(4):371-4.

Jailobaeva K, Falconer J, Loffreda G, Arakelyan S, Witter S, Ager A. An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries. Globalization and health. 2021;17(1):68.

Luna F, Luyckx VA. Why have Non-communicable Diseases been Left Behind? Asian bioethics review. 2020;12(1):5-25.

Warren Andersen S, Zheng W, Sonderman J, Shu XO, Matthews CE, Yu D, et al. Combined Impact of Health Behaviors on Mortality in Low-Income Americans. American journal of preventive medicine. 2016;51(3):344-55.

Nguyen TP, Rokhman MR, Stiensma I, Hanifa RS, Ong TD, Postma MJ, van der Schans J. Cost-effectiveness of non-communicable disease prevention in Southeast Asia: a scoping review. Front Public Health. 2023;11:1206213.

Lee LM. Public health ethics theory: review and path to convergence. The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics. 2012;40(1):85-98.

Finkelstein EA, Bilger M, Baid D. Effectiveness and cost-effectiveness of incentives as a tool for prevention of non-communicable diseases: A systematic review. Social Science & Medicine. 2019;232:340-50.

Ndubuisi NE. Noncommunicable Diseases Prevention In Low- and Middle-Income Countries: An Overview of Health in All Policies (HiAP). Inquiry. 2021;58:46958020927885.

Bertram MY, Chisholm D, Watts R, Waqanivalu T, Prasad V, Varghese C. Cost-Effectiveness of Population Level and Individual Level Interventions to Combat Non-communicable Disease in Eastern Sub-Saharan Africa and South East Asia: A WHO-CHOICE Analysis. Int J Health Policy Manag. 2021;10(11):724-33.

Organization WH. Noncommunicable diseases progress monitor 2022. 2022.

Jackson-Morris AM, Mutungi G, Maree E, Waqanivalu T, Marten R, Nugent R. ‘Implementability’ matters: using implementation research steps to guide and support non-communicable disease national planning in low-income and middle-income countries. BMJ Global Health. 2022;7(4):e008275.

Peters DH, Adam T, Alonge O, Agyepong IA, Tran NJB. Implementation research: what it is and how to do it. 2013;347.

Abbasloo F, Ebrahimi P, Ghadimi D, et al. The evaluation of depression prevalence and its association with obesity phenotypes in a community-dwelling aged population. Aging Clin Exp Res. 2024;37(1):2. Published 2024 Dec 21.

Peters D, Tran N, Adam TJWHO. Alliance for Health Policy and Systems Research, WHO. Implementation Research in Health: A Practical Guide [Internet]. 2021.

Carlson V, Chilton MJ, Corso LC, Beitsch LM. Defining the functions of public health governance. American journal of public health. 2015;105(S2):S159-S66.

Ortmann LW. Defining Public Health Ethics for Practitioners. Narrative Ethics in Public Health: The Value of Stories: Springer International Publishing Cham; 2022. p. 3-22.

Ebrahimi P, Payab M, Taheri M. et al. Plasma exchange as a rescue therapy for treatment-resistant thyroid storm with concurrent heart failure: a literature review based on a case report. Int J Emerg Med 17, 195 (2024).

Banerjee A, Pasea L, Harris S, Gonzalez-Izquierdo A, Torralbo A, Shallcross L, et al. Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study. The Lancet. 2020;395(10238):1715-25.

Chang AY, Cullen MR, Harrington RA, Barry M. The impact of novel coronavirus COVID‐19 on noncommunicable disease patients and health systems: a review. Journal of internal medicine. 2021;289(4):450-62.

Clark A, Jit M, Warren-Gash C, Guthrie B, Wang HH, Mercer SW, et al. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. The Lancet Global Health. 2020;8(8):e1003-e17.

Kursite M, Stars I, Strēle I, Gobiņa I, Ķīvīte-Urtāne A, Behmane D, et al. A mixed-method study on the provision of remote consultations for non-communicable disease patients during the first wave of the COVID-19 pandemic in Latvia: lessons for the future. BMC Health Services Research. 2022;22(1):1-15.

Ehsanipur F, Ebrahimi P, Tahernia L, Vafaee-Shahi M. A fulminant presentation of post-COVID-19 necrotizing pneumonia and ischemic stroke in an 8-year-old girl: A case report and literature review. Clinical Case Reports. 2024;12(8):e9222.

Varnaseri M, Amini F, Jamshididan R, Dargahi M, Gheibi N, Abolghasemi S, et al. Ivermectin as a Potential Addition to the Limited Anti-COVID-19 Arsenal: A Double-Blinded Clinical Trial. Jundishapur J Health Sci. 2024;16(2):e146703.

Edwards HB, Marques E, Hollingworth W, Horwood J, Farr M, Bernard E, et al. Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England. BMJ Open. 2017;7(11):e016901.

Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, et al. Integrating acute stroke telemedicine consultations into specialists’ usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Services Research. 2017;17(1):751.

Stamenova V, Agarwal P, Kelley L, Fujioka J, Nguyen M, Phung M, et al. Uptake and patient and provider communication modality preferences of virtual visits in primary care: a retrospective cohort study in Canada. BMJ Open. 2020;10(7):e037064.

Greenhalgh T, Shaw S, Wherton J, Vijayaraghavan S, Morris J, Bhattacharya S, et al. Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study. J Med Internet Res. 2018;20(4):e150.

Donaghy E, Atherton H, Hammersley V, McNeilly H, Bikker A, Robbins L, et al. Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care. British Journal of General Practice. 2019;69(686):e586.

Wang H, Yuan X, Wang J, Sun C, Wang G. Telemedicine maybe an effective solution for management of chronic disease during the COVID-19 epidemic. Primary Health Care Research & Development. 2021;22:e48.

Files
IssueVol 17 (2024) QRcode
SectionReview Article(s)
Keywords
Non-communicable diseases; Prevention; Health services; Gender equity; Management; Healthcare ethics.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Shahmohamadi E, Ayati A, Sharifi Y, Ebrahimi P, Shamsi Gooshki E, Djalalinia S, Ebrahimpur M, Payab M, Larijani B. Ethical considerations in prevention and management of non-communicable diseases: a narrative review. J Med Ethics Hist Med. 2024;17.