[MUSIC] In this video, I will discuss the burden of mental ill-health and other NCDs and discuss the factors which might worsen these two groups of illnesses in humanitarian settings. The burden of mental ill-health and other NCDs has been increasing steadily in humanitarian settings following the general developments seen globally. The prevalence of mental ill-health is expected to more than double in humanitarian crisis. Yet mental ill-health often remains invisible or simply persist unrecognized, unacknowledged or ignored. This was, for example, experience in the aftermath of the earthquake that hit Nepal in 2015. Thousands of survivors were left injured and without a home to go back to. When we talk about health, always physical health comes first. Mental health is always put in the shadows, we don't have a mental health act or anything. Why is this so? Let us begin by taking a look at how health is defined. The World Health Organization definition of health is the best known definition available. It defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. It has rightfully tried to frame health in a more positive way, that is not only the absence of disease or illnesses, but also promoting the importance of mental health and psychosocial support. The importance of mental health has further been emphasized by its inclusion in the United Nations Sustainable Development Goals for the post 2015 agenda. In the case of Nepal, it would mean that the survivors should be entitled to assistant in coping with both mental ill-health and other NCDs. However, mental health care is too often left out of discussions on NCD prevention and care, and they tend to sit in separate humanitarian and clinical guidelines. Globally, more than two-thirds of the deaths are attributable to NCDs with cardiovascular diseases, cancer, diabetes mellitus, chronic obstructive pulmonary disease and mental ill-health, comprising the largest portion of NCDs. Mental ill-health alone constitutes 7.4% of all global disability existed life years and 22.9% of all years live with disabilities. Today NCDs are not only a problem of high-income countries, more than three-quarters of the global NCD deaths, that is, 31.4 million deaths occur in low and middle-income countries. Which are at the same time those countries hosting the majority of humanitarian setting. In 2019, some 79.5 million people were forcibly displaced globally due to persecution, conflict, violence and human rights violations. NCDs make up a greatest of the burden of those displaced from conflicts. According to the latest WHO report, NCD accounted for 24% to 68% of mortality in the five most common countries of origin of refugees and migrants, including Syria, Afghanistan, South Sudan, Myanmar and Somalia. One person in five, that is 22%, living in humanitarian settings is estimated to have mental ill-health, post traumatic stress disorders, depression and anxiety are commonly reported. But what are the causes of mental ill-health and other NCDs? Attention to NCDs initially focused on four measure disease categories, including cardiovascular disease, diabetes, chronic obstructive pulmonary disease and cancer. And four measure behavioural risk factors including unhealthy diet, physical activity, tobacco use and harmful use of alcohol known as the four by four conditions. Recently, mental ill-health has been considered as the fifth NCD and environmental determinants as the fifth risk factor for NCDs known as five by five conditions. These two groups of illnesses are not only linked by underlying behavioural risk factors, but also by environmental and socioeconomic determinants, such as childhood adversity and poverty. They are powerfully interconnected, highly comorbid and frequently co-occur due to potential bidirectional relationships. Those affected by mental ill-health are more likely to also suffer from other NCDs and vice versa. A response which addresses both the illnesses might therefore be useful both to be more effective and to require less resources. If we look back at the case of Nepal, it clearly saw as an example of how people in humanitarian settings are at risk of exposure to trauma and daily stresses such as violence and worry, which can exhibit other NCDs. Notably the breakdown of social networks, lack of continuity of care and unhealthy coping mechanisms, like smoking and excess alcohol use can exhibit individuals risks of developing NCDs or worsen pre-existing conditions. Similarly today, more than half of the world's refugees and internally displaced people live in urban areas, often in underdeveloped informal settlements. Urban lifestyles may bring stress and sedentary habits that contribute to NCDs such as a stroke and diabetes. There is also a high level of stigma and discrimination against people living with mental ill-health, and this may lead to exclusion, treatment avoidance, delays to help-seeking and care, and even discontinuation of NCD treatment. The consequences of these conditions are felt not only by the individuals and families concern, but by society as a whole. Last but not the least, exposure to early childhood adversity such as violence, poor living conditions and a stressful family and community environments can also contribute to adoption of unhealthy behaviors, impairments in physical and mental well being, and eventually the development of NCDs in adulthood. To sum up, humanitarian settings can further higher burden of NCDs, including mental ill-health. And since the relationships between these two groups of illnesses are complex and bidirectional, these demands new ways of organizing healthcare systems to deal with these new challenges.
