Letter to the Editor

Re: Neglected Major Causes of Death Much Deadlier Than COVID-19

Dear Editor-in-Chief

We reviewed the editorial entitled: "Neglected Major Causes of Death Much Deadlier Than COVID-19", by Prof. Jalal Poorolajal ¹ with great interest. To answer to the question raised by the author as: "why do people not pay attention to the major causes of death as much as they do to COVID-19?” we grasp the opportunity to reshape the question as:" Why do health policymakers not pay attention to the major causes of death?".

Indeed, the burden of non-communicable diseases must be taken into account. We acknowledge the critical role of communities in prevention and control of diseases, especially non-communicable ones. Meanwhile, we shall not forget that a large portion of prevention and control efforts relies on the governments as a political obligation. There has been a growing awareness of the serious burden of major non-communicable diseases including cardiovascular diseases, diabetes, malignancies, and chronic obstructive pulmonary disease worldwide. In many parts of the world; however, these diseases are being overlooked in prevention measures. Global and national policies have failed to stop, and in many cases have contributed to, the chronic disease pandemic ² . One example is the critical role of policy makers in nutrition, a significant contributor to many major chronic diseases ³ . Uncoordinated, uninformed policymaking has caused serious consequences to the pattern of food preparation and distribution, leaving insurmountable barriers to make a healthy diet for many people worldwide. These barriers, which are responsible for health inequities, can be overcome thoughtfully by governments to provide evidence-informed policies ⁴ . Another example is the governmental contribution in regulating national policies to reduce the amount of sodium intake, another common and well-known risk factor for chronic diseases in most parts of the world ^5,6 . Low-cost and highly effective solutions for the prevention of chronic diseases are readily available; the failure to respond is now a political, rather than a technical issue ^2,6 .

Regarding the COVID-19 pandemic, we agree with the author on the important role of communities to stop spreading the pandemic. Nevertheless, the same premise concerning non-communicable diseases exists. Prevention and control of widespread epidemics such as COVID-19 is a political priority and commitment rather than a social responsibility. We disagree with the author on the points that more deaths will occur by the COVID-19, simply because communities will fed up with restrictions. Along with WHO, we truly believe that control of an epidemic or any other health crisis is the foremost priority for governments ⁷ . As for the COVID-19 epidemic in Iran, despite a few community-based endeavors by the government to tackle the disease ⁸ , major challenges to combat the epidemic in the country are insufficient whole-government, whole-society approach in managing the outbreak, inadequate lifesaving and protective equipment, and delayed decisive governance ⁹ . What we have learned from the COVID-19 pandemic shows that successful prevention and control measures relies heavily on the community involvement. Conditional on being asked by policy makers, people are appreciable collaborators in their own health.

In conclusion, we believe that prevention and control of the major causes of death worldwide are indeed health policy priorities and require professional advocacy attempts through appropriate inter-sectoral collaboration and whole-government coalitions. Meanwhile, we should not forget the significant role of media on a thriving community. The premise of a united society, which has a substantial responsibility on its health, is not achievable without governmental efforts to educate, aware, and mobilize it.

Conflict of interest

The authors declare that there is no conflict of interests.

References

1. Poorolajal J. Neglected Major Causes of Death Much Deadlier Than COVID-19. J Res Health Sci 2020; 20(2):e00478.
2. Geneau R, Stuckler D, Stachenko S, McKee M, Ebrahim S, Basu S. Raising the priority of preventing chronic diseases: a political process. Lancet 2010; 376:1689-98.
3. Mozaffarian D, Rosenberg I, Uauy R. ‎History of modern nutrition science–implications for ‎current research, dietary guidelines, and food policy. BMJ 2018; 361:k2392.
4. Mozaffarian D, ‎Angell SY, ‎Lang T, ‎Rivera JA. Role of government policy in nutrition-‎barriers to and opportunities for healthier ‎eating. BMJ 2018; 361:k2426‎.
5. Leyvraz M, Chatelan A, da-Costa BR, Taffé P, Paradis G, Bovet P. Sodium intake and blood pressure in children and adolescents: a systematic review and meta-analysis of experimental and observational studies. Int J Epidemiol 2018; 47(6):1796-810.
6. Webb M, Fahimi S, Singh GM, Khatibzadeh S, Micha R, Powles J. Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations. BMJ 2017; 356:i6699.
7. World Health Organization: Regional Office for Europe. Strengthening the health system response to COVID-19. WHO; 2020 [cited 1 Jun 2020]. Available from: https://www.euro.who.int/en/health-topics/Health-systems/pages/strengthening-the-health-system-response-to-covid-19/strengthening-the-health-system-response-to-covid-19-policy-brief.
8. Raeisi A, Sadegh-Tabrizi J, Gouya MM. IR of Iran National Mobilization against COVID-19 Epidemic. Arch Iran Med 2020; 23(4):216-9.
9. Raoofi A, Takian A, Akbari-Sari A, Olyaeemanesh A, Haghighi H, Aarabi M. COVID-19 Pandemic and Comparative Health Policy Learning in Iran. Arch Iran Med 2020; 23(4):220-34.

Reply

I thank very grateful to Prof. Koroush Holakouie-Naieni and his colleague for their kind comments on my recent editorial in the Journal of Research in Health Sciences.

I appreciate their concern and emphasize that their question “Why do health policymakers not pay attention to the major causes of death?” and mine “Why do people not pay attention to the major causes of death as much as they do to COVID-19?” are the both sides of the same coin. Indeed, people's lack of attention to the major causes of death and dangerous diseases is the result of negligence of the health policy makers and media. As I emphasized in the last paragraph of the paper, people do not pay enough attention to the importance and catastrophic consequences of common causes of death because they hear little about these realities in media ¹ . On the other hand, COVID-19 has become the major concern of the general population for several months because a huge propaganda and international campaign was launched to curb the disease. The media has a remarkable impact on public beliefs and awareness ² . They can manage and shape public beliefs and attitudes ^{3, 4} . So people pay attention to the same things on which policymakers and media focus.

References

1. Poorolajal J. Neglected major causes of death much deadlier than COVID-19. J Res Health Sci 2020; 20(2):e00478.
2. Laker-Oketta M, Butler L, Kadama-Makanga P, Inglis R, Wenger M, Katongole-Mbidde E. Using media to promote public awareness of early detection of Kaposi's Sarcoma in Africa. J Oncol 2020; 2020:3254820.
3. Oto MA, Ergene O, Tokgozoglu L, Ongen Z, Kozan O, Sahin M. Impact of a mass media campaign to increase public awareness of hypertension. Turk Kardiyol Dern Ars 2011; 39(5):355-64.
4. Gollust SE, Attanasio L, Dempsey A, Benson AM, Fowler EF. Political and news media factors shaping public awareness of the HPV vaccine. Women's Health Issues 2013; 23(3):e143-51.