To Go Deeper into Chronic Diseases, Go Beyond Health
By Rassel Meigan Rodriguez
MANILA - Cafeteria menus. Taxes. Climate change. TikTok influencers. The vape shop next door. What could these have in common? In one way or another, they help shape a significant area of life — one’s health.
They can influence a person's decisions and habits around food, what health resources and information they have as well as their interest in, and access to, alcohol or tobacco — factors that impact one's for non-communicable diseases (NCDs), which account for 74 % of deaths globally each year. These chronic illnesses kill 12 million people each year in the Western Pacific region, going by World Health Organization (WHO) data.
Major NCDs are diabetes, cancer, chronic respiratory disease and cardiovascular disease.
How health, illness and others factors in one’s physical and social environment are linked is not always obvious to many. But connecting these dots through effective stories was the focus of discussions at the ‘Unpacking NCDs’ media workshop, which was attended by 20 journalists from a mix of Asian countries as well as WHO communication officers in December 2024.
They listened to how the scope of NCD issues goes beyond hospital treatments, medicines or the 'lifestyle choices' commonly associated with them.
“I used to think that [NCDs] depended solely on the individuals, but I recently discovered that they were [caused] by many factors, including society, commerce and law,” shared Narangoo Bataa, a journalist from Mongolia's Mass Media Television and News Agency.
Egshiglen Bayarsaikhan, a communication officer from WHO Mongolia, said she learned that NCDs are less of a lifestyle disease and more of a “community-based disease” shaped by “social and commercial determinants.”
Held in the Philippines, the 4-5 December training event opened the second cycle of the Communicating NCDs Media Training and Fellowship Programme, which started in 2023. It is being carried out by the Probe Media Foundation, in partnership with Reporting ASEAN, and supported by the WHO Western Pacific Regional Office, whose resource persons spoke at most of the workshop sessions.
This year's workshop participants were from China, Lao People's Democratic Republic, Malaysia, Mongolia, Papua New Guinea and the Philippines.
HEALTH BEYOND THE HEALTH SYSTEM
Factors outside the health system define much more of a person's health, and that health is the result of complex interactions between individuals and genetics, behaviour and the social and economic and environmental aspects of life.
“Quality healthcare access is only 20% of the determinants of one’s health,” said Dr Hiromasa Okayasu, director of the Division of Healthy Environments and Populations for WHO's Manila-based Western Pacific office. “The rest of the 80% is determined by other things, like socio-economic factors, physical environment and health behaviours.”
World cafe sessions were held at the workshop to go deeper into the social, behavioural and commercial factors that affect health. Environmental factors like pollution and climate change were addressed in other sessions.
“Compared to healthcare factors, social determinants of health — meaning factors where you live, grow and age — disproportionately impact people’s health,” said Isabel Constance Espinosa, technical officer for gender, equity, and human rights at the WHO Western Pacific.
A baby’s health is impacted early on by his or her housing, the mother’s socio-economic condition and other factors outside of genetics, behaviour and the health sector.
From birth, people’s risk of developing NCDs accumulates across the life course, she explained. “As the person goes throughout life, from fetal life, to infancy, to adolescence, to adult life, it just gets exposed to more and more and different types of social determinants, and therefore the risk for NCDs go up,” added Espinosa.
These play out in the social settings people spend most of their time in — the home, school or the community. Children’s health is affected by their school lunches, and older adults are negatively impacted by the lack of access to spaces for physical activity or to nearby sources of healthy food.
The determinants that impact one’s family and friends are likely to impact an individual as well. For instance, if a mother can only afford, or is used to, having processed food served at home, her child will eat that food and can experience the effects of this eating habit.
Changes in behaviour and habits go a long way to address chronic illnesses. The WHO promotes the changing of behavioural risk factors, including alcohol use, tobacco smoking, unhealthy diet, and physical inactivity, to reduce premature mortality (death below age 70) from NCDs by one-third by 2030.
But behaviour is not something that is easy to modify. A journalist shared his struggle to quit smoking, saying that he “knows that it’s bad" although he believes it helps him handle stress. Another reported having difficulty trying to sleep earlier, although she knows full well that good sleep habits are key to health and well-being.
“We all know there are good habits which are good for your health, but for some reason, we cannot adopt those habits,” said Dan Fang, WHO technical officer for alcohol, injury and violence. “That means our behaviour is not just formed by our knowledge and our understanding. There are many factors.”
Fang said these factors on behaviour and decision-making include the capability and motivation to make a healthy choice as well as the environment that enables that choice — or not. In the case of alcohol, its use can be encouraged by the lack of policies to control drinking, its affordability or its appeal through liquor advertisements.
“All these promotions, availability, accessibility, help us make the wrong choice and adopt the negative behaviours,” Fang explained. “All these tactics used by industry — we need to counter them with policies so that we create an environment … to enable people to make a healthier choice.”
The creation of social and economic acceptability and easy access to products and habits that drive the NCD epidemic, including alcohol and tobacco, is among the commercial determinants of health, a phrase that describes the for-profit activities that impact public health.
For example, the consumption of sugar-sweetened beverages can be encouraged by pricing them lower than water. Other industry tactics include lobbying to hinder public health measures, tax avoidance, preference shaping through the media, funding research, threatening legal action or using illegal tactics.
At least 40% of all NCD deaths are attributed to three products commonly consumed these days — alcohol, tobacco and unhealthy food — in addition to air pollution coming from burning fossil fuels, Xi Yin, coordinator for the prevention of NCDs in the WHO Western Pacific, told the workshop. (At least a third of global deaths are attributed to just these four industry sectors around alcohol, tobacco, unhealthy food and burning fossil fuels, reflecting their steep cost on human society.)
In her explanation from data from the Global Burden of Disease, Xi Yin cited examples of unhealthy diets as those high in processed meat, sodium, sugar-sweetened beverages and have trans-fatty acids.
“Because the reason behind the disease is quite complicated, so the action should be multifaceted — not just more medicine, more doctors, more nurses, more diagnostics. We need to address all these things,” Dr Okayasu said.
Addressing NCDs, therefore, includes addressing the impacts of these determinants, lack of awareness and unhealthy lifestyles, low levels of resources for prevention and control, environmental challenges and gaps in data. In sum, it requires joint action that goes beyond the health sector, he pointed out.
For the WHO, prevention is key to lessening the health burden of NCDs, which bring significant costs in disease treatment and loss of productivity, as well as exacerbate and perpetuate poverty.
The world health body is pushing for governments to adopt ‘Best Buys’, which Xi Yin called a “set of prioritized, high-impact interventions to address modifiable risk factors and manage key NCDs”.
These include cost-effective health interventions that provide governments with high returns in productivity and lives saved — measures such as health taxes, bans, modified packaging and mass media campaigns that communicate the dangers of tobacco, alcohol or sugar-sweetened beverages.
LIFE DOESN’T HAPPEN IN A PETRI DISH
Journalists got the chance to discuss NCDs in their countries, challenges to reporting, skills they need and story ideas in the workshop’s ‘newsroom chats’.
The second day’s sessions focused on storytelling tools, such as health data from the WHO and other reliable resources, as well as tips for widening storytelling lenses in a session led by Johanna Son, Reporting ASEAN editor and one of the programme’s training designers.
When it comes to NCDs, there are different ways a journalist could enter a story, just as how there are several ways to enter a house. Telling a multifaceted story involves widening perspectives on health, life and the individual — going beyond medicine and clinical environments, viewing human well-being holistically and diversifying news sources beyond doctors and medical experts.
“Remember that life doesn’t happen in a petri dish,” Son said. “We don’t live in a laboratory; we live in the real world, which means that our health, and everything related to that, occurs in real life, and that’s where the potential is for looking at how to enter an NCD story.”
With insights from the first cycle of the Communicating NCDs media fellowship, Son recommended exploring local angles, under-reported or misunderstood aspects of NCDs, how NCDs and risk factors affect different groups in different ways, and how personal perspectives can be mixed with relevant and reliable data.
NCD stories do not need to be confined to a news outlet’s health pages, and can appear in the lifestyle, sports, culture, political sections too, because they are grounded in the human experience, she said.
STORY FAIR
In the ‘story fair’, the workshop’s last session, participants came up with proposals for an NCD story as an application of what they had learned over the two days. They then reviewed each other’s ideas and voted on which they liked most.
Hanyu Tang, a health journalist from Caixin Media in China, received the most votes for her story idea around how elderly Chinese who live by themselves can have a healthy diet, considering the trends of rapid population ageing and declining fertility.
This was inspired by a visit to her own grandmother, who lives alone in another province, the Beijing-based journalist shared. When she went with her grandmother to a community canteen that provides meals to the elderly, Tang remembers being concerned that the food served there was cheap but poor in quality.
“They may not be very good meat, not very good parts,” she said of the food. “And if it’s the fish, you can see those are the parts with a lot of bones. Not very good for elder people actually, I think. That left a deep impression on me,” Tang explained.
“And yesterday, when we talked about social determinants, I think Isa (Isabel Espinosa) mentioned community spaces have strong impacts on the health of older people, so that’s the kind of inspiration to gather, for me,” she added.
The story proposal of WHO Mongolia’s Bayarsaikhan to feature Mongolian herders who cope with loneliness by drinking was in second place, followed by Malaysian WHO communication officers Varun Chaudhary and Rohini Rajadorai's idea about what goes on behind the social media reels of influencers who do food reviews online.
In fourth place was the story pitch by video journalist Sherbien Dacalanio, who wanted to see how smoking and alcohol use have affected the traditional spearfishing abilities of the Philippines’ Badjao people, who live in its southern Sulu province.
“I used to think NCDs (and other health topics) are more like a medical thing — about treatments and procedures,” reflected Caixin’s Tang at the end of the workshop. “Now I’ll think more about its socio-[economic] factors and human side.”
(END/Edited by J Son)
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