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NAFLD – the silent epidemic

Nancy Lee and Henry Mark highlight a global health challenge in urgent need of greater attention.

‘Non-alcoholic fatty liver disease (NAFLD) is an illness most of us have never heard of, but is far more common than cirrhosis and far more baffling.’ Bill Bryson, The Body

NAFLD, the silent epidemic: what is it?

There’s a good chance you’ve never heard of the fatty liver disease NAFLD, or its more aggressive form NASH, yet staggeringly, it is estimated that a quarter of the global adult population have the disease. Worryingly, the condition is also becoming increasingly common in children.

NAFLDH is generally asymptomatic, meaning people with the disease have no symptoms. Combined with a lack of public awareness, the disease is largely undiagnosed and untreated. When symptoms do arise, they are often in the later stages of disease. This means it is harder to treat and manage, resulting in an increased risk of death. The disease is already a leading cause of cirrhosis and liver transplantation globally.

The science behind NAFLD is complicated. The disease shares a close relationship with other highly prevalent diseases, including diabetes and obesity, and is referred to as a multisystem disease due to the impact on a range of organs beyond the liver including the heart, kidney, and pancreas.

While most people living with NAFLD can be managed by a general practitioner, an estimated 5% have advanced scarring of the liver, known as advanced fibrosis, and need specialist care. The lack of any drugs treatment specifically licensed for the disease further complicates the situation.

NAFLD, a sustainable development issue?

NAFLD is already having a significant impact on public health, including mental wellbeing, while also leading to significant economic costs. Annual direct medical costs for NAFLD patients in the US are estimated at US $103 billion dollars, and in four European countries – Germany, France, Italy, and the United Kingdom – this figure totals €35 billion.

Beyond the direct medical costs, NAFLD also has wider socio-economic costs, including from lost productivity. While most of the data on the impact of NAFLD comes from high-income settings, it is increasingly an issue in emerging economies, where health systems are facing the dual burden of communicable and non-communicable diseases.

NAFLD is expected to affect an increasing number of people over the next decade, especially in emerging economies, resulting in greater health and economic impact. Yet despite this, policy responses at the national and global level have been lacking. A survey conducted in the past 2 years found that not one of the 102 countries surveyed had a written strategy for addressing NAFLD or NASH.

NAFLD represents an archetypical public health challenge of the 21st century and addressing it will require new ways of thinking and working, from the design of public policy and how health systems are structured to the types of collaborations between sectors and disciplines.

‘Liver health is a window to the general health challenges of Europe in the 21st century.’ Thomas Berg, Secretary-General, EASL

Wilton Park supporting the liver health community 

One of Wilton Park’s core aims is to bring people together to consider what is needed to tackle complex global challenges. Much of this work centres around providing the space for communities and networks to develop ideas and consider how to drive forward policy thinking. Our previous work  includes supporting the development of a global roadmap to defeat meningitis by 2030, a process that was initiated through two Wilton Park dialogues, with the roadmap ultimately being endorsed by the World Health Assembly in November 2020.

Over a series of virtual dialogues we have supported the liver health community to consider how to initiate a coordinated and collaborative public health response, taking a ‘whole of society’ approach to understand the transformations needed within and beyond health systems. This week, the final series dialogue takes place in person at Wilton Park, building upon past discussions to support the development of a research and action roadmap to guide and spur action on this neglected public health challenge.

Despite its anonymity, NAFLD/NASH is a challenge that requires greater attention and action within the global health community and beyond. We hope this Wilton Park series will be a useful contribution to making this a reality. Find out more here: NAFLD – developing a research and action roadmap for fatty liver disease – Wilton Park

Blog co-authored by Wilton Park’s Global Health and Health Policy programme director Nancy Lee and consultant programme director Henry Mark.

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