Noncommunicable diseases (NCDs) are a major global public health threat. As the leading cause of death, they account for 65.5% of mortality [1] and 54% of disability-adjusted life years globally [2]. The danger posed by NCDs to population health is further heightened during disasters. The growing recognition that NCDs are important to health and development, as reflected in their inclusion in Goal 3 of the sustainable development Goals, is an opportunity for synergy between disaster risk reduction (DRR), sustainable development, and health [3].

NCDs in disasters are a challenge for global health equity. Almost three quarters of all NCD related mortality occur in low- and middle-income countries (LMICs) [4]. The challenges posed by NCDs are projected to be ever-growing in LMICs, as more countries make nutrition and disease transitions in the context of globalization. Further, the increase in NCDs is not only limited to the countries undergoing demographic changes with aging populations, but is also affecting young populations due to more sedentary lifestyles and the resultant obesity epidemic. At the same time, LMICs face a greater burden of natural disasters (frequency and intensity), climate change sequelae, and wider disaster hazards relative to high income countries [5] as a result of relatively weak national health systems, higher levels of absolute and relative poverty, rapid urbanization, and associated planning deficiencies, as well as less adequate early warning systems.

Inequity does not only exist between high income countries and LMICs, but is also within local communities. Vulnerable groups include those from lower socioeconomic groups, the homeless, the disabled, those requiring chronic care, women, and the very young and old [6]. For example, individuals from lower socioeconomic groups often have insecure livelihoods, lack economic and social welfare safety nets, live in areas at heightened risk of disaster, and are less likely to evacuate when requested [5]. As such, vulnerable groups are simultaneously more likely to be inadequately managed for chronic conditions [6] and more susceptible to the adverse effects of disasters [7].

NCDs in disasters can entrench, exacerbate, and cause further health disparities. Following disasters, public health infrastructures become overwhelmed by acute injuries and immediate disaster relief needs, such as those related to infectious disease and maternal/child health. As a result, chronic conditions may remain untreated and those with chronic conditions can experience acute exacerbations and increased mortality, and a worsened long-term prognosis. For example, disrupted dialysis provision following the 2005 Kashmir earthquake led to significant health consequences among chronic renal disease patients [8].

Additionally, conditions that were previously managed with little or no impact on activities of daily living may deteriorate on account of reduced access to care and/or medication loss [9]. For example, exacerbation of rheumatoid arthritis debilitates patients and causes wider social disruptions including loss of income and security [10]. Such a reduced functional capacity, particularly at a time of heightened physical, social, and mental stress postdisaster can in turn adversely impact on livelihoods and as a result, entrench individuals in poverty and exacerbate inequity [5]. Given this, mitigating against the impact of NCDs in the context of disasters can improve the long-term economic outlook for both the individual and community (supporting postdisaster economic recovery and maximizing tax revenue for subsequent reinvestment into public sector services/infrastructure). There is a need for further research to explore how NCDs impact inequities postdisasters in the short and longer term.