TWN Info Service on Health
Issues No. 11
A recent WHO report warned that chronic diseases which affect more people in low- and middle-income countries will claim the lives of some 35 million people in 2005. This is projected to increase between now and 2015 and the direct costs in the treatment of chronic diseases are enormous.
However inexpensive and cost effective measures have produced rapid health gains e.g. salt reduction in processed foods; improved school meals; and taxes on tobacco products.
The article below highlights the key issues in the WHO report. It was published in the South North Development Monitor (SUNS) of 6 October 2005.
With Best Wishes
Chronic diseases could kill 35 million in 2005, says WHO
By Kanaga Raja
Geneva, 5 October 2005
Chronic diseases will take the lives of an estimated 35 million people in 2005, including many young and those in middle age, the World Health Organization (WHO) said Wednesday.
In its report 'Preventing Chronic Diseases - a vital investment', WHO said that the estimated 35 million deaths this year is double the number of deaths from all infectious diseases (including HIV/AIDS, tuberculosis and malaria), maternal and perinatal conditions, and nutritional deficiencies combined.
Approximately 16 million chronic disease deaths occur each year in people under 70 years of age.
Without action to address the causes, deaths from chronic diseases will increase by 17% between 2005 and 2015. However, global action to prevent chronic disease could save the lives of 36 million people who would otherwise be dead by 2015.
For chronic diseases, the impact is clear, the report said. Eighty percent of all chronic disease deaths occur in low- and middle-income countries, where most of the world's population lives, and the rates are higher than in high-income countries.
The report dispelled the common misunderstanding that chronic diseases mainly affect people in the wealthy countries. The reality is that four out of five chronic disease deaths are in low- and middle-income countries.
The report also dispelled the belief that chronic diseases can't be prevented. It said that if the risk factors associated with chronic diseases were eliminated, at least 80% of all heart disease, stroke and type-2 diabetes and 40% of cancer would be prevented.
The report focuses on the major chronic diseases that include heart disease, stroke, cancer, chronic respiratory diseases (such as asthma) and diabetes. Visual impairment and blindness, hearing impairment and deafness, oral diseases and genetic disorders are other chronic conditions that account for a substantial portion of the global burden of disease.
The causes of the main chronic disease epidemics are well established and well known, it said, the most important modifiable risk factors being unhealthy diet and excessive energy intake; physical inactivity; and tobacco use.
Many more risk factors for chronic diseases have been identified, such as harmful alcohol use being an important contributor to the global burden of disease. It has been estimated to result in 3% of global deaths and 4% of the global burden of disease, almost half of which being the result of unintentional and intentional injuries.
Other risk factors for chronic disease include infectious agents that are responsible for cervical and liver cancers, and some environmental factors such as air pollution, which contribute to a range of chronic diseases including asthma. Psycho-social and genetic factors also play a role.
The report said that there is now extensive evidence from many countries that conditions before birth and in early childhood influence health in adult life. For example, low birth weight is now known to be associated with increased rates of high blood pressure, heart disease, stroke and diabetes.
Childhood obesity, according to the WHO, is associated with a higher chance of premature death and disability in adulthood. Approximately 22 million children under the age of five are obese. While affecting every country, overweight and obesity in children are particularly common in North America, the United Kingdom, and south-western Europe. In Malta and the United States, for example, over a quarter of children aged 10-16 years are overweight.
According to Dr Catherine le Gales-Camus, WHO Assistant Director-General of Non-Communicable Diseases and Mental Health, childhood obesity is emerging as the number-one public health problem. This problem, she said, has to be discussed with the food industry.
Dr Robert Beaglehole, WHO Director of Chronic Diseases and Health Promotion, stressed that the food industry has a critical role to play since what people consume - in the form of processed foods - is what is available for them. He added that the WHO is currently in dialogue with the food industry.
The report highlighted several underlying determinants that are a reflection of the major forces driving social, economic and cultural change - globalization, urbanization, population ageing and the general policy environment.
The negative health-related effects of globalization include the trend known as the 'nutrition transition' - populations in low- and middle- income countries are now consuming diets high in total energy, fats, salt and sugar. The increased consumption of these foods in these countries is driven partly by shifts in demand-side factors, such as increased income and reduced time to prepare food.
Supply-side determinants include increased production, promotion and marketing of processed foods and those high in fat, salt and sugar, as well as tobacco and other products with adverse effects on population health status.
The report noted that in the second half of the 20th century, the proportion of people in Africa, Asia and Latin America living in urban areas rose from 16% to 50%. Urbanization creates conditions in which people are exposed to new products, technologies, and marketing of unhealthy goods, and in which they adopt less physically active types of employment.
As well as globalization and urbanization, rapid population ageing is occurring worldwide. The total number of people aged 70 years or more worldwide is expected to increase from 269 million in 2000 to 1 billion in 2050. High-income countries will see their elderly population (defined as people 70 years of age and older) increase from 93 million to 217 million over this period, while in low- and middle-income countries the increase will be 174 million to 813 million - more than 466%.
The report also noted that poverty and social exclusion increase the risks of developing a chronic disease, developing complications and dying. The immediate cause of inequalities in chronic diseases is the existence of higher levels of risk factors among the poor. The poor and people with less education are more likely to use tobacco products, consume energy-dense and high-fat food, be physically inactive, and be overweight or obese.
The poor also have decreased access to health services. Thus, investment in chronic disease prevention programmes is essential for many low- and middle-income countries struggling to reduce poverty.
The leading risk factor for chronic disease globally is raised blood pressure, followed by tobacco use, raised total cholesterol, and low fruit and vegetable consumption. The major risk factors together account for around 80% of deaths from heart disease and stroke.
Each year at least 4.9 million people die as a result of tobacco use; 1.9 million people die due to physical inactivity; 2.7 million people die as a result of low fruit and vegetable consumption; 2.6 million people die as a result of being overweight or obese; 7.1 million people die as a result of raised blood pressure; and 4.4 million people die as a result of raised total cholesterol levels.
Globally, in 2005, it is estimated that over 1 billion people are overweight, including 805 million women, and that over 300 million people are obese. If current trends continue, average levels of body mass index are projected to increase in almost all countries. By 2015, it is estimated that over 1.5 billion people will be overweight.
As to projections of future deaths by 2015, in general, the report said that deaths from chronic diseases are projected to increase between 2005 and 2015, while at the same time deaths from communicable diseases, maternal and perinatal conditions, and nutritional deficiencies combined are projected to decrease.
There will be a total of 64 million deaths in 2015: 17 million people will die from communicable diseases, maternal and perinatal conditions, and nutritional deficiencies combined; 41 million people will die from chronic diseases; cardiovascular diseases will remain the single leading cause of death, with an estimated 20 million people dying, mainly from heart disease and stroke; and deaths from chronic diseases will increase by 17% between 2005 and 2015, from 35 million to 41 million.
Although the MDGs have successfully focused attention on the plight of the world's poorest children and mothers, and on some infectious disease epidemics, chronic diseases - the major cause of death in almost all countries - have not been included within the global targets. A recent WHO publication on health and the MDGs has recognized that there is scope for doing so within Goal 6 (combating HIV/AIDS, malaria and other diseases).
The direct costs of health-care resources and non-medical goods and services consumed in the treatment of chronic diseases are enormous, the report said.
In the United States, for example, the estimated total health-care costs resulting from heart disease increased from $298.2 billion in 2000, to $329.2 billion in 2001 and $351.8 billion in 2002. The estimated 2 million stroke cases in the United States in 1996 cost the health-care system $8.3 billion, and caused 5.2 million work days to be lost.
Obesity has been reported to account for approximately 5% of national health expenditure in the United States, and from 2% to 3.5% in other countries. The direct health expenditures attributable to physical inactivity have been estimated at approximately 2.5% of health expenditure in Canada and the United States. In 1999, the World Bank estimated that tobacco-related health-care accounts for between 6% and 15% of all annual health-care costs and between 0.1% and 1.1% of GDP in high-income countries.
Evidence suggests that a modest reduction in the prevalence of certain chronic disease risk factors could result in substantial health gains and cost savings. For instance, a Norwegian study estimated that savings of $188 million from averted heart disease and stroke over 25 years would result from lowering the population blood pressure level by 2 mmHg, by means of a reduction in salt intake.
Countries will potentially lose substantial amounts of national income as a result of the impact of deaths from chronic diseases on labour supplies and savings, the report cautioned.
In 2005, the estimated losses in national income from heart disease, stroke and diabetes (reported in international dollars to account for differences in purchasing power between countries) are $18 billion in China; $11 billion in the Russian Federation; $9 billion in India; and $3 billion in Brazil. Similarly, the losses for the United Kingdom, Pakistan, Canada, Nigeria and Tanzania are 1.6 billion, 1.2 billion, 0.5 billion, 0.4 billion, and 0.1 billion international dollars, respectively.
Estimates for 2015 for the same countries are between approximately three and six times those of 2005. The cumulative and average losses are higher in the larger countries like China, India and the Russian Federation - as high as $558 billion in China (2005-2015); for India $236 billion; and $303 billion for the Russian Federation.
To counter the threat of chronic diseases, the WHO has proposed a new global goal - to reduce the projected trend of chronic disease death rates by 2% each year until 2015. This would prevent 36 million people from dying of chronic diseases in the next 10 years, nearly half of them before they turn 70.
This represents an increase of approximately 500 million life years gained for the world over the 10-year period. Cardiovascular diseases and cancers are the diseases for which most deaths would be averted.
The averted deaths would translate into substantial labour supply gains. This in turn would translate to an accumulated gain in income of over $36 billion in China, $15 billion in India and $20 billion in the Russian Federation over the next 10 years.
In order to achieve the goal, all sectors from government, private industry, civil society and communities will have to work together, WHO said.
The report examined the vast evidence-based knowledge about inexpensive and cost-effective measures that can produce rapid health gains and for which the benefits far outweigh the costs. Examples include: salt reduction in processed foods; improved school meals; and taxation of tobacco products, which is not only cost-effective but also raises revenues for governments.
Also, providing access to exercise facilities, walking and cycle ways, along with compact urban planning, increase the opportunities for, and reduce barriers to, physical activity.