Chronic diseases will kill 35 million in 2005

In its report Preventing Chronic Diseases - a vital investment, WHO said that the estimated 35 million deaths this year, will include some 16 million chronic disease deaths in people under 70 years of age, many of them still young.

Without action to address the causes, it says deaths from chronic diseases will increase by 17 per cent 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.

This can be achiewved, it says, if countries adopt a target of bringing down deaths from chronic disease by 2 per cent, every year until 2025.

The report dispels the common misunderstanding that chronic diseases mainly affect people in the wealthy countries. The reality is that four out of five of chronic disease deaths are in low- and middle-income countries, where most of the world�s population lives.

The report also dispels 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 per cent of all heart disease, stroke and type-2 diabetes and 40 per cent of cancer would be prevented.

Environmenal factors

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. It has been estimated to result in 3 per cent of global deaths and 4 per cent 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 contributes to a range of chronic diseases including asthma. Psycho-social and genetic factors also play a role.

Obese children

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.

Population ageing

The report highlighted several underlying determinants that are a reflection of the major forces driving social, economic and cultural change � globalisation, urbanisation, population ageing and the general policy environment.

The negative health-related effects of globalisation 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.

Other determinants include the 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 per cent to 50 per cent. Urbanisation 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 globalisation and urbanisation, 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 per cent.

Poverty factors

The report also notes 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 per cent 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.

Millions overweight

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 (immediately before and after birth), 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 Millennium Development Goals (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 recognised 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 workdays 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 just by reducing salt intake by 2mmHg, it would be possible to would save $188 million from averted heart disease and stroke over 25 years.

New goal

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) are $18 billion in China; $11 billion in the Russian Federation; $9 billion in India; and $3 billion in Brazil.

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 per cent 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, with a bog impact on the labour supply, equivalent in income gain over the period of over $36 billion in China alone. But to achieve this e goal, all sectors of government, private industry, civil society and communities will have to work together, the WHO says.

Inexpensive and cost-effective measures include salt reduction in processed foods; improved school meals; and taxation of tobacco products. Other changes could provide better access to exercise facilities, walking and cycle ways, along with compact urban planning, to increase the opportunities for, and reduce barriers to, physical activity.

Source: Third World Network Features

Kanaga Raja is a researcher with Third World Network, based in Geneva.

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