WHO: Chronic diseases could kill 35 million in 2005
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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.
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 invest-
ment', WHO said that the estimated 35 million deaths this year
is double the number of deaths from all infectious diseases (in-
cluding HIV/AIDS, tuberculosis and malaria), maternal and peri-
natal 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 dis-
eases 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 re-
ality 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 dis-
ease, stroke and type-2 diabetes and 40% of cancer would be pre-
vented.
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 dis-
orders are other chronic conditions that account for a substan-
tial portion of the global burden of disease.
The causes of the main chronic disease epidemics are well estab-
lished 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 identi-
fied, 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 in-
tentional 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 Direc-
tor-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 proc-
essed 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 to-
tal energy, fats, salt and sugar. The increased consumption of
these foods in these countries is driven partly by shifts in de-
mand-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 ef-
fects 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 liv-
ing in urban areas rose from 16% to 50%. Urbanization creates
conditions in which people are exposed to new products, tech-
nologies, and marketing of unhealthy goods, and in which they
adopt less physically active types of employment.
As well as globalization and urbanization, rapid population age-
ing 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 complica-
tions 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 choles-
terol, 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 mil-
lion people die as a result of low fruit and vegetable consump-
tion; 2.6 million people die as a result of being overweight or
obese; 7.1 million people die as a result of raised blood pres-
sure; 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 re-
port said that deaths from chronic diseases are projected to in-
crease 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 perina-
tal conditions, and nutritional deficiencies combined; 41 mil-
lion people will die from chronic diseases; cardiovascular dis-
eases will remain the single leading cause of death, with an es-
timated 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 na-
tional health expenditure in the United States, and from 2% to
3.5% in other countries. The direct health expenditures attrib-
utable to physical inactivity have been estimated at approxi-
mately 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 dis-
ease and stroke over 25 years would result from lowering the
population blood pressure level by 2 mmHg, by means of a reduc-
tion 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 dis-
ease, 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 approxi-
mately three and six times those of 2005. The cumulative and av-
erage losses are higher in the larger countries like China, In-
dia 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 pre-
vent 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. Cardiovascu-
lar diseases and cancers are the diseases for which most deaths
would be averted.
The averted deaths would translate into substantial labour sup-
ply 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, pri-
vate industry, civil society and communities will have to work
together, WHO said.
The report examined the vast evidence-based knowledge about in-
expensive 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 opportuni-
ties for, and reduce barriers to, physical activity.