The global burden of NCDs

Map showing age standardized death rate (per 100,000) from non-communicable diseases, both sexes. Death rates are considerably higher in low and middle (LIMC) countries. Source: WHO Global Infobase










Historically thought to be diseases of the high-income countries like the USA, NCDs are in fact a worldwide pandemic of devastating proportions. In 2005 alone there were an estimated 35 million deaths from heart disease, stroke, cancer and chronic respiratory diseases. Of these, 80% occurred in low and middle income countries (LMICs), twice as many deaths as from HIV, malaria and tuberculosis combined. Heart disease alone is the second leading cause of death in Africa and the leading cause of death in those over 30 years of age. In many countries, the poorer one is, the more likely one is to suffer or die from an NCD.

According to the World Economic Forum’s 2009 Global Risks Report,[6] NCDs pose a greater threat to global economic development than fiscal crises, natural disasters, and pandemic flu.

NCDs account for 60% of all deaths worldwide and are largely driven by factors that are woven into the fabric of societies and socioeconomic development. For example, increasingly urbanized societies in a rapidly globalizing world are exposed to marketing of tobacco products; diets high in fats, salt, sugar, and calories; concentrated availability of unhealthy foods; and characteristically more sedentary lifestyles through emergence of service-based economies and mechanized transportation methods. LMICs in particular, are experiencing accelerated rates of this socioeconomic transition.

It is no surprise then that the leading risks for mortality globally include high blood pressure, tobacco use, high blood glucose, physical inactivity, overweight and obesity, and high cholesterol. This pattern of mortality risks is consistent in all country income-groups, and the disproportionate toll (80%) in experienced in LMICs is more likely to occur during the most economically productive years of youth and middle age[7, 8]. As an illustration of this point, it has been estimated that 26.1% of coronary heart disease deaths in Mexico[9] and 35% of CVD-related deaths in India[10] occur in persons under 65 years of age; this contrasts starkly with the United States where only 12% of CVD-deaths occur in this age range.

Another disconcerting comparison of chronic infectious cancers shows that mortality rates associated with cervical cancer —a largely preventable malignancy— in Mexico (24 per 100,000) are several-fold higher than rates in Canada (4 per 100,000) and the US (5 per 100,000).[11]

Long-term costs of NCDs include treatment and productivity losses which impact micro- (individuals, families) and macro-level (societal) economies. Increases in burdensome healthcare costs, disability, absenteeism, and foregone income contribute to widening socioeconomic disparities, which in turn curtail individual and household lifestyle choices and vocational opportunities, perpetuating NCD risk and completing a vicious cycle.

At the family level, a loss of income due to NCDs is a tragedy for a family struggling for survival. Family income otherwise spent on housing and child education is instead spent on health care and treatment. For these reasons NCDs can contribute to poverty, trapping poor households in a cycle of debt and illness, and further increasing economic and social inequality.

At a societal level this lost productivity further compounds the challenges of economic growth. Continued and projected losses in productivity stifle economic development in LMICs – the same countries that also continue to be plagued by infectious diseases, nutritional deficiencies, and poor maternal and child health (e.g., Mexico’s infant and maternal mortality rates are 15 per 1000 and 60 per 100,000, respectively — both far higher than other OECD countries).[12-14]

Author: Dr Mohammed Ali

References

  1. Mathers, C.D., A.D. Lopez, and C.J.L. Murray, The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001, in Global Burden of Disease and Risk Factors,, A.D. Lopez, et al., Editors. 2006, Oxford University Press: New York.
  2. International Diabetes Federation. The human, social & economic impact of diabetes. Facts & Figures: The costs of diabetes 2007 February 2008]; Available from: http://www.idf.org/home/index.cfm?node=41.
  3. Economic Intelligence Unit, The silent epidemic: An economic study of diabetes in developed and developing countries, June 2007, The Economist New York, London, Hong Kong.
  4. Mathers, C.D. and D. Loncar, Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006. 3(11): p. e442.
  5. Strong, K., et al., Preventing chronic diseases: how many lives can we save? Lancet, 2005. 366(9496): p. 1578-82.
  6. World Economic Forum. Global Risks 2009: A Global Risk Network Report. January 2009 [cited 2010 October]; Available from: http://www.weforum.org/pdf/globalrisk/2009.pdf.
  7. Daar, A.S., et al., Grand challenges in chronic non-communicable diseases. Nature, 2007. 450(7169): p. 494-6.
  8. Yach, D., et al., The global burden of chronic diseases: overcoming impediments to prevention and control. JAMA, 2004. 291(21): p. 2616-22.
  9. Secretaria de Salud. Sistema Nacional de Informacion en Salud. 2007 [cited 2010 October 5th]; Available from: http://sinais.salud.gob.mx/mortalidad/index.html.
  10. Lopez, A.D. and C.C. Murray, The global burden of disease, 1990-2020. Nat Med, 1998. 4(11): p. 1241-3.
  11. Kuri-Morales, P., et al., The prevalence of chronic diseases and major disease risk factors at different ages among 150 000 men and women living in Mexico City: cross-sectional analyses of a prospective study. BMC Public Health, 2009. 9(1): p. 9.
  12. Directorate for Employment Labour and Social Affairs. Policy Note: Health Policy in Mexico. September 2006 [cited 2010 October 7th]; Available from: http://www.oecd.org/dataoecd/51/60/38120478.pdf.
  13. Yusuf, S., et al., Global Burden of Cardiovascular Diseases: Part I: General Considerations, the Epidemiologic Transition, Risk Factors, and Impact of Urbanization. Circulation, 2001. 104(22): p. 2746-2753.
  14. World Health Organization and UNICEF. Countdown to 2015 decade report (2000-2010): taking stock of maternal, newborn and child survival. 2010 [cited 2010 October 21st]; Available from: http://www.countdown2015mnch.org/.

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