Derek Yach, M.B.Ch.B., M.P.H., from the World Health Organization, Geneva, Switzerland, presented the special communication today at a JAMA media briefing at the National Press Club in Washington, D.C.
According to background information provided by the authors: "Chronic diseases are the largest cause of death in the world, led by cardiovascular disease (17 million deaths in 2002, mainly from ischemic heart disease and stroke) and followed by cancer ( 7 million deaths), and chronic lung diseases (4 million), and diabetes mellitus (almost 1 million). These leading diseases share key risk factors: tobacco use, unhealthful diets, lack of physical activity, and alcohol use."
Yach and colleagues write that the "global prevalence of all the leading chronic diseases is increasing, with the majority occurring in developing countries and projected to increase substantially over the next 2 decades." The authors note that "between 1990 and 2020, mortality [death] from ischemic heart disease in developing countries is expected to increase by 120 percent for women and 137 percent for men." The authors add that risks for chronic diseases are also rising with higher rates of smoking and obesity levels among adolescents in developing countries.
"Chronic diseases have not simply displaced acute infectious ones in developing countries. Rather, such countries now experience a polarized and protracted double burden of disease. India, the second most populous country, has the highest number of diabetics in the world and annual coronary deaths are expected to reach 2 million by 2010. At the same time, around 2.5 million children in India die from infections such as pneumonia, diarrhea, and malaria every year. In South Africa, infectious diseases account for 28 percent of years of lives lost while chronic diseases account for 25 percent." The authors add that the health services in these countries are being strained by the double burden.
"In most developing countries inadequate financing and lack of manpower to address chronic diseases have been major impediments to chronic disease control." The authors continue, "Many key decision makers still believe chronic diseases afflict only the affluent and the elderly and arise only from freely acquired risks and that their control is ineffective and too expensive and should wait until infectious diseases are addressed." The authors point out that "chronic diseases in developing countries are not just diseases of the elderly, since cardiovascular disease accounts for as many deaths in young and middle-aged adults as HIV/AIDS. Also, in developing countries chronic diseases affect a much higher proportion of people during their prime working years than in developed countries."
The authors write that "decision makers need to be fully informed with the up-to-date evidence about the burden and impacts of chronic disease." They add that health systems need to be realigned to accommodate diagnosis and prevention of chronic diseases. Policy leaders need to encourage transnational corporations to improve health while also putting into place new business models, and encourage creation of codes and incentives for healthy foreign investment. Coordinated and focused emphasis on chronic disease prevention with intensified attention to tobacco, unhealthy diets and physical activity, "is essential to address the enormity of the burden of those who now survive beyond childhood around the world," the authors conclude.
(JAMA. 2004;291:2616-2622. Available post-embargo at JAMA.com)
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