Some shocking statistics on death and disease rates due to chronic diseases in developing countries are uncovered in the final paper in The Lancet Series on Chronic Disease and Development. Around 23 million deaths occur due to chronic diseases in just 23 high-burden countries, which represent some 60% of all chronic disease-related deaths globally each year. Six in every ten of those chronic disease deaths in the 23 countries are in people aged 70 or younger. In this final paper, Dr Ala Alwan, Non-communicable Diseases and Mental Health, WHO, Geneva, Switzerland, and colleagues take a critical look at progress in these nations over the past decade, and lament the inadequate coverage of basic interventions that could make a massive difference. They suggest a number of key surveillance strategies that are well within the scope of these countries despite their limited resources.
High smoking rates in men across many of these 23 nations (Russia 65%, China 57%) expose the lack of effective tobacco control therein. To review tobacco control progress, authors looked at elements required through WHO's Framework Convention on Tobacco Control (FCTC). WHO is assisting countries to implement some of the demand reduction measures of the FCTC including monitoring of tobacco use and prevention policies; protecting people from tobacco smoke; offering help to quit; warning about the dangers of tobacco; and, enforcing bans on advertising, promotion, and sponsorship, and raise taxes on tobacco products. Iran was a success here, having achieved all these goals except higher levels of taxation on cigarettes. The only country to increase taxes to at least 75% of the retail price of tobacco was Poland. Overweight and obesity are also big problems in these nations. For example, overweight in men ranged from 4% in Vietnam to 74% in Argentina, and in women from 3% in Ethiopia to 74% in Egypt.
In 14 of these 23 countries that had vital registration data, age-standardised death rates from chronic diseases were 711 per 100000 for men (58% higher than men in high-income countries), and 508 per 100000 for women (69% higher than women in high-income countries).
The authors predict that in these 23 nations, infectious disease rates will fall by 2% per year over the next 40 years, while cancer cases will increase by 1.1% per year and cardiovascular disease cases by 0.7% per year.
Despite these depressing numbers, things are improving, albeit slowly. Comparing assessments of country capacity from 2000 to 2010, many countries that lacked policies for chronic disease in some or most areas have been able to improve their situations. For example, 95% of countries had a dedicated chronic disease office within their Ministry of Health in 2010, compared to 70% in 2000.
The authors' propose a national surveillance framework for chronic diseases which encompasses key risk factors (consisting of behavioural, dietary, physiological, and metabolic factors), outcomes (mortality and morbidity), health-system response interventions, and health-system capacity. For every component of the proposed surveillance framework, a core and expanded set of indicators was proposed for global and national monitoring. Collection of data necessary to monitor these core indicators are within the capacity of all countries despite limited resources.
In conclusion, the authors say that despite the dearth in resources for and actions on chronic diseases in developing countries, great hope has emerged following the UN General Assembly Resolution on non-communicable diseases, which calls for higher priority to be placed on these conditions in health, national, and global agendas. There will be a high-level meeting of the General Assembly on chronic diseases in September 2011.
The authors say: "The UN resolution provides an unprecedented opportunity for countries, UN agencies, international development organisations, civil society, and the private sector to work jointly around a common vision and a road map to address the enormous chronic-disease burden that low-income and middle-income countries are increasingly facing. Challenges to prevention of non-communicable diseases, such as strengthened surveillance, more effective intersectoral action, and improved access to basic health care (including essential medicines and technologies), are key issues that are pivotal to include in the discussions over the coming months."
Paul Garwood, Communications Officer Noncommunicable diseases and Mental health, WHO. T) +41794755546 / +41227913462 E) Garwoodp@who.int
For full Series paper 5, see: http://press.thelancet.com/cdd5.pdf
Journal
The Lancet