Global Burden Of Chronic Diseases - A Challenge to Face

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By Dr. Judith Lobo, Muscat

Muscat, 28 April 2010: Every country in the world is affected by the rising tide of chronic diseases. The need for access to appropriate and affordable care for people with chronic conditions is of great concern. According to the World Health organization (WHO) Major diseases such as diabetes, cancer and cardiovascular and respiratory diseases are the world’s biggest killers, causing an estimated 35 million deaths each year. Out of these 80% of the deaths occur in the countries with low and middle income groups.

These diseases are preventable. Chronic diseases have traditionally been associated with the developed world and seen as diseases of affluence affecting mainly the elderly and the wealthy, while attention and resources in the developing world have been focused largely on communicable diseases. However, statistics show that 60% of deaths globally are due to chronic disease and 80% of these occur in low and middle income countries increasing numbers of working age people are affected due to these diseases. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health. According to a WHO statement, “The rapidly increasing burden of these diseases is affecting poor and disadvantaged populations disproportionately, contributing to widening health gaps between and within countries.”

Diabetes Facts (WHO 2009a): WHO estimates that more than 180 million people worldwide have diabetes. This number is likely to more than double by 2030. In 2005, an estimated 1.1 million people died from diabetes. Almost 80% of diabetes deaths occur in low and middle-income countries. Almost half of diabetes deaths occur among people under the age of 70 years; 55% of diabetes deaths are among women. WHO projects that diabetes deaths will increase by more than 50% in the next 10 years if urgent action is not taken. Most notably, diabetes deaths are projected to increase by over 80% in upper-middle income countries between 2006 and 2015.

Cardiovascular Facts (WHO 2009b): Cardiovascular Diseases(CVDs) are the number one cause of death globally: more people die annually from CVDs than from any other cause. An estimated 17.1 million people died from CVDs in 2004, representing 29%of all global deaths. Of these deaths, an estimated 7.2 million were due to coronary heart disease and 5.7 million were due to stroke. Low- and middle-income countries are disproportionally affected: 82% of CVD deaths take place in low and middle income countries and occur almost equally among men and women. By 2030, almost 23.6 million people will die from CVDs, mainly from heart diseases and stroke. These are projected to remain the single leading causes of death. The largest percentage increase of this disease will occur in the Eastern Mediterranean Region. However, the largest increase in number of deaths will occur in the South-East Asia Region.

Cancer Facts (WHO 2009c): Cancer is a leading cause of death worldwide: it accounted for 7.4 million deaths (around 13% of all deaths) in 2004. Lung, stomach, liver, colon and breast cancer cause the most cancer deaths each year. The most frequent types of cancer differ between men and women. It is believed that more than 30% of cancer deaths can be prevented. The use of tobacco is the single most important risk factor for cancer. Cancer arises from a change in one single cell. The change may be started by external agents or inherited genetic factors. Deaths from cancer worldwide are projected to continue rising, with an estimated 12 million deaths in 2030.

Chronic Respiratory Disease Facts (WHO 2009d): Hundreds of millions of people suffer every day from chronic respiratory diseases. Currently 300 million people have asthma, 210 million people have chronic obstructive pulmonary disease (COPD) while millions have allergic rhinitis and other often-under diagnosed chronic respiratory diseases. Like any other diseases, the Chronic Respiratory Diseases are also preventable.

Up to 80% of heart disease, stroke and type 2 diabetes and over a third of cancers could be prevented by eliminating shared risk factors, mainly tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. Unless addressed seriously, the mortality and disease burden from these health problems will continue to increase. WHO projects that globally deaths caused by Non-communicable diseases (NCD) will increase by 17% over the next 10 years. The greatest increase will be seen in the African region (27%) and the Eastern Mediterranean region (25%). The highest absolute number of deaths will occur in the Western Pacific and South-East Asia regions.

What are the Causes?

These are some of the major causes of the diseases listed above:
1. Urbanization and economic globalization;
2. Political and social policies;
3. Issues of social injustice as well as population ageing.
4. Disproportionate levels of poverty and poor living conditions.
5. Associated with these changes is an increase in the prevalence of the main modifiable risk factors: smoking, poor diet, lack of physical exercise, excessive use of alcohol, unsafe sexual practices, and unmanaged psychosocial stress. These give rise to intermediate risk factors including rise in blood pressure, rise in blood glucose, rise in cholesterol and obesity which lead to cardiovascular disease, stroke, some kind of cancers, chronic respiratory disease and diabetes.

How these Diseases can be Prevented?

(a) Individual level: Taking a decision today to participate in the disease prevention activities one can reduce the risk of chronic disease. These activities are simple but important: Stopping smoking, using nicotine replacement therapy if necessary; responsible drinking of alcohol, not exceeding maximum recommended levels; regular exercise at least the equivalent to a vigorous 30 minute walk three times a week; maintenance of appropriate weight and a healthy body mass index (BMI) and eating at least five helpings of fresh fruit and vegetables daily, reducing salt intake and switching to unsaturated fat.

Even for people who have the opportunity, resources and motivation to reduce their risk of developing chronic disease sustaining these activities until they become fully incorporated into day to day life can be challenging

(b) Societal level: Changes at societal level include among other things, policy changes related to taxes for example on tobacco and alcohol; legislation regarding smoking and drinking: policy changes related to food labeling, marketing and product manufacturing. Changes in industrial processes to reduce unhealthy food components – such as the amount of trans fat or salt in manufactured food can have a substantial impact on people’s diets.

India accounts for nearly a third of an estimated three million tobacco-related deaths in the world per year, and there has been a rise in pre-cancerous lesions in the mouth, which doctors are convinced are caused by chewing tobacco. Chewing tobacco has been socially acceptable and is increasingly popular across India particularly among the young. Mouth cancer has a ten year incubation period, so there is fear that a huge bout of oral cancer will hit India in a few years time. The State of Goa passed some of the toughest anti-tobacco laws in the world. The Goa Prohibition of Smoking and Spitting Act prohibits smoking and spitting chewed tobacco in public places of work or use, including bus stands, beaches, and public transportation. It bans all tobacco advertising in the state and the sale of tobacco products within 100 meters of a school or place of worship.

Reference: Report of World Health Organization.

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