Global Chronic Diseases

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Science  21 Jan 2005:
Vol. 307, Issue 5708, pp. 317
DOI: 10.1126/science.1108656

Chronic diseases, particularly cardiovascular disease (CVD), type 2 diabetes, cancer, and chronic respiratory disease, account for more than 50% of all deaths worldwide. Tobacco use, poor diet, and physical inactivity are among the major risk factors contributing to this disease burden. Yet even as the harmful impact of these diseases on health and economies strengthens and spreads globally, there is still only limited public health, financial, and political support for programs aimed at their prevention. One reason for this neglect has been the belief by governments and philanthropists that chronic diseases are afflictions of affluent populations who have led a life of sloth. In reality, these diseases are now global problems that have been driven by profound changes in consumption patterns. Ubiquitous marketing of tobacco and unhealthy food introduces children to (and in the case of tobacco, addicts them to) lifestyles that greatly elevate their disease risk. Rapid changes in transport, work, and leisure activities have led to a global collapse in physical activity levels. Overall, unhealthy choices have become the easy choices.

Already, chronic diseases exert a significant negative impact on the health and economies of developing countries. A recent World Bank analysis of how best to improve health in Europe and Central Asia concluded that measures to control CVD would produce more gains in life expectancy than would measures to address the Millennium Development Goals* that focus on selected infectious diseases and maternal and child health. This finding probably applies to many of the 4 billion people living in low- and middle-income countries. About 3 million deaths from CVD occur annually in both India and China. One million tobacco-related deaths occur annually in China and 700,000 in India. With 1 in 5 children in the world now smoking and 1 in 10 classified as overweight or obese, future prospects regarding CVD and type 2 diabetes are grim. Because chronic diseases diminish worker productivity, investor returns in developing countries will be affected, which in turn will likely affect the growth of countries within the Organization for Economic Co-operation and Development. Recent reports by investment banks have raised concerns that transnational corporations and pension funds face future risks from the rise in obesity rates.


Governments internationally need to act more decisively. The implementation of two major strategies adopted by all governments at World Health Assemblies could make a huge difference in global prevention of the major risk factors driving the chronic disease epidemics: the Framework Convention on Tobacco Control (FCTC), adopted in 2003; and the Global Strategy on Diet, Physical Activity and Health (Global Strategy), adopted in 2004. The FCTC will carry the force of international law when it takes affect on 28 February 2005. Already, it has stimulated increases in tobacco excise taxes, the implementation of marketing bans, and the introduction of smoke-free public places in many countries. These actions have been well documented as effective. In contrast, because there are no long-term best practices against obesity or physical inactivity, applied research is needed to assess the effectiveness of the core educational, legislative, intersectoral, and financial elements of the Global Strategy as it is implemented.

Efforts in chronic disease prevention can often take decades to yield benefits. Potentially, these benefits could be achieved more rapidly by investing in clinically based primary care treatments that focus on people at elevated risk for chronic disease, particularly CVD and diabetes. The recent report by the World Health Organization on Priority Medicines for Europe and the World emphasizes the need to expand access to currently available smoking cessation products, antihypertensives, statins, and aspirin, while investing in research to develop heat-stable insulin and a “polypill” to prevent complications and recurrences in patients with CVD.

At the core, chronic disease prevention and health promotion require a shift in thinking and actions by governments and diverse stakeholders. Each society must decide what it is willing to do and pay to help make healthy choices become the easy choices. The gains for global health and economy could be profound.

  • *World Bank, Millennium Development Goals for Health in Europe and Central Asia. Relevance and Policy Implications (World Bank, Washington, DC, 2004).

  • Too Big to Ignore: The Impact of Obesity on Mortality Trends (Swiss Reinsurance Company, Zurich, Switzerland, 2004).

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