March 2001 Insights Health Issue #1
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Diseases of affluence?
Global trends and predictions
NCDs are often called 'diseases of affluence'. They
include cancer, heart disease, stroke, diabetes and lung disease - all
frequently linked in popular perception to a wealthier 'Western'
lifestyle. But are NCDs restricted to the rich?
The Global Burden of Disease Study, carried out by the
World Bank and WHO in the early 1990s, provides the most comprehensive
international data on the causes of ill-health and death. There are
three groups of diseases:
1. Communicable, perinatal, maternal and nutritional
2. NCDs
3. Injuries.
As Figure 1 shows, the absolute
number of deaths from NCDs in 1990 was greater in the developing world
than in higher income regions. Although infectious diseases such as HIV,
malaria and TB are a major burden for the developing world, the death
rates for NCDs are even higher - causing half of all deaths. Only in
India and sub-Saharan Africa do group 1 causes still predominate.
Figure 1
Source: Mortality by cause for eight regions of the world, Global
Burden of Disease Study, The Lancet 349 pp 1269-76 by C. Murray and A.
Lopez (May 3rd 1997)
The death rate from NCDs is predicted to rise. The
'epidemiological transition' describes the change in a nation's health
as it develops economically. Initially there is a decrease in infant and
adult mortality from infectious diseases and birth rates fall in
response. Life expectancy increases and the population ages. As the
number of adults relative to children rises, the commonest health
problems become those of adults, producing a surge in NCDs. Some
developing countries are well advanced in the epidemiological
transition, whereas much of sub-Saharan Africa remains in an early
phase.
Figure 2 shows the predicted
trends in deaths in developing countries due to different causes. By the
year 2020, NCDs are expected to account for seven out of every ten
deaths in lower income regions. Deaths due to tobacco use are projected
to rise from three million worldwide in 1990 to 8.4 million in 2020,
surpassing deaths from any single disease, including the HIV epidemic.
Health policy in all countries will need to adapt to cope with these
changes.
Figure 2
Source: Summary: The global burden of disease, WHO, Geneva,
Switzerland by C. Murray and A. Lopez (1996) |
