Africa,
Eastern Europe, and Asia face alarming chronic disease levels, way above
high-income countries
WASHINGTON, September 15, 2011 – The World
Bank warned today that heart disease, cancer, diabetes, chronic respiratory
conditions, and other non-communicable diseases (NCDs) increasingly threaten
the health and economic security of many lower- and middle-income countries,
and that most countries lack the money and health services to be able to ‘treat
their way out’ of the NCD crisis. On the eve of a special United Nations summit
on NCDs in New York, the Bank said the rise of chronic diseases, especially among
young working adults in these countries, was a danger that warranted immediate
global attention.
According to the new report−The Growing Danger
of Non-Communicable Diseases: Acting Now to Reverse Course−Africa, Eastern
Europe, and Asia face alarming chronic disease levels, in excess of those in
high-income countries where NCDs have long been the leading cause of death and
illness.
For example, in South Asia, where
cardiovascular disease is already a major cause of death and disability, people
have their first heart attacks at an average age of 53 compared with 59 in the
rest of the world. In the Middle East and North Africa, NCDs are growing among
women and adolescents, driven by factors unrelated to age, such as growing
rates of obesity and smoking. And ominously, one in four people in Ukraine
between the ages of 18 and 65 has a chronic disease with growing numbers of
young people being affected, prompting the conclusion that the country could
‘lose the next generation to chronic disease.’
If current trends persist, the new report says
that Sub-Saharan Africa will be the region hardest-hit by the NCDs crisis. If
left unchecked, chronic diseases will account for 46 percent of all deaths by
2030, up from 28 percent in 2008. South Asia could see the share of deaths from
NCDs increase from 51 to 72 percent during the same period. More than 30
percent of these deaths will be premature and preventable. At the same time,
these countries will continue to grapple with the widespread prevalence of
communicable diseases such as HIV, malaria, tuberculosis, and mother and child
conditions, thus facing a “double burden” of disease not experienced by
wealthier nations.
“What makes the development impact of chronic
diseases so daunting for lower and middle income countries is that they don’t
have the money and the health systems to treat their way out of this crisis,
and they’re facing it at far earlier stages of economic progress than their
better-off OECD neighbors had to,” says Tamar Manuelyan Atinc, the Bank’s Vice
President for Human Development.
Prevention
is vital to stop and reverse NCDs
The Bank reports says that much of the rise in
chronic diseases in developing countries can be traced to individual risk
factors such as physical inactivity, malnutrition in the first thousand days of
life, unhealthy diet (including
excessive salt, fat, and sugar intake), tobacco use, alcohol abuse, and
exposure to environmental pollution.
Country evidence suggests that more than half
of the NCD burden could be avoided through effective health promotion and
disease prevention programs that tackle such risk factors. Particularly
effective at very low costs are measures to curb tobacco, such as taxes, as
indicated in the WHO Framework Convention on Tobacco Control, and to reduce
salt in processed and semi-processed foods.
In India this has meant, among other things,
subsidizing and promoting kitchen stoves that use clean fuels and do not cause
respiratory disease. In Bogotá, Colombia, the city government has built cycle
paths across the city and has started a community exercise program that takes
place every Sunday and now draws the active participation of more than a
million pedestrians and cyclists each week.
The report notes that a compelling OECD
example comes from New York City, where the mayor brought the health sector and
hospitality industries together to reduce smoking and ban the use of
trans-fats. The proportion of restaurants using trans-fats fell from 50 percent
to less than 2 percent in two years, while the percentage of adult New Yorker
smokers fell from 21.5 percent to 15.8 percent during the same period.
“The good news is that with prevention first,
the reduction of risk factors such as smoking through the use of tobacco taxes,
and the right political and community leadership in place, countries can stem
the rise of chronic diseases and cushion their financial and social effects,”
says Dr. Cristian Baeza, the Bank’s Director of Health, Nutrition, and
Population, whose team produced the new report.
Baeza says it will be vital to prepare health
systems in developing countries to deliver cost-effective and fiscally
sustainable health NCDs care for poor people, and that comprehensive prevention
programs can target a number of risk factors at the same time. For example, a
prevention program in Finland’s North Karelia province, which targeted diet,
exercise, and smoking, showed that between 1972 and 2006, the province’s yearly
deaths from chronic heart disease fell by some 85 percent. An anti-smoking
effort in Uruguay, championed by the country’s president, banned smoking in
public places and workplaces and reduced air nicotine concentrations in the
capital city by 91 percent over five years.
Anti-NCD measures can work quickly
On the eve of the special UN summit on NCDs in
New York, the new Bank report says that the best examples of anti-NCD measures
show that these can improve health faster than commonly thought—within a few
years of eliminating people’s exposure to risk factors. As the report notes in
conclusion, “Leaders at the national and local level have the power to save
many lives, avoid widespread suffering, and forestall major human and economic
cost, all within a short space of time. Now is the time to act.”
In fiscal year 2011, the Bank mobilized $2.96
billion in financing for health, nutrition, and population. The portfolio is at
a historic high of $ 10.8 billion, more than half of which goes to the world’s
poorest countries.
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