“We are dealing now with a problem of huge magnitude. These are health problems increasing in all six regions of the world,” said Ala Alwan, a WHO assistant director general.
The devastating effects of this epidemic have prompted the U.N. General Assembly to convene a two-day session next week on “noncommunicable diseases,” as this vast territory of human affliction is known. It’s a global focus comparable to the two big international health efforts of the past decade — providing anti-retroviral therapy to people with HIV in poor countries, and accelerating the decline of maternal and child deaths.
The attention on noncommunicable diseases and on a short list of ways to combat them pushes the global health community into a messy world of hard-to-change human behavior, powerful commercial interests and political debate about how much governments should do to protect people from themselves.
Whether it will slow progress against those glaring health inequalities is a question just starting to be debated. But the problem is too big to ignore.
“Every year that passes, the noncommunicable diseases get bigger,” said Christopher J.L. Murray, a co-author of the landmark 1993 “Global Burden of Disease” report, which was the first to rigorously catalogue the toll. “The trends are all pretty clear, the message has been repeated over and over, and it has slowly gotten traction.”
The WHO report summarizes two decades of research challenging the view that people in poor countries die of infections, and people in rich countries die of diseases brought on by the effects of overeating, smoking and a sedentary lifestyle. While not entirely untrue, that stereotype masks an overlooked and growing number of “rich-people’s diseases” in the developing world.
Noncommunicable diseases cause 36 million of 57 million deaths each year, or nearly two-thirds of global mortality, based on 2008 statistics, the most recent available. Most of the victims live in low- and middle-income countries — places such as Kenya, Indonesia and Poland. More than 80 percent of deaths from cardiovascular disease and diabetes occur outside industrialized nations such as the United States, France and Japan.
Particularly troubling, say the authors of the report, is the amount of “premature death” — defined in this case as death before age 60 — occurring in places where the incidence of the diseases is rising rapidly.
In low-income countries, 41 percent of people dying of heart attacks, strokes and cancer are younger than 60. In middle-income countries, the fraction is 25 to 28 percent; in high-income countries, it’s 13 percent.