Malaria and HIV often get the headlines in stories about global health problems, but the biggest threats in poor countries are the same ones afflicting the wealthy and well-fed: lack of exercise, smoking and diets brimming with fat, salt and sugar.
Chronic, or noncommunicable, disease recently became the world's leading killer, accounting for 63 percent of deaths in 2008, according to the U.N.'s World Health Organization (WHO).
The effects of modern lifestyles — including greater reliance on automobiles, pollution, increases in smoking and unhealthy diets are spreading preventable cancers, diabetes and respiratory and heart disease to every corner of the globe. The illnesses are having the greatest impact, however, where poverty is rampant and health systems are inadequate.
The vast majority of cancers in the developing world, for example, are detected in their late stages, but effective treatments are lacking in general. In Uganda, 96 percent of those who die from cancer never see a health care provider. Moreover, in many developing countries, even pain medications for cancer often are unavailable.
Chronic diseases are killing people at earlier ages in developing countries than in the developed world. Nearly 30 percent of deaths from noncommunicable diseases occur among people under age 60 in low- and middle-income countries, compared to 13 percent in high-income countries.
“In wealthy countries, deaths from heart disease and strokes have declined significantly,” said Margaret Chan, WHO's director-general. “But this gives a distorted picture. For some countries, it is no exaggeration to describe the situation as an impending disaster — a disaster for health, for society and most of all for national economies.”
In September the United Nations unanimously called chronic diseases “a challenge of epidemic proportions” and set out a plan to develop global and national goals for disease reduction, particularly in low- and middle-income areas.
Included in draft targets are recommendations to reduce smoking and decrease salt levels in food. The WHO also developed a list of low- or no-cost disease-prevention steps that countries could adopt, such as promoting public awareness about diet and physical activity.
In addition, the U.N. is working to accelerate implementation of the WHO Framework Convention on Tobacco Control, an international health treaty developed in 2003 that promotes tobacco regulation.
As in the United States, attacking chronic diseases requires a multiprong approach, including strengthening health systems, changing government policies in areas such as urban planning and school physical education requirements and encouraging the involvement of business.
The global food industry has resisted stiffer government regulations, but some companies are participating in voluntary efforts. In 2008, the International Food and Beverage Alliance, which includes such giants as Coca-Cola, Kraft and Kellogg's, committed to five actions over five years to make products healthier: Reformulating food content, providing nutrition information to consumers, advertising responsibly, raising awareness of nutritious diets and promoting physical activity.
But some U.N. officials say such voluntary efforts are too weak to adequately address global health problems.
“World leaders must not bow to industry pressure,” said Olivier De Schutter, U.N. Special Rapporteur on the Right to Food, a watchdog role at the international organization. “It is crucial for world leaders to counter food-industry efforts to sell unbalanced processed products and ready-to-serve meals too rich in trans fats and saturated fats, salt and sugars. Food advertising is proven to have a strong impact on children and must be strictly regulated in order to avoid the development of bad eating habits early in life.”
Despite the rapid growth in chronic illnesses around the globe, international aid aimed at helping developing countries improve their health systems has been weak. Only an estimated 3 percent of health-related development assistance is devoted to chronic disease. That isn't expected to change any time soon as major donors, including the United States, face their own economic woes and continue to focus on current funding commitments, primarily to fight AIDS, tuberculosis, malaria and afflictions facing children and pregnant women.
Some view the focus as shortsighted. Without a stronger effort to reduce chronic diseases globally, said Ann Keeling, chair of NCD Alliance, an international coalition that focuses on the problem, “the world is essentially sleepwalking into a sick future.”
— Nellie Bristol