The global goal* of an additional 2% yearly reduction in mortality rates for chronic diseases would avert millions of deaths and save billions of dollars of GDP in low- and middle-income countries. Further, almost 80% of life-years gained would come from deaths averted in people aged under 70 years. These are the conclusions of Dr Colin Mathers, Department of Measurement and Health Information, World Health Organisation, Switzerland, and colleagues, authors of the first paper in The Lancet Chronic Diseases Series.
Averted deaths mean people live longer lives, hopefully in good health. Clearly, they will eventually die -- and possibly of a chronic disease, but this could occur much later if the strategies outlined in this Series are implemented. The research in this Series suggests that people in the 23 countries** studied in it will live more than 18 years longer -- this figure is calculated by dividing life years gained (454 million) by deaths averted (24 million).
The 23 countries** selected by the authors for their analysis account for around 80% of the total burden of chronic disease mortality in developing countries, including China, India, Russia, Brazil, Turkey, Mexico, Pakistan, South Africa, Poland and Nigeria. In these 23 countries, chronic diseases -- mainly cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes -- were responsible for 50% of the total disease burden in 2005. For 15 of the selected countries with death registration data, estimated death rates from chronic diseases were 54% higher for men and 86% higher for women than those for men and women in high-income countries.
The authors say: "If nothing is done to reduce the risk of chronic diseases, an estimated US$84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015." The 2% additional yearly reduction in mortality rates due to chronic diseases, if achieved, would avert 24 million deaths in these countries, and save almost 10% of the expected loss in income and around $8 billion collectively for the 23 countries by 2015.
Should nothing be done, chronic disease mortality -- which in 2005 accounted for 23.1 million deaths in these 23 countries -- is expected to cause 27.2 million deaths in 2015, and 34.3 million by 2030. In terms of percentages, chronic disease mortality caused 61% of all deaths in 2005, and is expected to cause 71% by 2030. For people aged under 70 years, chronic disease mortality, which caused 46% of deaths in this age group in 2005, will cause an estimated 53% of deaths by 2030. The paper looks at a case study of Brazil, which postulates that healthy life years gained by recent reductions in tobacco use have probably been offset by the effect of rising cholesterol and obesity levels. There, chronic diseases were estimated to account for 70.5% of all deaths in 2005.
The authors ask: "How realistic is the global goal proposal"". Under baseline projections, chronic disease death rates for 0-59 and 60-69 age groups are expected to fall by an annual average 0.3% and 1.2% respectively for these 23 countries. Thus the global goal would correspond to an annual average reduction of 2.3% for 0-59 year age group and 3.2% for the 60-69 year age group between 2005 and 2015. The authors say the experience of some high-income and middle-income countries show what can be achieved with sustained interventions. In the 0-59 age group, chronic disease death rates in, for example, El Salvador, Germany (men), and Panama fell by more than 2%. And in the 60-69 age group, average yearly decrease in chronic disease death rates exceeded 3% for several populations, including Australia, Czech Republic, and the UK (England and Wales). The authors also say that healthy life expectancy at birth would improve by between 0.7 and 2.1 years in the 23 countries should the global goal be achieved.
They conclude: "Although most communicable diseases are widely accepted as primarily diseases of poor people, policymakers do not fully understand that chronic diseases have also become diseases of poor people in most settings.
"The rising burden of chronic disease will be especially severe in low-income and middle-income countries, which are those than can least afford a health-related setback to development. In these countries, resources for treatment are already stretched to the limit, and chronic disease prevention -- focusing on reducing known, modifiable risk factors -- will therefore be central to incidence and mortality reductions."
This paper associated with this release can be found at http://www.eurekalert.org/jrnls/lance/CD1.pdf
*The Global Goal for reduction of chronic disease mortality was set out by WHO in 2005.
**The 23 countries studies in the Series are: Argentina, Bangladesh, Brazil, Burma, China, Colombia, Democratic Republic of Congo, Egypt, Ethiopia, India, Indonesia, Iran, Mexico, Nigeria, Pakistan, Philippines, Poland, Russia, South Africa, Thailand, Turkey, Ukraine, Vietnam.
Journal
The Lancet