Map showing age standardized death rate (per 100,000) from non-communicable diseases, both sexes. Death rates are considerably higher in low and middle (LIMC) countries. Source: WHO Global Infobase
Historically thought to be diseases of the high-income countries like the USA, NCDs are in fact a worldwide pandemic of devastating proportions. In 2005 alone there were an estimated 35 million deaths from heart disease, stroke, cancer and chronic respiratory diseases. Of these, 80% occurred in low and middle income countries (LMICs), twice as many deaths as from HIV, malaria and tuberculosis combined. Heart disease alone is the second leading cause of death in Africa and the leading cause of death in those over 30 years of age. In many countries, the poorer one is, the more likely one is to suffer or die from an NCD.
According to the World Economic Forum’s 2009 Global Risks Report, NCDs pose a greater threat to global economic development than fiscal crises, natural disasters, and pandemic flu.
NCDs account for 60% of all deaths worldwide and are largely driven by factors that are woven into the fabric of societies and socioeconomic development. For example, increasingly urbanized societies in a rapidly globalizing world are exposed to marketing of tobacco products; diets high in fats, salt, sugar, and calories; concentrated availability of unhealthy foods; and characteristically more sedentary lifestyles through emergence of service-based economies and mechanized transportation methods. LMICs in particular, are experiencing accelerated rates of this socioeconomic transition.
It is no surprise then that the leading risks for mortality globally include high blood pressure, tobacco use, high blood glucose, physical inactivity, overweight and obesity, and high cholesterol. This pattern of mortality risks is consistent in all country income-groups, and the disproportionate toll (80%) in experienced in LMICs is more likely to occur during the most economically productive years of youth and middle age[7, 8]. As an illustration of this point, it has been estimated that 26.1% of coronary heart disease deaths in Mexico and 35% of CVD-related deaths in India occur in persons under 65 years of age; this contrasts starkly with the United States where only 12% of CVD-deaths occur in this age range.
Another disconcerting comparison of chronic infectious cancers shows that mortality rates associated with cervical cancer —a largely preventable malignancy— in Mexico (24 per 100,000) are several-fold higher than rates in Canada (4 per 100,000) and the US (5 per 100,000).
Long-term costs of NCDs include treatment and productivity losses which impact micro- (individuals, families) and macro-level (societal) economies. Increases in burdensome healthcare costs, disability, absenteeism, and foregone income contribute to widening socioeconomic disparities, which in turn curtail individual and household lifestyle choices and vocational opportunities, perpetuating NCD risk and completing a vicious cycle.
At the family level, a loss of income due to NCDs is a tragedy for a family struggling for survival. Family income otherwise spent on housing and child education is instead spent on health care and treatment. For these reasons NCDs can contribute to poverty, trapping poor households in a cycle of debt and illness, and further increasing economic and social inequality.
At a societal level this lost productivity further compounds the challenges of economic growth. Continued and projected losses in productivity stifle economic development in LMICs – the same countries that also continue to be plagued by infectious diseases, nutritional deficiencies, and poor maternal and child health (e.g., Mexico’s infant and maternal mortality rates are 15 per 1000 and 60 per 100,000, respectively — both far higher than other OECD countries).[12-14]
Author: Dr Mohammed Ali
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