The worldwide rise of chronic noncommunicable diseases: a slow-motion catastrophe
Dr Margaret Chan
Director-General of the World Health Organization
Minister Golikova, distinguished delegates, ladies and gentlemen,
Let me thank the government of the Russian Federation for convening this ministerial conference on healthy lifestyles and noncommunicable disease control.
This is the first such meeting of its kind, and it sends a powerful signal on at least three fronts.
First, it speaks to the significance of these diseases as one of the most serious, and most prevalent, threats to health in the 21st century.
Second, it places a rightful emphasis on promoting healthy lifestyles. And third, it stresses the vital need to engage multiple sectors in the fight to combat these diseases.
Let me elaborate on each of these three points.
First, the significance of the threat. This is a costly threat in its social, economic, and health dimensions, and the threat is spreading.
The epidemic is being driven by powerful, almost universal trends, namely demographic ageing, rapid unplanned urbanization, and the globalization of unhealthy lifestyles. These trends are not easily reversed.
In a sense, this is a slow-motion catastrophe, as most of these diseases develop slowly. But unhealthy lifestyles that fuel the epidemic are spreading with a stunning speed and sweep.
In an alarming shift, nearly 80% of the burden of diseases like cardiovascular disease, diabetes, cancer, and chronic respiratory diseases is now concentrated in low- and middle-income countries.
In poor and vulnerable populations, people with these diseases fall sicker sooner and die earlier than their counterparts in wealthier societies.
Chronic noncommunicable diseases are not neglected diseases. Their initial burden was concentrated in affluent societies with strong R&D capacities. Effective treatments are available and constantly being improved.
In wealthy countries, deaths from heart disease and strokes have declined significantly, cancer patients are being cured or surviving longer and people with diabetes have better access to essential and effective treatments.
But this apparent success gives a distorted picture. It leaves the impression of a manageable situation and conceals what is, in reality, an impending disaster.
When drugs are available to reduce blood pressure, lower cholesterol, and improve glucose metabolism, the situation looks somehow under control. This appearance is misleading. The root causes of these diseases are not being addressed. The failure to promote population-wide preventive measures is evident in just a few statistics.
Worldwide obesity rates have almost doubled since 1980. The epidemic of diabetes, which is closely associated with obesity and urbanization, has skyrocketed in rich and poor countries alike. This is a world in which more than 40 million pre-school children are obese or overweight.
Comforting assumptions that noncommunicable diseases are somehow being managed carry three serious dangers.
First, they fail to consider the spiralling costs of chronic care. In some countries, the costs of caring for diabetes alone consume nearly 15% of the national health budget.
Second, they blunt the signals of an urgent need for sweeping policy changes aimed at prevention.
Third, they fail to recognize that many interventions are currently beyond the financial reach of countries with limited resources and exceed their coping capacity.
While the diseases themselves have not been neglected by R&D, the need to find solutions that work in low-income settings has been almost totally neglected.
The consequences for societies and economies are devastating everywhere, but most especially so in poor, vulnerable, and disadvantaged populations. Health services are almost totally unprepared to cope with the onslaught of chronic demands that come with the rise of noncommunicable diseases.
In large parts of the developing world, these diseases are detected late, when patients need extensive and expensive hospital care for severe complications or acute events. Many cancer patients present so late that the only viable option is pain relief and a dignified death.
Most of this care is covered through out-of-pocket payments, leading to catastrophic medical expenditures.
For all of these reasons, chronic noncommunicable diseases deliver a two-punch blow to economies and development. They cause billions of dollars in losses of national income, and they push millions of people below the poverty line, each and every year.
Ladies and gentlemen,
When we look at the particular focus of this meeting, on promoting healthy lifestyles, the situation looks far more optimistic.
Yesterday, WHO released its first global status report on noncommunicable diseases. Some of the news is good. Current evidence unequivocally demonstrates that chronic noncommunicable diseases are largely preventable.
In a key achievement, the report sets out a menu of options for addressing these diseases through both population-wide interventions, aimed at prevention, and individual health care interventions, aimed at early detection and treatment.
Many of these interventions can prevent disease in the first place, or slow progression to severe disease and its costly complications.
To aid priority setting and encourage immediate action, the report puts forward a series of highly cost-effective “best buys”. Primary health care is clearly identified as the best framework for implementing recommended interventions.
We know the lifestyle factors that need to change: tobacco use, unhealthy diets, the harmful use of alcohol, and inadequate physical activity. The report gives us the statistical baseline for measuring changes in these and other areas.
Tobacco control is an excellent “best buy”. Through price increases, workplace bans on smoking, health warnings, and bans on advertising, an estimated 5.5 million deaths can be averted each year. Tobacco control in a low-income setting costs less than 40 cents per person.
Some recommended measures are extremely simple. A very low-cost regimen of four generic drugs can significantly reduce deaths in people at high risk of cardiovascular disease.
But the report is also realistic. As noted, the epidemic of these diseases already extends far beyond the capacity of lower-income countries to cope.
This brings me to the third point, the need to engage multiple sectors when devising population-wide preventive measures that contribute to healthy lifestyles. Promoting healthy lifestyles is best done at the policy level.
Though the health sector bears the brunt of these diseases, most preventive policies fall within the domain of non-health sectors, like trade, agriculture, customs, industry affairs, urban design, and education. Good policies in these sectors represent a whole-of-government approach that makes healthy choices the easy choices.
Civil society organizations have a major role to play, as do food and beverage corporations. As just one example, the industrialization of food production and the globalization of its marketing and distribution have brought processed foods, rich in fat, sugar, and salt, but low in essential nutrients, into every corner of the world.
In many cases, highly processed foods are the cheapest and most convenient way to fill an empty stomach. They are also the most unhealthy way.
The world certainly needs to feed its nearly seven billion inhabitants. But we do not need to feed them junk food.
Ladies and gentlemen,
The September high-level meeting on noncommunicable diseases is an opportunity that the health sector must seize. We dare not fail.
Leading up to that event, this Moscow meeting will help us sharpen our evidence and arguments and sound a loud alarm.
The WHO global status report spells out options and establishes priorities, for different resource settings, for each of these diseases. We know what needs to be done.
But the warning remains stark. In the absence of urgent action, the rising financial burden of these diseases will reach levels that are beyond the capacity of even the wealthiest countries in the world to cope.