By Alessandro R Demaio
The World Health Organization (WHO) has just
released its Global Status
Report on Noncommunicable Diseases, the second in a series
tracking worldwide progress in the prevention and control of
cancers, lung disease, diabetes and cardiovascular disease. It
focuses on how to reach the internationally agreed overarching
target of a 25 per cent reduction of premature mortality
from these four major non-communicable diseases by 2025.
Read more: Bad lifestyle choices kill 16m each year -
in 2013, the target is to be reached via nine goals including
reducing harmful use of alcohol, increasing physical activity and
lowering salt or sodium intake as well as tobacco use.
They also include halting the rise of diabetes and obesity and
improving coverage of treatment and prevention of heart attacks and
strokes. There's also a goal for improving the availability and
affordability of technologies and essential medicines for
For those who don't follow the machinations of the WHO, this may
all seem a little confounding, or even esoteric. But don't let the
almost innocuous title fool you - non-communicable diseases are one
of the biggest threats facing humanity today.
The bigger picture
Non-communicable diseases, which are sometimes called
"lifestyle" or "chronic diseases", are caused by common risk
factors. The good news is that they can also be prevented by
largely shared strategies. Tobacco control, for example, helps
reduce cancers, heart disease, stroke and lung diseases - all of
which are non-communicable diseases. Improving the diet of
populations will help avoid obesity, cancer, diabetes and heart
attacks - also all non-communicable disease.
Non-communicable diseases were of little public health concern
as recently as a couple of decades ago, but their burden has since
skyrocketed. The prevalence of diabetes in Australia, for
instance, has more than doubled in the last 25 years, from about 2
per cent to 4 per cent. In the
United Kingdom and
United States, the number of people living with diabetes has
more than doubled and tripled, respectively.
The picture is even grimmer in the developing world. Over the
same period as above, the prevalence of
diabetes in China rose even more starkly, from 1 per cent
in 1980 to almost 12 per cent today - or 114 million people.
Non-communicable diseases now kill more people than any other
cause across the world; they were responsible for 38 million (68
per cent) of the world's 56 million deaths in 2012. More than 40
per cent of them (16 million) were premature deaths - that is, the
people who died were under the age of 70 years.
Almost three-quarters of all such deaths (28 million), and the
majority of premature deaths (82 per cent), occur in the world's
low- and middle-income countries.
Seven things you need to know
Today's WHO report aims to outline the how to for governments
around the world, providing the most effective methods for
achieving these goals. But for those of us not in positions to make
decisions that could stop the wave of non-communicable diseases,
here are seven key lessons from this latest update.
1. Bad news for the poor
Non-communicable diseases cause poverty and poverty causes
non-communicable diseases. The burden of these diseases is
concentrated in poor and sometimes the poorest populations. It acts
as a barrier to economic development and has the potential to undo
the progress of the past few decades.
Even in developed countries, such as the United States,
research shows a strong link between poor people and
higher risk of obesity and related diseases.
2. Some countries are doing better
While some countries are doing well in the fight against these
illnesses, many are not doing much to address their risk factors
and impacts. The report urges governments to take heed of the
growing evidence base and proven case studies from around the world
in the fight against non-communicable diseases.
These include Australia's efforts in plain packaging tobacco,
UK's food labelling laws and the growing number of nations
with childhood junk food
advertising bans and taxes on junk food.
It also points to the many gaps in national policies globally.
This is particularly an issue in low- and middle-income countries,
which often face fierce opposition and even legal challenge from
the private sector, just as Australia is facing the challenge to
plain packaging law in the World Trade Organisation.
3. Governments need to start acting
Government inaction is often not a matter of a lack of money,
but money ill-spent, according to this report. Cost-effective
interventions are available for avoiding a third of all
cancers and 80% of heart disease and diabetes. Governments just
have to choose and invest wisely - and we have to demand this of
This challenge is not just a risk to health either.
Research reported in the American Diabetes Association
journal states that the links between obesity, inactivity and
poverty may be too costly to ignore. Non-communicable disease
including obesity-associated chronic disease already account for 70
per cent of all US health costs.
4. Talk is cheap
nine voluntary global targets for the prevention and
mitigation of non-communicable diseases are an important start, but
the WHO is calling on governments to also set local targets and
ways of monitoring their achievements. This would allow countries
to tailor their efforts and interventions for greater
effectiveness. It would also help them target the non-communicable
disease most affecting their populations.
5. Not just health
Non-communicable diseases are caused - and so can be solved - by
collaboration across traditionally divided actors and sectors,
including agriculture and food production, urban planning, water
and air management, transport and engineering, among others.
For a new challenge, we need new platforms for change. Consider
the EAT Stockholm Food
Forum, which is a multilateral platform convening leading
scientific, policy, private sector and civil society thinkers on
the interrelated challenges of non-communicable diseases, food
systems and climate change.
6. Investing in health systems
The report is a reminder that spending on health is an
investment - both economic and social - and that it must be seen as
such. Even countries with strong health-care systems can do better,
and the key is prevention.
Investing in cost-effective strategies that will nip
non-communicable diseases in the proverbial bud is our only hope if
we are to afford an ageing population, the rising obesity burden
and the greater expected burdens of chronic disease.
7. A new type of health worker
The report reinforces the idea that, as the major diseases
affecting the population change, so too must the skills of doctors,
nurses and other health staff.
Prevention, public health and public policies are the most
effective responses to reducing non-communicable diseases without
blowing health-care budgets, so we need to start teaching talking
about them in courses that are not related to health. We need to
start talking about the causes and ways to prevent these diseases
with urban planners, food experts, agriculturalists and
agronomists, and economists, to name just a few related
Non-communicable diseases are a growing, urgent and universal
health challenge affecting almost every one of us. These diseases
and their environmental, commercial and social drivers are here to
stay, unless we take local and international action. The WHO is
urging governments - and those who vote them in - to prioritise
action on this rising global burden.
Alessandro R Demaio is an Australian Medical Doctor;
Postdoctoral Fellow in Global Health & NCDs at Harvard
At time of publication, Dr Alessandro R Demaio is an
advisory board member of the not-for-profit EAT Stockholm Food