June 25, 2018
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WHO warns of growing pace of death from noncommunicable diseases

By David Brown, The Washington Post

WASHINGTON — The world is facing a growing avalanche of death from heart attack, stroke, cancer, emphysema and diabetes, with many of the victims working-age people in poor countries. Up to half of those deaths could be prevented or deferred by implementing a short list of interventions, some by individual people and some by governments. But no country is doing all it could.

Those are the messages of a global scorecard on the prevention of chronic illnesses released Tuesday by the World Health Organization.

The 207-page document comes less than a week before a two-day meeting of the United Nations General Assembly on “noncommunicable diseases,” as this vast territory of human affliction is known. It arrived on the same day the U.S. government announced a plan to prevent 1 million heart attacks and strokes over the next five years.

“We are dealing now with a problem of huge magnitude. These are health problems increasing in all six regions of the world,” said Ala Alwan, an Iraqi physician and assistant director-general of WHO.

The report summarizes two decades of research challenging the view that people in poor countries die of infections and people in rich countries die of diseases brought on by the effects of overeating, smoking and a sedentary lifestyle. While not entirely untrue, that stereotype masked an overlooked and growing number of “rich-people’s diseases” in the developing world.

Noncommunicable diseases today cause 36 million of 57 million deaths each year (2008 statistics), or nearly two-thirds of global mortality. Most of the victims live in low- and middle-income countries, such as Kenya, Indonesia and Poland. More than 80 percent of deaths from cardiovascular disease and diabetes now occur outside industrialized nations such as the United States, France and Japan.

Particularly troubling, say the authors of the report, is the amount of “premature death” — defined in this case as death before age 60 — occurring in places where the incidence of the diseases is rising rapidly.

In low-income countries, 41 percent of people dying of heart attacks, strokes and cancer are younger than 60. In middle-income countries, the fraction is 25 to 28 percent; in high-income countries it’s 13 percent.

Premature death is especially common in Africa, the only continent where infectious diseases, childbirth-related deaths, malnutrition and fatal injury as a group still cause most deaths.

The attention on noncommunicable diseases pushes the global health community into a messy world of hard-to-change human behavior, powerful commercial interests and political debate about how much governments should do to protect people from themselves. It also competes with the two big international health efforts of the past decade — providing antiretroviral therapy to HIV patients in poor countries and accelerating the decline of maternal and child deaths.

Whether it will slow progress against those glaring health inequalities is a question just starting to be debated.

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