The staggering toll of noncommunicable diseases

October 29, 2013 — Chronic diseases including heart disease, diabetes, and cancer, are the leading cause of death worldwide, with the burden falling heaviest in low- and middle-income countries. A new article by Harvard School of Public Health (HSPH) researchers outlines the global burden of chronic, or noncommunicable, diseases and proposes ways in which national leaders and heads of international organizations can develop systems to cope with these long-term conditions that the authors call the “dominant global public health challenge of the 21st century”.

The article was published October 3, 2013 in the New England Journal of Medicine as part of a series on global health edited by co-author David Hunter, Vincent L. Gregory Professor in Cancer Prevention and Dean for Academic Affairs at HSPH, and Harvey Fineberg, president of the Institute of Medicine and former Dean of HSPH.

According to World Health Organization (WHO) estimates, noncommunicable diseases contributed to 36 million deaths globally in 2008, accounting for 63% of 57 million total deaths. The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 estimated that mortality due to noncommunicable diseases increased from 57% of total deaths in 1990 to 65% in 2010. About 80% of deaths related to noncommunicable diseases occur in low- and middle-income countries.

“As people around the world live longer and adopt Western diets and sedentary lifestyles, new patterns of disease have emerged,” Hunter said. “We need to develop health systems that can cope with chronic, long-term conditions such as diabetes that are rarely ‘cured’, in addition to acute illness episodes such as most infectious diseases and surgical emergencies.”

The United Nations and WHO have called for a 25% reduction by 2025 in deaths from noncommunicable diseases among persons between 30 and 70 years of age, in comparison with mortality in 2010, adopting the slogan “25 by 25.”

Hunter and co-author Srinath Reddy, adjunct professor of epidemiology, first Bernard Lown Visiting Professor of Cardiovascular Health and President of the Public Health Foundation of India, propose a multilevel approach to accomplishing this goal that integrates policy actions, regulations, education about healthy lifestyles, and efficient health systems. As an example of promising actions taken at the country level, they point to Brazil, which has passed a new anti-tobacco law, signed agreements with the food industry to reduce salt consumption and eliminate trans fats from processed food, and improved access to cardiovascular drugs.

Amy Roeder

Learn more

Study finds years living with disease, injury increasing globally (HSPH News)
Infographic: The dollars and sense of chronic disease (Harvard Public Health)
Energized, global effort needed to target noncommunicable diseases (HSPH News)
Strengthening health systems to address New Challenge Diseases (NCDs) (Harvard Public Health)