Chronic diseases

President's editorial

Editor-in-Chief's editorial

The World Health Organization (WHO) estimates that in 2005, HIV/AIDS, TB and malaria combined were responsible for around 4 million deaths. In the same year, chronic non-communicable diseases killed nearly 30 million people. Shocking as they are, these figures do not tell the full story of the disability, suffering and personal hardship that results from diabetes complications; or, on a larger economic scale, the enormous healthcare costs and lost productivity attributable to diabetes.

Heart disease, stroke, diabetes and cancer are now among the leading causes of death and disability around the world. The causes of these diseases include modifiable lifestyle-related risk factors, such as smoking, poor diet, lack of physical activity, as well as non-modifiable risk factors, including age and genetics. Due to population growth and the relative success of efforts to reduce communicable diseases, the number of people with non-communicable diseases will continue to rise in the future.

Much is heard of late about the high costs of chronic diseases like diabetes: chronic diseases are going to ‘break the bank’, impose tremendous costs on already struggling healthcare systems, and, very possibly, hinder growth in developing countries. Often, however, the suffering of people with chronic diseases seems to be lost in all the talk of money.

Chronic diseases are increasing in global prevalence and seriously threaten developing nations’ ability to improve the health of their populations. Indeed, chronic disease has become the dominant health burden in many developing countries. It is estimated that in 2005, chronic diseases were responsible for 50% of deaths and illness in 23 selected developing countries. Surveys from countries in all corners of the world reveal significant health and economic consequences from chronic diseases, with the greatest impact likely to occur in the poor countries that are least able to respond.

The metabolic syndrome is becoming a global public health issue. Those affected have higher risk of suffering a heart attack or stroke – as well as of dying from such an event – compared with people without the syndrome. This cluster of factors is closely linked with the worldwide increases in type 2 diabetes, cardiovascular disease and other chronic diseases. The resulting premature deaths and disabilities are set to cripple health budgets in both developed and developing countries. Criteria for diagnosis of the metabolic syndrome entail a combination of cardio-metabolic risk factors.

After World War II, chronic diseases, cardiovascular diseases in particular, became a major public health problem in industrialized countries. These diseases were perceived as diseases of affluence. Finland was hit hard: in the 1960s, Finland had the world’s highest rate of deaths from coronary heart disease. Middle-aged men were dying in great numbers. The rates were even higher in the east of the country – the highest figures being in the Province of North Karelia.

In most countries in the Americas, chronic diseases are now the leading cause of premature death and disability. Responsible for two of every three deaths among the general population, chronic diseases caused almost half of the mortality in people under 70 years old in 2002. The significant socio-economic inequities in Latin America compound the burden of chronic disease (including early death) among poorer people, locking many into a cycle of deprivation and ill-health.

About a decade and a half ago, public health priorities in low- and middle-income countries were centred on infectious diseases and maternal and child health issues. Subsequently, however, data published in leading medical journals and reports by multilateral agencies has shown that more than 50% of the burden of disease in developing countries is attributable to chronic diseases – including heart disease, diabetes, cancers and some chronic lung conditions.