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New Burden for Developing World: Chronic Disease

Health professionals also have to fight acute viral ailments

TUESDAY, June 1, 2004 (HealthDayNews) -- Chronic diseases such as heart trouble and diabetes are the largest causes of death in the world, yet the global response to the problem is woefully inadequate, a World Health Organization public health expert warns.

This rising global burden of chronic disease needs a coordinated effort from policy makers, advocates and health professionals, according to Dr. Derek Yach, the lead author of a special communication in the June 2 issue of the Journal of the American Medical Association.

In the report, Yah and his co-authors predict that, between 1990 and 2020, deaths from ischemic heart disease in developing countries are expected to increase by 120 percent for women and 137 percent for men.

In 2000, 171 million people, or 2.8 percent of the world's population, were estimated to have diabetes; by 2030 the number is expected to increase to 366 million, or 6.5 percent, the authors say.

In China, the world's most populous country, death rates for circulatory disease increased between 200 percent and 300 percent in those aged 35 to 44 between 1986 and 1999, and by more than 100 percent in those aged 45 to 54, the researchers report.

For developing countries, the problem is especially critical because the increase in chronic disease presents a double burden, Yach and his co-authors explain. Although persistent maladies have not taken the place of acute infectious diseases as the chief health problem in these countries, they have added to the toll as professionals are forced to fight a two-front-war against them.

"While we are not the first to describe the pending chronic disease epidemics, we are the first to describe in depth the response of major players, including donors, to the problem," Yach said. In this case, donors are aid agencies as well as private investments from foundations.

In most developing countries, there is inadequate financing and lack of manpower to address chronic diseases. And many decision makers, Yach said, are not yet convinced that chronic diseases afflict anyone other than the affluent.

Yach blames, among other problems, the marketing of powerful commercial images to children that have helped to fuel the growth in consumption of tobacco, fast foods, sodas, snacks and alcohol.

To stem the problem, chronic disease prevention and diagnosis must be higher on the health agenda of key policy makers, Yach said, and they must be provided with information about risk factor control. A more concentrated policy approach is needed to reverse the rising toll of chronic disease worldwide.

Some success is already evident, Yach said. "There are excellent examples of success in controlling some aspects of the epidemic," he said. "So we look to Finland for coronary vascular disease control. Brazil, Thailand, South Africa and Nordics have brought down tobacco use.."

But, he added, "we have yet to find an example of a country that has reduced its obesity levels and, thereby, reduced its long-term, type 2 diabetes rate."

Dr. Nathaniel Clark, a spokesman for the American Diabetes Association, said the study's conclusions are on the mark. "They identified that our health-care system in the United States, and probably the world as well, is not set up to deal with chronic disease," said Clark, the national vice president for clinical affairs for the group. "It's set up to deal with acute disease, such as injury, infection, and trauma."

More information

To learn more about global diabetes, visit the World Health Organization.

SOURCES: Derek Yach, M.B.ChB., M.P.H., executive director, Noncommunicable Diseases and Mental Health cluster, World Health Organization, Geneva; Nathaniel Clark, M.D., national vice president for clinical affairs, American Diabetes Association, Alexandria, Va.; June 2, 2004, Journal of the American Medical Association
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