• Non-communicable diseases (NCDs)

Non-communicable diseases (NCDs)

This report from the Earth Institute at Columbia University in the United States warns of a major global health crisis that is about to happen due to rising levels of cardiovascular disease (CVD) in developing countries. As it will affect the working population most severely, this health crisis will also have serious economic consequences.

CVD includes a range of diseases, including heart attack, stroke and kidney failure. It is set to become the leading cause of death and disability in the world by 2020. The report examines the current social and economic impact of CVD in five middle and low income countries (Russia, Brazil, China, South Africa and India) and the projected impact up to 2040.

Findings include the following:

• Heart disease and stroke kill 17 million people every year, compared to 3 million due to HIV and AIDS. 80 per cent of these deaths occur in low and middle income countries.
• Even if the risk factors for CVD remained as they are now, there will be a major increase in levels of CVD in developing countries in the next 30 years due to the rising populations in these countries. However, the risk factors will also increase substantially over this time due to increased levels of urbanisation and industrialisation.
• The group which will be most affected will be those aged between 34 and 65. Experience from developed countries show that the rise in the prevalence of CVD in developing countries will affect the poor disproportionately.
• The extent to which women are affected by CVD is often ignored in favour of a focus on reproductive health. In Brazil, twice as many women aged between 15 and 34 die due to CVD than due to pregnancy-related causes.
• The economic consequences of CVD include the loss of workers due to disability and death, the loss of experience and skills since those most affected are those in mid-life, the direct health costs, the cost of disability payments, and the loss of workers, especially women, who have to leave the workforce to take care of sick relatives.
• The problem of CVD in developing countries receives very little international attention, particularly in comparison to communicable diseases. This is partly because it affects older adults rather than children and because it is mistakenly thought of as a disease of affluence.

The causes of CVD include those which cannot be prevented (age, gender and genetic predisposition) and those which are social and environmental (smoking, diet, exercise, stress) and therefore can be modified. The interventions which are needed to help prevent CVD are all currently available and have been very successful in developed countries. The report warns that there is a very limited opportunity available to implement these interventions in developing countries if the predicted crisis is to be avoided. Key recommendations include:

• Putting CVD in the developing world on the international health and development agenda
• Further work of the type done for this report to accumulate more extensive and detailed data on the prevalence of CVD in developing countries and its projected economic costs
• Advocacy and partnership work with governments of developing countries to ensure that CVD becomes a priority in health and related areas of policy
• Providing specialist training in prevention and treatment of CVD to health professionals in developing countries
• Undertaking trial treatment and prevention interventions
• Long-term research to monitor the effectiveness of CVD prevention interventions and other health system changes.

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