K.M. Venkat Narayan: Chronic Diseases – a Major Global Challenge that Threatens Health and Economies Alike

Venka Narayan

The impact of chronic diseases to the health and well-being of the world is a growing threat – not only to the health and well-being of people from all countries but to all economies – rich and poor —  as well.

Already, Mexico is overtaking the United States in the proportion of people obese and overweight. And in India and China, the prevalence of diabetes is much higher than the United States. In urban India the prevalence rate of diabetes is about 16-18% and in the United States it’s about 9%.

In fact, six of the top 10 risk factors for mortality worldwide are chronic disease not infectious diseases, according to a recent report from the World Health Organization. They include high blood pressure, tobacco use, high blood glucose levels, physical inactivity, overweight or obesity and high cholesterol levels.

These risk factors pervade countries of all income levels, even in low-income countries.

A lot of the solutions are going to require active global cooperation, such as what’s being done in climate change. But the awareness is not there yet. Most governments and funders believe that in developing countries the most pressing issues are only with infectious diseases, undernutrition and maternal mortality. People with chronic diseases are most vulnerable to infectious diseases. People with undernutrition are vulnerable to chronic diseases. So, these are all inter-connected problems. The biggest impact on Millennium Development Goals (MDGs) for HIV and tuberculosis reduction and infant andchild mortality could be to invest in chronic diseases – may sound counter-intuitive and paradoxical, but data support these assertions. Although chronic diseases are not part of the MDGs, we cannot meet the MDGs unless we invest in chronic disease prevention and reduce their impact on mortality. Without a huge investment in chronic disease prevention, economic activity will greatly decline because of the loss to workforce and health care costs. This will affect high-, middle-, and low-income countries all alike. 

Solutions need to come in three main forms: 1) At the policy level, major economic lenders like the International Monetary Fund, World Trade Organization and national governments need to address chronic diseases with a sense of urgency.  2) At a consumer level, transfats should be banned like cigarettes; salt in processed foods should be reduced; there needs to be stringent regulations on food labeling; strategies need to focus on reducing intake of refined carbohydrates, and there needs to be promotion of healthy fruit and vegetables. 3) At the health-system level, more attention needs to be given to chronic diseases. This means health systems need to be strengthened and reoriented toward prevention and management of chronic diseases. Trials have shown that 50-60-% of diabetes could be prevented if there were prevention-oriented clinical systems focused to chronic diseases rather than an acute medicine model of care.

For more on this topic, see the perspectives article “Global Noncommunicable Diseases — Where Worlds Meet” published in the New England Journal of Medicine Sept. 15 by Emory researchers, including myself, Mohammed K. Ali and Dr. Jeffrey P. Koplan.

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