Chronic diseases, such as diabetes, account for four out of five deaths in the developing world.

In the developing world, the impact of infectious diseases, such as AIDS and malaria, is well-known and highly publicized. However, deaths and debilitating effects from chronic diseases in the developing world have not received as much attention. In 2005, chronic diseases accounted for 72 percent of the total global, financial burden of disease.¹

According to the World Health Organization (WHO), four out of five deaths from chronic, non-communicable diseases, such as diabetes and heart disease, occur in the developing world.² While rich countries have seen a decline in many chronic diseases in recent years, low and
middle-income countries are experiencing an increase.

Globalization contributes to the rise of risk factors for chronic diseases, such as poor diet, physical inactivity and tobacco use, through increased migration to cities and the resulting sedentary lifestyles. Trade agreements and liberalization brought fast food restaurants and soda companies into the developing world, further contributing to poor diet.

Globalization contributes to the rise of risk factors for chronic diseases, such as poor diet, physical inactivity and tobacco use, through increased migration to cities and the resulting sedentary lifestyles.

Economic prosperity and the better treatment of infectious diseases, in many middle-income countries, such as China and India, also play a role in the rise of chronic diseases in those countries, as their populations age and face diseases usually associated with the elderly. The increased number of elderly in China, which is projected to rise from seven percent of the population in 2000 to 20 percent of the population in 2040, could result in a 200 percent increase in deaths from cardiovascular disease over this period.³

Losses in national income due to chronic diseases, such as an estimated loss of $556 billion in the coming decade in China, will have a profound effect on the ability of developing countries to pull the majority of their population out of poverty.⁴ Policymakers will need to develop action plans that engage civil society, address common risk factors of multiple diseases, and that involve the ministries of health, as well as the executive branch.

Diabetes

In the past 20 years, the number of people suffering from diabetes around the world has increased from 30 million to 230 million. Today, in China and India, an estimated 70 million people have diabetes.⁵ Some predict that in the next 20 years, India alone will have 75 million diabetics.⁶

Lifestyle choices of the rising middle class have been one of the major causes of this phenomenon. "Jokingly in talks, I say you haven't made it in society until you get a touch of diabetes," states Dr. Mohan, an Indian doctor.⁷ Mainstream India has seemed to accept this reality with stores selling "Music for Diabetes" and restaurants offering special discounts for the obese. The poor sectors of Indian society tend to suffer most, as treatment is too expensive to afford and health insurance is rare. Norms in India, such as bare feet, also speed up the onset of side effects, such as foot infections and loss of sensation in the feet.⁸

About 20 percent of the population in Africa has diabetes; of this number 80 percent have type II diabetes, the form associated with obesity and inactivity.

In African countries and elsewhere in the developing world, health care systems are inadequately prepared to handle diabetes and other chronic diseases. In Mali, the average life span after onset of diabetes is 30 months.⁹ About 20 percent of the population in Africa has diabetes; of this number 80 percent have type II diabetes, the form associated with obesity and inactivity.¹⁰ There is less information available on Africa because many countries have not conducted national level studies on the prevalence of chronic diseases.

It is important to address diabetes because it also compounds other health problems. According to the U.S. Center for Diseases Control (CDC), diabetics are two to four times more likely to develop heart disease and strokes, and three times more likely to die from flu or pneumonia. Poor circulation from diabetes often results in the amputation of limbs. Complications in pregnancy, gum disease, tooth loss, high blood pressure, and high cholesterol are all associated with diabetes.¹¹ Left untreated, blindness may result as well.

Cardiovascular Disease and Cancer

Cardiovascular disease is the world's number one killer; eighty percent of all deaths from heart disease occur in low- and middle-income countries. From 1990 to 2020, heart diseases are expected to increase 120 percent for women and 137 percent for men in developing countries; while only increasing 30 to 60 percent in the developed world.¹²

A 2003 survey in China found that 30 percent of poor households attributed their poverty to health care costs and an inability to afford insurance or pay for medical treatments.

Many associate the rise in heart disease in the developing world with the increased prevalence of smoking. The majority of the world's 1.1 billion smokers in 1995 lived in low-income and middle-income countries.¹³ India is the world's largest producer and consumer of tobacco products. India has tried to address this trend by passing the Indian Tobacco Control Act of 2003, which prohibits advertising for tobacco products, smoking in public places, selling tobacco products to minors, and selling tobacco near educational institutions.

The connection of smoking and lung cancer is highly correlated. Death rates from lung cancer death rates doubled in Chinese men from 1991 to 1995, also increasing two to five percent annually in urban and rural men between the ages of 15-54.¹⁴

Economic Outcomes

Chronic diseases are now becoming common at earlier ages, resulting in long-term economic losses. In the next decade, India is expected to lose $236 billion and Russia $303 billion from lost productivity due to chronic health issues.¹⁵

In 2005, China lost an estimated $18 billion dollars in national income and may lose as much as $556 billion in the next decades, due to heart disease, stroke, and diabetes.¹⁶ A 2003 survey in China found that 30 percent of poor households attributed their poverty to health care costs and an inability to afford insurance or pay for medical treatments.¹⁷


Where Do We Go From Here?

While clinical solutions, such as new medications, testing and other higher tech solutions may be too expensive for developing countries, policy solutions do exist that can help decrease the prevalence of chronic disease. The WHO estimates that 80 percent of coronary heart diseases, 90 percent of type II diabetes cases, and one-third of cancers can be prevented by maintaining proper diets, increasing exercise and by stopping smoking.¹⁸

The WHO recommends a "stepwise surveillance" approach to national governments who are trying to stem the tide of chronic diseases in their countries. The approach involves:

1. Research: estimating population needs through conducting studies to determine the distribution of risk factors among the population;
2. Development: creating a unified framework for prevention and control among all stakeholders;
3. Implementation: working with different sectors of society, such as the Ministry of Health, the legislative branch, and civil society groups, to develop and implement a comprehensive action plan. Multiple sectors need to be involved because there are common risk factors that cut across multiple diseases and the major determinants lie outside the health sector.¹⁹

Such approaches have been implemented in various forms in both China and India. India has developed an integrated national program for the prevention and control of diabetes, cardiovascular disease and cancer. As part of the program, a statewide health systems project was launched with the support from the World Bank. India has also started a National Rural Health Mission to improve rural health services.²⁰ From 2005 to 2012, the National Rural Health Mission plans to increase public expenditure on health, reduce regional imbalances in health infrastructure, and increase community participation in the management of the health system.²¹

The WHO recommends a "stepwise surveillance" approach to national governments who are trying to stem the tide of chronic diseases in their countries. The approach involves a combination of research, development, and implementation.

China started a community-based intervention trial for the management of diabetes and hypertension, which studied how Chinese are managing these diseases. China has received loans from the World Bank to start health promotion campaigns in seven target cities, which has resulted in a 15 percent reduction in smokers and a fall of 15 percent in cardiovascular disease death rates among those targeted in the campaign. ²²

One of the most cost-effective tools for preventions is the tobacco tax. Tobacco tax policies have been effective in rich countries, and research shows that a tax would be effective in low- and middle-income countries as well. Studies show that tobacco use among teenagers, the poorly educated, and the indigent is negatively correlated to price changes: as prices increase, demand decreases.

Chronic diseases are starting to be noticed by major funders. The Clinton Global Initiative was launched in October 2006 to be a catalyst for change among global leaders. The initiative asked its participants to commit to action in the field of global public health. Some of the highlighted commitments include:

• a project by VillageReach to improve access to health services and to improve those services in a model program in Mozambique.
• a new efforts by the WHO to implement the Framework Convention on Tobacco Control and to address the issue of obesity; and,
• a new project by World Diabetes Foundation to prevent diabetes in children and provide better care for early onset cases in South Africa.

Conclusion

Deaths and disabilities from chronic disease are indeed preventable with the right, timely investments. Funded initiatives and government policy can play a vital role in reducing obesity, inactivity and tobacco-use, but they are not enough. When the governments of the United Kingdom forced schools to offer healthier foods in the cafeteria, many students still opted to bring their own lunch instead.²³ The decision to change lifestyle choices and habits cannot be imposed on a population. Until people are convinced of the need to live in a more health fashion, chronic diseases will continue to plague developing and developed societies alike.

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Footnotes

¹ Kathleen Strong, et al. "Preventing Chronic Diseases: How Many Lives Can We Save?" The Lancet. Vol. 366. October 29th, 2005.
² Sonia Shah. "Halt Global Diabetes Epidemic." The Miami Herald. Section A, page 23. April 6, 2006.
³ Longde Wang, et. al. "Chronic Diesases 4. Preventing Chronic Disease in China." The Lancet. Vol. 366. November 19, 2005.
⁴ Wang, Longde et. al. "Chronic Diesases 4. Preventing Chronic Disease in China." The Lancet. Vol. 366. November 19, 2005
⁵ Michael Birt. "Chronic Neglect." Foreign Policy. September/October 2006.
⁶ N.R. Kleinfeld. "Modern Ways Open India's Door to Diabetes." New York Times. September 13 2006. ⁷ Ibid.
⁸ Ibid.
⁹ Michael Birt. "Chronic Neglect." Foreign Policy. September/October 2006.
¹⁰ Disease Risk Factor Weekly. Page 31. Atlanta. July 30, 2006.
¹¹ N.R. Kleinfeld. Diabetes and Its Awful Toll Quietly Emerge as a Crisis." New York Times. January 9th, 2006.
¹² Michael Birt. "Chronic Neglect." Foreign Policy. September/October 2006.
¹³ Prabhat Jha, and Frank Chaloupka (Eds.) Tobacco Control in Developing Countries. Oxford University Press. 2000.
¹⁴ Longde Wang, et. al. "Chronic Diesases 4. Preventing Chronic Disease in China." The Lancet. Vol. 366. November 19, 2005.
¹⁵ Donnelly, John. "A Growing Danger in Chronic Disease." International Herald Tribune. October 5, 2005.
¹⁶ Wang, Longde et. al. "Chronic Diesases 4. Preventing Chronic Disease in China." The Lancet. Vol. 366. November 19, 2005
¹⁷ Ibid.
¹⁸ "Facts Related to Chronic Diseases." World Health Organization.
¹⁹ Epping-Jordan, JoAnne E. et al. "Chronic Diseases 2. Preventing Chronic Disease: Taking Stepwise Action." The Lancet Vol. 366. November 5, 2005.
²⁰ Wang, Longde et. al. "Chronic Diesases 4. Preventing Chronic Disease in China." The Lancet. Vol. 366. November 19, 2005.
²¹ "National Rural Health Mission: Mission Document."
²² Ibid.
²³ Lyall, Sarah. "Glorious Food? English Schoolchildren Think Not." New York Times. October 18, 2006.




Reprinted with permission from Globalization101.org.

To read another Global Envision article about Diseases in the Developing World, see AIDS Threaten India's Prosperity.



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