Tag: Non-communicable disease

NCDs account for the majority of deaths worldwide

A few days before my last post and still about the UN High Level Meeting on Prevention and Control of Non-communicable Diseases, The Economist issued a daily chart showing that non-communicable diseases (NCDs) account for the majority of deaths worldwide. I copy the chart below:

The Economist: non-communicable diseases account for the majority of deaths worldwide
The Economist: non-communicable diseases account for the majority of deaths worldwide

I have nothing to add about the chart on the left (except I don’t think stacked bars are really useful to visually distinguish between quantities ; ok, I added something). My first reaction to the chart on the right was: these countries in the lower middle income group should really do something to tackle non communicable diseases: they represent more than the double amount of deaths than the total number of deaths in other income groups. Even for communicable diseases, they should do something: from the chart, it seems to be a bit less than 10m deaths from communicable diseases, i.e. approximately the same amount as the total number of deaths in other income groups too!

Just for you information (and because I also had to recall which countries were in that lower middle income group), here are some countries in the various groups (*):

  • Low income group: Afghanistan, Bangladesh, Ethiopia, North Korea, Nepal, Somalia, Togo, a.o.
  • Lower middle income group: Angola, Bolivia, Congo, Georgia, India, Iraq, Morocco, Pakistan, Sudan, Ukraine, Vietnam, a.o.
  • Upper middle income group: Algeria, Brazil, China, Cuba, Libya, Malaysia, Russian Federation, Serbia, South Africa, Thailand, a.o.
  • High income group: E.U. countries, Japan, Singapore, Switzerland, USA, a.o.

(*) Technically it follows the way the World bank classifies countries: economies are divided according to 2010 GNI per capita, calculated using the World Bank Atlas method. The groups are: low income, $1,005 or less; lower middle income, $1,006 – $3,975; upper middle income, $3,976 – $12,275; and high income, $12,276 or more.

Then you realize that if you just take the absolute number of deaths and compare these group of countries (as it’s done in the chart on the left), you don’t compare exactly on the same basis. What if some groups have more countries or lower/higher population? What if the total surface of countries in one group are much higher (lower) than in other groups? Idem for the population density, etc.

Fortunately, the WHO has a parameter one can use in order to objectivize a little bit this issue: the “Age-standardized mortality rate by cause (per 100 000 population)”. If you plot this parameter in the same way as above, you obtain this chart:

Age-standardized mortality rate by cause (per 100 000 population) per income group
Age-standardized mortality rate by cause (per 100 000 population) per income group

From this you can now say that low income countries should really do something about NCDs but also communicable diseases, etc.

Presented like this, the number of deaths due to injuries and communicable diseases (per 100,000 pop.) decreases if the income of the country increases. In other word, more income you have, relatively less risk you have to die from injuries or communicable diseases. That explains why 1 death under a fallen wall is reported as a big sad news in Belgium while 60 deaths in a bus crash are not even reported in the news in India.

Another striking conclusion is that in low income countries there is approximately the same number of deaths (per 100,000 pop.) due to NCDs and due to communicable diseases (+/- 20%). We are all aware of tuberculosis, malaria, AIDS/HIV, etc. in less rich countries but it seems NCDs are an equally important issue.

But the most frightful conclusion from these numbers is that there is approximately the same number of deaths (per 100,000 pop.) due to NCDs in all income groups (674 ± 75) except the high income one. In other words, irrespective of you location or your income (except high income), you have the same chances to be affected by a non communicable disease. And irrespective on your income (and this time, even for high income countries), you have more chances to die from a non communicable disease than a communicable disease.

Ways to mitigate risk factors for NCDs (end of previous post) are still on.

N.B. WHO numbers are from 2008 for both charts.

The state of non communicable diseases

Last week, United Nations gathered in New York, USA, to talk about prevention and control of non-communicable diseases (NCDs). Non-communicable diseases are non-infectious, of long duration and generally progressing slowly. Due to the fact they are not infectious, there is no pathogen to target and there is no transmission medium to fight. Due to their long duration and slow progression, one usually notices NCDs when it’s too late and eradicating NCDs is less spectacular than other (not less important) infectious diseases. However WHO measured that NCDs represents more than 60% of all deaths in the world. For the occasion, WHO released an introductory video that summarize the issue.

So there are 4 main non-communicable diseases:

  1. Cardiovascular diseases
  2. Diabetes (both of them represent 70% of deaths by NCDs)
  3. Cancers (~ 20% of deaths by NCDs)
  4. Chronic respiratory diseases (~ 10% of deaths by NCDs)

NCDs are not directly in the UN Millenium Development Goals but I already mentioned they represent 4 of the top 5 killers in the USA. Two of them are also in the top 5 killers worldwide. If the Millenium Goals succeed, non-communicable diseases will be the next big issue in health.

Although NCDs were considered as a disease limited to high income countries (with infectious diseases affecting low income countries), this is not really the case anymore. For instance, the map of male deaths due to cardiovascular diseases and diabetes in 2008 shows an approximately uniform rate in high income countries with some higher rates in low income countries (especially on the African continent).

World : Cardiovascular diseases and diabetes, death rates per 100 000 population, age standardized: Males, 2008
WHO World : Cardiovascular diseases and diabetes, death rates per 100 000 population, age standardized: Males, 2008

If you are looking for more numbers, visit the WHO Global Health Observatory on Noncommunicable diseases.

If nothing is done, the incidence of NCDs will increase. On top of being a health issue, a matter of life and death, it will also become an economical problem as the costs of treatment as well as the indirect costs will also dramatically increase (increase per case treated and increase due to the number of cases treated).

Incident cases and cost of diagnosed diabetes per 1,000 people
Incident cases and cost of diagnosed diabetes per 1,000 people (adapted from Boyle et al. 2010 and Alternative Futures Diabetes 2025)

If you are looking for more figures about the cost of non-communicable diseases, here are two detailed reports recently published:

In a nutshell, non-communicable diseases are everywhere and the future doesn’t look happy. However …

However risk factors are identified and many of them are related to our own lifestyle:

  • Physical inactivity
  • Unhealthy diet
  • Tobacco use
  • Harmful use of alcohol

To end on a positive note, all these risk factors can be easily controlled and for a limited additional cost. For instance, governments can protect people from tobacco (taxes as well as bans on tobacco advertising, promotion and sponsorship, …) and alcohol (access restriction, bans on advertising, …) as well as promote public awareness about diet and physical activity. Companies can also promote healthy diet and physical activities to their employees. On top of that, the food industry can also include relevant actions in their corporate social responsibility policies. Finally on a personal level, we can increase our physical activity, increase fruit and vegetable intake, reduce our use of tobacco and alcohol, etc. Simple, cheap actions ; huge interesting consequences.