Chronic disease in the developing world
We've been educated over the last few years about the impact that chronic illness -- diabetes, heart disease, cancer -- has on health-care costs in the United States and other industrialized countries. When it comes to health-care problems in the developing world, though, we think of infectious diseases like AIDS, tuberculosis and malaria. Chronic disease, with its link to obesity, seems like a product of more advanced economies.
That's no longer true. Even as it struggles to control infectious disease, the developing world has caught up with developed countries in terms of the prevalence of chronic illness. The reasons aren't fully understood, but one may be increasing obesity, which Julio Frenk, dean of the Harvard School of Public Health, terms a "global pandemic."
Chronic disease is now the leading cause of death worldwide (except for in Sub-Saharan Africa, which is getting close) and the biggest health-care cost component as well. India and China alone account for more cardiovascular disease than in all the developed world. Over the next decade, chronic disease is on track to increase by 27 percent in Africa, 25 percent in the Middle East and 21 percent in Asia and the Pacific -- making up three-quarters of deaths worldwide.
The conundrum is that international health efforts, heroic as they may be, are geared toward combating communicable diseases, not preventing or treating chronic ones. But if both diabetes and malaria are serious threats, why have a mechanism for distributing mosquito nets but not for insulin? David Mwakyusa, health minister of Tanzania, told a panel here today that cancer kills more people in his country than AIDS, malaria and tuberculosis combined.
This phenomenon presents problems of public education as well. "We have challenges which you don't have," Mwakyusa said. "To convince someone who has a lump in a breast to go in for testing is at challenge."
This quiet revolution in public health deserves more attention than it has yet received.
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