THE LANCET PUBLISHES SERIES ABOUT CHRONIC DISEASESThe medical journal The Lancet has published a series of papers about the grossly neglected epidemics of cardiovascular disease and the other principal chronic diseases, which include cancer, chronic respiratory diseases and diabetes. These papers represent a step forward in our understanding of the evidence on cost-effective patient care and population-based interventions. Among the series’ findings is that scaling up to treat cardiovascular disease with multi-drug therapies in 23 low- and middle-income countries would achieve three-quarters of the World Health Organization’s goal of a 2% annual reduction in the death rate from chronic diseases. The World Heart Federation’s Foundations Advisory Board Chairman Srinath Reddy and Chief Executive Officer Janet Voûte are among the series’ reviewers and authors. Meeting 2% goal would avert millions of deathsThe series’ five papers and one editorial describe the enormous harm that chronic diseases cause to human health and development and the many cost-effective interventions that could be undertaken to greatly mitigate their impact. The authors focus on the 23 low- and middle-income countries – China, the Democratic Republic of Congo, India, Ethiopia and Nigeria, to name a few – that account for 80% of the total chronic disease burden among all the low- and middle-income countries. The authors find that meeting the World Health Organization’s goal to increase the reduction of death rates by 2% per year over the next 10 years would avert 24 million deaths in the 23 countries. Almost half of the averted deaths would be in people under age 70. On average, each person whose death is averted would proceed to live another 18 years. If nothing is done to reduce the risk of chronic disease, an estimated US$84 billion of economic production will be lost from heart disease, stroke and diabetes alone in the 23 countries between 2006 and 2015, they report. Achievement of the World Health Organization’s 2% goal would save an estimated US$8 billion. “There’s a lot that can be done to avert deaths and to prevent and control these epidemics,” said Colin Mathers, an epidemiologist at the World Health Organization and co-author of the first paper of the series, which is entitled, “The burden and costs of chronic diseases in low-income and middle-income countries.” Interventions are cost-effective, economically feasibleThe evidence for cost-effective and economically feasible interventions is abundant, according to the second paper in the series, which is entitled, “Scaling up interventions for chronic disease prevention: the evidence.” Among the many cost-effective and financially-feasible interventions would be strategies to reduce salt intake and control tobacco usage and multi-drug therapies to treat and control cardiovascular disease. Salt and tobacco reduction are keySimply reducing salt intake by 15% in the 23 countries would avert 8.5 million deaths over 10 years. Implementing tobacco-control strategies in the 23 countries through the World Health Organization Framework Convention on Tobacco Control would avert another 5.5 million deaths over 10 years. Through these two interventions, 13.8 million deaths could be averted at a cost of less than USD$0.40 per person per year in the 23 low- and middle-income countries and USD$0.50–1.00 per person per year in upper middle-income countries, according to the authors of the third paper entitled, “Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use.” Treating cardiovascular disease would achieve three-quarters of goalOver 10 years, scaling up to treat cardiovascular disease with multi-drug therapies in the 23 countries would avert 17.9 million deaths – more than half of them in people younger than 70 years, with more deaths averted among women than men. The cost would be US$1.08 per person per year. “This package could effectively meet three-quarters of the proposed [2%] global goal with a moderate increase in health expenditure,” said the authors of the paper, which is entitled, “Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs”. Serious and sustained worldwide effort neededThe fifth and final paper in the series was entitled “Prevention of Chronic Diseases: a call to action”. The paper urged a “serious and sustained worldwide effort to prevent and control chronic diseases in the context of a general strengthening of health systems”. “Urgent action is needed by WHO, the World Bank, regional banks and development agencies, foundations, national governments, civil society, non-governmental organizations, the private sector including the pharmaceutical industry, and academics,” the paper said. It concluded: “This Series of papers in The Lancet provides evidence that achievement of the global goal for the prevention and control of chronic diseases is both possible and realistic through available interventions.” Read the chronic disease series in The Lancet (registration required). | |||||||
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