Addressing the Challenge of Noncommunicable Diseases: Some Key Issues and a Country Case Study.

Abstract

Life expectancy at birth continues to increase remarkably in Asia-Pacific countries, reflecting sharp reductions in mortality rates at all ages, particularly among infants and children.1 These gains in longevity can be attributed to a number of factors, including rising living standards, better nutrition, and improved drinking water and sanitation facilities. However, conversely, the burden from noncommunicable diseases (NCDs) among adults—the most economically productive age group—is rapidly increasing in the Asia-Pacific region. Increasing development in countries is bringing an “epidemiological transition,” whereby communicable diseases are being replaced by NCDs.2 The level of adult mortality, all-cause mortality, and cause of death are important for identifying a country’s public health priorities and assessing the effectiveness of a country’s health system. NCDs such as cardiovascular diseases and cancers were the most important causes of death in the Asia-Pacific region, being responsible for on average 70% of all deaths across 20 Asian countries.3 Noncommunicable diseases are no longer diseases of old men in developed countries. Rich foods, cigarettes, fine wines, leisurely lifestyles—and the accompanying health risks—were once the accompaniments of a good life. The poor seemed to have a different set of problems: malnutrition, hard labor, and infectious diseases. Yet urbanization and globalized markets are harmonizing cultures and nudging people worldwide toward unhealthy habits. From New York to New Delhi, city streets are filled with fast-food restaurants and billboards advertising unhealthy foods and alcohol. It doesn’t stop with old men—they are also diseases of women, young adults, and children. The prevalence of childhood obesity is increasing in all countries, with the most rapid rise in lowand middle-income countries; the majority of overweight or obese children live in developing countries, where the rate of increase has been more than 30% higher than that of developed countries. Children who are overweight or obese are at greater risk of a range of health problems, including asthma, high blood pressure, musculoskeletal disorders, fatty liver disease, insulin resistance, and type 2 diabetes. In later life, they are at greater risk of obesity, cardiovascular disease, some cancers, obstructive respiratory disease, as well as mental, emotional, and social health problems. In addition to these health risks, the rapid rise in obesity negatively impacts their opportunity to participate in educational and recreational activities, and imposes a range of economic burdens at familial and societal levels.4 The new scientific field of Developmental Origins of Health and Disease (DOHaD) proposes new models of causality and the mechanisms