Developing countries face double burden of disease.

Abstract

Following 18 months of multi-stakeholder consultations, and two days of tense negotiations at the 57th World Health Assembly in May, the Global strategy on diet, physical activity and health was finally--and unanimously--adopted by WHO Member States. The adoption of the nonbinding strategy opens the way for policy-makers to develop new initiatives to tackle the global rise in chronic noncommunicable diseases (NCDs) such as cardiovascular diseases, a rise that has been particularly marked in the developing world. "Noncommunicable diseases are imposing a growing burden upon low-and middle-income countries, which have limited resources and are still struggling to meet the challenges of existing problems with infectious diseases," said Dr Catherine Le Gales-Camus, Assistant-Director General at WHO's department of Noncommunicable Diseases and Mental Health. WHO estimates that non-communicable diseases--including cardiovascular diseases, diabetes, cancers and obesity-related conditions--now account for 59% of the 56.5 million deaths which occur globally every year and almost half (45.9%) of the global burden of disease. Traditionally associated with developed countries, some 80% of all cardiovascular disease-related deaths now occur in low- and middle-income countries. An estimated 171 million people were affected by diabetes in 2000, two-thirds of which live in developing countries. By the year 2030, WHO predicts that there will be 284 million people with diabetes living in developing countries. Worst affected countries are China where there were 20.8 million cases in 2000 and India where in 2000, there were 31.7 million cases of diabetes. Obesity, commonly associated with industrialized nations--in the US about 30% of adults are obese--is becoming a major problem in some developing nations too. According to data from the WHO Global NCD InfoBase Online, in Egypt between 1991 and 1994, 56% of men and 45% of women in Cairo's urban region were obese. In South Africa, 30% of women were obese in 1998, rising to 46% for women aged between 55 and 64 years. More than one billion adults worldwide are currently overweight, of which 300 million are clinically obese. The majority of cardiovascular diseases can be attributed to major risk factors such as high cholesterol, high blood pressure, low fruit and vegetable intake, inactive lifestyle and tobacco use. Worldwide people are consuming more foods that are nutritionally poor but energy-dense--high in sugar and/or saturated fats--or excessively salty. "In developing countries, the change in nutritional intake combined with increasingly sedentary lifestyles resulting from food market globalization and increasing urbanization, has led to the emergence of chronic diseases as a major new health threat," said Amalia Waxman, Project Manager for the Global strategy on diet, physical activity and health. "In Viet Nam for example, the shift from bicycles to motorbikes as the most popular form of transport has led to a dramatic fall in levels of physical activity contributing, together with dietary changes and tobacco consumption, to a rise in noncommunicable disease risk factors whilst the country is still trying to bring malnutrition under control. …