Customers smoke and drink beer with their food at a stall in Beijing: Tobacco,… (Niranjan Shrestha/AP )
In the arc of human history it has to count as a form of success that the biggest threat to health in the world today is too much — too much food, drink, pleasure and leisure.
For all but the last few blinks of time, most people died of such things as cold, starvation, childbirth, accident, violence and microbes that hand-delivered infection to every organ in the body.
Of course, lots of people still die in the old ways. But the major killers now are a different set of enemies, a drab regiment marching under the banner of “noncommunicable disease.” The big ones are cardiovascular ailments (heart attacks and stroke mostly); cancer; chronic lung diseases such as emphysema; and diabetes. There are many others — kidney failure, cirrhosis, arthritis — nearly as important.
Fueled by behavior-driven epidemics of smoking, obesity and inactivity, they are taking a toll around the globe, hitting poor nations as well as the rich.
“NCDs” are what the human body will encounter if it lives long enough. That makes them a hard target. They’re not like smallpox (eradicated) or polio (headed that way) or malaria (gone from Europe and North America). They’ll always be with us.
But they can be prevented and delayed and their effects treated, and what’s now clear is that without a concerted effort to do that, the world is in big trouble. That’s the message public-health experts, epidemiologists and activists delivered to world leaders at the United Nations this week.
NCDs now account for 63 percent of deaths worldwide and are the leading cause of death everywhere but sub-Saharan Africa, where infections, malnutrition and deaths associated with childbirth still dominate. Many of the risk factors underlying them are already more commonplace in poor countries than in rich ones, or are rising quickly. Elevated blood pressure, for example, is more common in low-income countries such Zambia and Burma, and in middle-income countries such as Indonesia and Argentina, than it is in the United States.
But ill health and early death are just part of the problem. Increasingly, noncommunicable diseases are seen as a threat to prosperity. They consume personal wealth, cut workplace productivity and require vast amounts of spending on health care.
The average poor household in Nepal spends 10 percent of its income on cigarettes. In Russia, the average worker misses 10 days of work a year due to chronic illness or injury. A month’s worth of the four drugs people should take after a heart attack cost five days’ wages for the lowest-paid government worker in Brazil.
In the mega-countries of India and China, where lifestyle changes and economic growth are galloping hand in hand, the future is especially alarming. In 2004, Indians lost 7.1 million years of life by dying of heart attacks before age 60; that annual toll of premature death is projected to be 17.9 million years in 2030. Between 2006 and 2015 China will lose slightly more than half a trillion dollars in national income because of heart disease, stroke and diabetes.
A bigger challenge
So how much of this present can be changed and the future avoided? Quite a bit. At least that’s what scientific research, chance events in recent history and the opinions of experts say.
The prevention strategies, however, are more complicated and controversial — also more numerous and varied — than the ones that have proved so successful against infectious and maternal-and-child deaths.
Prevention of infectious and noncommunicable diseases both require two kinds of interventions. The first target individuals and are usually delivered by doctors and nurses. The second target populations and are delivered by government, or the things that government can influence.
Vaccines are the classic examples of the first. They’ve eradicated smallpox, tamed measles and made rare pathogens such as Haemophilus influenzae type B (Hib) even rarer. Their great advantage is they have to be given only a few times — sometimes just once — to do their work. Delivering chlorinated water in pipes is the second kind of intervention. No government action in the last two centuries has saved as many lives. And it goes vaccination one better: All that’s required to the reap the benefits is to turn on the tap.
With noncommunicable diseases, prevention is harder.
There’s no vaccine to prevent smoking (although scientists are working on one), no pill to make people exercise more or eat less. Drugs that control blood pressure or lower cholesterol have to be taken every day.