The Killers We Ignore
Nellie Bristol
Americans and other rich country denizens have been hearing the message for years: snub out the smokes, cut out the chips, crawl off the couch, and move your body. But in many low- and middle-income countries, daily lives were consumed with ensuring children lived past the age of five and getting through the days’ back breaking labor to feed the family. Now globalization, urbanization and successes in combating infectious disease are bringing the burden of “lifestyle” diseases to health systems that are still struggling to catch up with rich-country levels of vaccine coverage and sanitary standards. Experts say the trend adds another formidable argument for focusing scant resources less on specific diseases and more toward health system strengthening and public health activities.
Chronic diseases, including cardiovascular disease, chronic respiratory disease, diabetes and cancer, now account for about half of all deaths and disability in low- and middle-income countries, a figure that is expected to increase dramatically in the coming decades. The rise is occurring in compressed form, catching health systems and donors unprepared.
“It’s quite astonishing how quickly chronic diseases have overtaken infectious diseases in developing countries,” said Rachel Nugent, the Center for Global Development’s deputy director for global health. She cites figures from Bangladesh that show an 86 percent reduction in age-standardized mortality for diarrhea and dysentery, and 79 percent for respiratory infections (excluding TB). The same time period (1986-2006) shows a 3,500 percent increase in deaths from cardiovascular and cerebrovascular disease, and a 495 percent increase from cancer.
