Though the worldwide spread of H1N1 brought the implications of a global pandemic to the fore again, another global health risk unfortunately illustrates the need to address ongoing slow failures. As both the Global Risks Landscape and the RIM show, chronic diseases (or non-communicable diseases (NCD), including: heart disease, stroke, diabetes, some chronic lung conditions and preventable cancers) are strongly connected to a number of other global risks: fiscal crises; underinvestment in infrastructure; food, water and energy security. The cost of treating chronic diseases has risen globally, as have associated rates of morbidity and mortality, driven by demographic changes and dietary shifts, causing some to call it a "silent" pandemic.
Though linked to the rise in obesity associated with developed nations, low - and middle-income countries account for 80% of all deaths from chronic diseases globally. These conditions are the leading cause of death worldwide with the exception of sub-Saharan Africa and, unfortunately, chronic disease mortalities will overtake those of infectious diseases in that region as well by 2030. Out of the 35 million people who died from chronic diseases in 2005, one-half were under 70 and one-half were women. Over the next decade, if not addressed effectively, chronic diseases will increase by 27% in Africa, 25% in the Middle East and 21% in Asia and Pacific, accounting for 75% of all deaths globally.
Click here for the full Risks Interconnection Map (RIM) 2010.
A problem neither the developed nor the developing world can afford
Declining development assistance has already led to a significant reduction of public spending on health in many countries. When funds are limited, governments tend to focus on basic health services, in line with the United Nation's Millennium Development Goals (MDGs), at the expense of the prevention and treatment of chronic diseases. Most developing countries, with the exception of several sub-Saharan African nations, will experience a historic shift over the next decades. Deaths from infectious diseases; maternal and perinatal conditions; and nutritional deficiencies combined are projected to decline by 3% over the next 10 years. However, over the same period, deaths due to chronic diseases are projected to increase by 71%. In countries plagued by poverty and social divides, failure to protect populations from basic and preventable health risks brakes economic development and threatens social well-being and stability. The fact that chronic diseases are not part of the mainstream global health and development agenda and that these are outside of the remit of the time-bound, outcome-based targets of the MDGs shows that more long-term and integrated planning is needed to address health risks.
Chronic diseases and food security: tackling malnutrition and poor nutrition holistically
As the crisis of 2008 showed, food price spikes and volatility affect consumption patterns of poor populations rapidly and can result in increased exposure to NCD risk. Poorer populations can suffer from malnutrition and can also suffer disproportionately from poor nutrition linked to chronic diseases. Climate change in combination with water and energy scarcity further adversely affect food security, creating a vicious cycle. Although poverty has traditionally been associated with underweight because of poor diet, research has revealed a paradox in the US, which is unfortunately now also being observed in developing countries: low income and obesity can coexist in the same population. The UN Food and Agriculture Organization and World Food Programme are starting to look at this problem. Future policies for nations with poor and low-income populations who are most exposed to food price volatility and shortages must aim not only to address basic food needs but should also look at the quality of nutrition, embedding health in food security discussions.
Spending less for more
Healthcare spending in many developed economies already represents a huge fiscal burden. With sharply deteriorating fiscal positions, higher unemployment and ageing populations, developed economies will feel the costs and social impact of chronic diseases even more over the coming years. Total health spending in the US accounts for 15% of GDP. A third of this spending on health is for obesity-related chronic diseases. In other developed countries, this figure is between 2% and 3.5%. As pressures on public finances and health insurance costs mount, chronic disease risks exemplify how much more cost effective it would be for health institutions, governments and businesses to focus on prevention rather than treatment. Evidence suggests that a modest reduction in the prevalence of certain chronic disease risk factors, such as tobacco and alcohol consumption, and healthier diets, could result in substantial health gains and cost savings. For instance, a Norwegian study estimated that savings of US$ 188 million could be made by lowering the population blood pressure level by a 2 mm Hg reduction in salt intake. A Canadian study estimated that a 10% reduction in the prevalence of physical inactivity could reduce direct healthcare expenditures by Can $150 million (approximately US$ 124 million) in a year.
Information and innovation are key to prevention
In several countries, the application of existing knowledge has led to major improvements in the life expectancy and quality of life of middle aged and older people. For example, through campaigns to raise awareness and better education of prevention, heart disease death rates have fallen by up to 70% in the last three decades in Australia, Canada, the United Kingdom and the United States. Middle-income countries, such as Poland, have also been able to make substantial improvements in recent years by informing the population of the benefits of good diet and exercise. From 1970 to 2000, the World Health Organization has estimated that 14 million cardiovascular disease deaths were averted in the United States alone. The United Kingdom saved 3 million lives during the same period. Given the inexorable rise in health costs as populations age, governments need to rethink their health systems to make them more effective. New models of health financing, mixing public and individual contributions, will need to create incentives for greater emphasis on prevention, and this will undoubtedly go far beyond the traditional approach to health systems in both the developed and developing world.
The risk for business
One-half of those who die from chronic diseases are in their productive years and so the social costs and economic consequences in terms of lost productivity are considerable. This fact, coupled with rising healthcare costs to employers, has made the private sector aware of this problem, in particular because many of these costs are preventable. In the US, the avoidable indirect impact of chronic diseases, due for example to productivity losses, is four times as high as the direct costs of healthcare coverage.
The WHO estimates that between 2005 and 2015 income loss could rise to as much as US$ 558 billion in China, US$ 237 billion in India, US$ 303 million in Russia and US$ 33 billion in the United Kingdom. Brazil, Russia, India and China currently lose more than 20 million productive life-years annually to chronic diseases, and that number is expected to grow 65% by 2030. The losses in productivity associated with those diseases, through disability, unplanned absences and increased accidents, are as much as 400% more than the cost of treatment. It is now well established that workable solutions exist to prevent 40-50% of these diseases and their negative impact on business and the economy at large in both developed and developing countries.
The private sector can contribute significantly to the fight against NCDs by informing and supporting actions to tackle the lifestyle-related risks, tobacco and alcohol use, unhealthy diet and lack of physical activity among employees and customers. Not only is it important for good global citizenship but there is also a strong business case. By focusing on responsible food marketing to children, reducing trans-fatty acids and salt, and providing simple, clear and consistent food labels, significant gains can be achieved at the population level. The WHO has recently announced the "Chan Commitments", a groundbreaking set of voluntary commitments by nine of the largest food and beverage manufacturers to shift to healthier options.
The democratization of health information, growth in self-care technology, increased level of social interaction through social media and liberation of the Web through mobile platforms are shifting worldwide attitudes and can support person-centred health. Mobilization of social forces and people outside of health systems is critical as it is clear that chronic diseases are affecting social and economic capital globally.
|Chronic Diseases: Mitigating measures recommended by the Global Agenda Council of the World Economic Forum on Chronic Diseases|
|Global support for international governance
| ||The World Health Organization, as the lead technical agency in health, must garner necessary resources and cross-sector political will to implement the Global Action Plan for Non Communicable Diseases, 2008-2015. It must work in partnership with all relevant multilateral and bilateral agencies to provide coordinated and consolidated guidance to implement plans, policies and programmes. |
| ||The 22 development partners, who presently spend less than 1% of the US$ 22 billion on chronic diseases, must now be more proactive in their support of individual country requests for assistance to address chronic diseases. |
| ||Ongoing work on negotiated agreements for the reduction of salt in processed food and the work of the Conference of Parties in giving shape to the terms of the Framework Convention on Tobacco Control and the forthcoming WHO Alcohol Strategy should be supported by the development partners, countries and industry.|
|National and global incentives
| ||Countries should mount a serious public policy response to this threat. Measures should be instituted to support the control of tobacco and alcohol use, and to provide strong incentives for the production and
availability of healthy foods (e.g., shift towards healthy agriculture policies). |
| ||The food industry should work collaboratively towards reshaping the industry to introduce new products with better nutritional value and make healthy options, affordable and available. They should focus on responsible food marketing to children, reducing trans-fatty acids and salt and provide simple, clear and consistent food labels. Incentives at national and global levels to support this shifting should be developed simultaneously. |
| ||Stimuli and incentives for employers from private and public sectors should be put in place to support further implementation of workplace health.|
| ||Countries must prepare for changing patterns in the volume and composition of service delivery and demands for patient education and long-term pharmaceutical use in view of the changed disease trends.|
|A yardstick to measure progress
| ||A global mechanism should be developed to map and track chronic diseases, set benchmarks and track trends of solution implementation and its impact on disease burden. A "health and well-being footprint" could serve as yardstick to indicate progress that governments, public and private sector producers and service providers, and individuals achieve on health. Such measurement should be embedded as well as part of the Millennium Development Goals review process.|