Elsevier

The Lancet

Volume 362, Issue 9387, 13 September 2003, Pages 903-908
The Lancet

Public Health
Globalisation and the prevention and control of non-communicable disease: the neglected chronic diseases of adults

https://doi.org/10.1016/S0140-6736(03)14335-8Get rights and content

Summary

The growing global burden of non-communicable diseases in poor countries and poor populations has been neglected by policy makers, major multilateral and bilateral aid donors, and academics. Despite strong evidence for the magnitude of this burden, the preventability of its causes, and the threat it poses to already strained health care systems, national and global actions have been inadequate. Globalisation is an important determinant of noncommunicable disease epidemics since it has direct effects on risks to populations and indirect effects on national economies and health systems. The globalisation of the production and marketing campaigns of the tobacco and alcohol industries exemplify the challenges to policy makers and public health practitioners. A full range of policy responses is required from government and non-governmental agencies; unfortunately the capacity and resources for this response are insufficient, and governments need to respond appropriately. The progress made in controlling the tobacco industry is a modest cause for optimism.

Section snippets

The global burden of non-communicable disease

This year there will be an estimated 56 million deaths globally, of which 60% will be due to non-communicable diseases:6 16 million deaths will result from cardiovascular disease (CVD), especially coronary heart disease (CHD) and stroke; 7 million from cancer; 3·5 million from chronic respiratory disease; and almost 1 million from diabetes. Mental health problems are leading contributors to the burden of disease in many countries and contribute substantially to the incidence and severity of

Causes of non-communicable disease

The burden of non-communicable disease results from past and cumulative risks; the future burden will be determined by current population exposures to risk factors. Although the major risk factors for noncommunicable disease epidemics are more complex than those for infectious disease, they are well known and account for almost all such events; 11, 12 many are common to the main categories of non-communicable diseases and most are modifiable and operate in the same manner in all regions of the

Effects of globalisation

Financial and economic globalisation and the World Trade Organization (WTO) rules that regulate trade, can improve population health status by increasing national incomes. However, the poorest and most excluded countries have not experienced this benefit.14 Global rules and power imbalances constrain the ability of countries and national health services to respond adequately to health problems. Although national governments can shape international trade rules their influence has been limited by

Globalisation and the tobacco pandemic

Tobacco is the only consumer product that, when used as recommended by its manufacturers, eventually kills half its regular users. Transnational tobacco companies are aggressively exploiting the potential for growth in tobacco sales in developing countries. The main targets of the industry and associated marketing campaigns are women and young people;20 in many developing countries, marketing strategies are used that have long been banned in many developed countries. Tobacco companies have

Globalisation, nutrition transitions, and alcohol

Replacement of a traditional diet rich in fruit and vegetables by a diet rich in calories provided by animal fats and low in complex carbohydrates, is happening in all but the poorest countries.27 Such changes will in general lead to increased rates of many non-communicable diseases, although not necessarily stroke rates, in countries previously protected by balanced and healthy diets. Asia is experiencing a particularly striking shift in consumption patterns, although rates of coronary disease

Prevention

Rates of non-communicable disease, notably of lung cancer in men and CVD, have fallen substantially in many wealthy countries. For lung cancer, the reduction in mortality is due to the substantial fall in tobacco consumption by men as a result of active dissemination of scientific research results by politically engaged doctors.41 However, in many European countries and in Korea, China, and Jordan, lung cancer epidemics are increasing, especially in women. This increase is a result of an

Conclusion

The pace of globalisation of the major risks for noncommunicable diseases is increasing. However, the prospects for non-communicable disease prevention and control are only slowly improving. Sustained progress will occur when governments, relevant international agencies, non-governmental agencies, and civil society acknowledge that public health must include non-communicable diseases and their risk factors. The challenges are enormous and the ongoing tobacco wars indicate that progress will

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