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