Intro
Public health specialists concerned with low- and middle-income countries have devoted considerable attention to communicable diseases and maternal and child health for some time. Recently, however, their attention has turned to noncommunicable diseases such as cardiovascular disease (CVD), diabetes, and various cancers and intentional and unintentional injuries. This shift is due to the recognition that the burden of noncommunicable disease in low- and middle-income countries not only is growing rapidly but is already astoundingly large. Indeed, by 2001, CVD had become the leading cause of death worldwide in both developing and developed countries. Noncommunicable diseases are now dominant sources of morbidity and mortality around the globe.
The profile of some noncommunicable diseases in low- and middle-income countries is similar to that in high-income countries. In all regions of the world, for example, at least 80 percent of the burden of CVD comes from ischemic heart disease, congestive heart failure, and stroke. These conditions share many risk factors—obesity, high blood pressure, physical inactivity, and salt intake—and hence are susceptible to the same interventions.
Other noncommunicable diseases exhibit different profiles in developing and developed countries. Cancer, for example, displays considerable geographic variation. The types of cancers that predominate in the high-income countries—lung, colorectal, breast, and prostate cancer—can be traced to such factors as the earlier beginnings of the tobacco epidemic, earlier exposure to carcinogens, and diet and lifestyle. By contrast, the cancers that predominate in low- and middle-income countries—cervical, liver, and stomach cancer—are associated with chronic infections with human papillomavirus, hepatitis B, and Helicobacter pylori. Cancer causes a large and increasing disease burden worldwide, but its epidemiology, and consequently the relevant interventions, differ significantly in low- and middle-income countries and high-income countries.
The burden of noncommunicable disease is growing, but many low- and middle-income countries have not yet experienced the full demands that these conditions will place on their health systems. Ironically, part of that burden will result from successes in preventing or treating communicable diseases and reducing childhood mortality: with improved public health, individuals who would have died in childhood will now survive and become susceptible to noncommunicable disease.
"As loss of life from communicable disease is reduced, it need not be replaced by an equal loss of life from noncommunicable disease."
Some of the burden of noncommunicable disease and injury is avoidable. By adopting policies that promote healthy eating and discourage smoking, for example, low- and middle-income countries may escape the risk profiles that wealthier countries acquired as they developed. Implementing proper road safety measures would also permit low- and middle-income countries to avoid a substantial burden of road traffic injuries, which increase as motorized traffic increases. As loss of life from communicable disease is reduced, it need not be replaced by an equal loss of life from noncommunicable disease.
