West's Diseases Shake Developing World
Sydney Morning Herald
Monday April 26, 2004
Heart attack and stroke, thought to be quintessential Western diseases, are fast becoming big threats in developing countries.
They cause two to three times more deaths in mothers in developing countries than childbirth and HIV/AIDS combined. HIV/AIDS accounts for 3 million deaths a year: stroke and heart attack cause 17 million.
In the US there are 116 deaths per 100,000 men aged 35-59 from heart disease and stroke each year; in Russia there are 576. India and China each have 3 million deaths a year from these causes. Australia and the US have a similar profile. Developing economies are witnessing devastation to their workforces that Western countries experienced 50 years ago but have since escaped.
These rumbles mark the beginning of the storm. As working people move from rural to city living they are pressed to eat more food. City food is cheap and high in fats, salt and sugars. The car supplants the bicycle and the foot. With prosperity comes an epidemic of obesity; even where under-nutrition persists in poorer quarters, high levels of diabetes, heart disease and stroke lie ahead.
There are no pro-E bola or pro-SARS lobbies, but a tidal wave of globalised commercial greed propels tobacco consumption into the poorest nations.
We recognise the ageing of the population in industrially advanced societies as life expectancy increases and birth rates stabilise or decline. A generation of old baby boomers will challenge our social security system and medical care facilities. But this dramatic reshaping of the age structure of populations is occurring everywhere. World Bank projections show that, while people aged 65-plus in the world now number about 500 million, they will tip 1 billion by 2020.
Heart disease and stroke will be the principal causes of death in older people and account for one-third of all disability.
There is good news to counter these dark prophesies.
In Australia, New Zealand, the US and parts of Europe, the death toll from heart disease and stroke has tumbled by 60 per cent since 1960. Better diet, less smoking, better drugs for blood pressure and cholesterol, exercise and improved medical and surgical care have reduced the number of deaths and transferred these diseases from middle age into the later years.
In Australia in 1968 50 per cent of deaths from heart disease and stroke occurred among those aged 75-plus. Today the figure is 76 per cent. Deaths among those aged 55-64 have fallen by two-thirds, and among the 64-75 year olds by a half.
Smokers who quit cut their risk of heart disease and stroke by a half within two years, while treatment of raised blood pressure and blood lipids radically reduces risk.
Governments have cut tobacco consumption by taxes and eliminating advertising. They plan pro-walking environments and can ensure that all citizens have access to clinics where health personnel measure their risk and offer long-term treatment.
Heart disease and stroke are already pushing families into poverty in developing countries as young breadwinners and mothers die. These breadwinners are productive members of the workforce and are among those who determine investment and prosperity.
Many developing countries have yet to create programs to control these diseases.
Control measures include long-term changes to dismantle agricultural subsidies and implement the WHO Framework Convention on Tobacco Control, and introduce effective clinical care.
Developing countries should take the first step in program development themselves, because success will require a 20-year collaborative effort from all elements in civil society and professional capability in prevention and treatment.
Countries need the encouragement of strong vocal advocacy for change that world agencies can provide. Commitment from the highest levels of government is essential for comprehensive heart disease and stroke prevention.
Heart foundations and national NGOs can lobby for change in social policies to help prevention and treatment. Corporations, too, can be part of the solution through their investment in preventive programs for their workers. Medical associations and other professional bodies, national and international, should be at the table, too.
International aid agencies should open their agendas to work with developing countries to contain these threats to global health, national prosperity and family life.
Stephen Leeder is a visiting Australian public health physician at Columbia University and director of the Australian Health Policy Institute at the University of Sydney. A report prepared by him and his colleagues, A Race Against Time: the Challenge of Cardiovascular Disease in Developing Economies, is published today.
© 2004 Sydney Morning Herald