A new report published by the World Health Organization calculates that almost two-thirds of all worldwide deaths are now the result of non-communicable diseases. These mainly comprise cardiovascular diseases, cancers, diabetes and chronic lung diseases, and their epidemic, says WHO Director-General Dr Margaret Chan, is being driven by powerful forces now touching every region of the world: demographic ageing, rapid unplanned urbanisation, and the globalisation of unhealthy lifestyles. "While many chronic conditions develop slowly," adds Dr Chan, "changes in lifestyles and behaviours are
occurring with a stunning speed and sweep."
The report also points out that, contrary to popular opinion, nearly 80% of deaths from non-communicable disease occur in low- and middle-income countries. And the culprit risk factors - tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol - are now the "pervasive aspects of economic transition, rapid urbanization and 21st-century life".
Commenting on the report for the ESC, Professor Pantaleo Giannuzzi, President of the European Association for Cardiovascular Prevention & Rehabilitation, one of the five ESC associations, said: "This is a very important document. For the first time we now have the hard figures representing the present and future impact of non-communicable diseases worldwide, not only in the acute phase but in the chronic phase too.
"Within the context of cardiovascular diseases this is a reminder of how important the prevention and management of chronic disease - and its impact - really is. We have made great progress in managing CVD in the acute phase, but the WHO research emphasises the extent to which avoidable risk factors and unhealthy lifestyle contribute to global mortality. So here is an authoritative statement that only through simple improvements in lifestyle - with attention to diet, exercise, smoking and weight - will this epidemic of chronic disease be reversed. This can only be achieved through the concerted efforts of populations, professionals and politicians.
"In our own field we still face the challenge of developing a successful model for the prevention of readmissions and new episodes. We have been successful with acute episodes, but more must now be done for structured follow-up and the continuity of care. Again, simple interventions will be appropriate and should be central to our post-discharge programmes."
Among "best-buys" recommended by the WHO report at the population level are restrictions on smoking (sales and community bans), raised taxes on tobacco and alcohol, reduced salt in foods, the replacement of trans-fats with polyunsaturated fat, and public awareness about diet and physical activity.
Best-buys at the individual intervention level include counselling and multidrug therapy, including glycaemic control for diabetes, and aspirin therapy for AMI
The report estimates that the worldwide number of deaths attributable to non-communicable disease will increase by 15% between 2010 and 2020, with the greatest increases in Africa and South-East Asia. Most of these deaths will be associated with the four risk factors noted above. Tobacco use, for example, if unchecked will account for 10% of all deaths by 2010.
The report emphasises the power of primary prevention initiatives, and particularly their effect on CVD. More than half the dramatic decline in CHD mortality in the UK between 1981 and 2000 was attributed to risk factor reduction. The WHO's own MONICA data indicate that population-wide primary prevention and individual healthcare interventions go hand-in-hand to reduce the burden of CVD. Yet many of these initiatives and interventions are unavailable in many poor resource countries.
The World Heart Federation, of the which the ESC is a member, has described the forecasted trend in rising CVD incidence as "unacceptable" and has urged a global response which puts CVD prevention at the centre of national development initiatives.
The Chronic Disease Alliance, an association of ten science-based European organisations of which the ESC is a founding member, has also declared its objective in reversing the rise in chronic non-communicable diseases by urging political action against tobacco use, poor nutrition, lack of physical activity and alcohol.