The World Health Organisation (WHO) predicts that levels of disease caused by chronic conditions and lifestyle-related illnesses will outpace those caused by infectious diseases such as HIV/Aids and tuberculosis.
The prediction comes from the latest World Health Statistics report, which was released by the WHO last week ahead of the 61st World Health Assembly attended by 190 countries.
In a statement, the Health Assembly announced a six-year plan to tackle non-communicable diseases, which it describes as being “the leading threats to human health”.
Non-communicable diseases are caused by lifestyle and socio-economic factors and are not spread by infectious agents from person to person.
“These diseases — particularly cardiovascular diseases, diabetes, cancers and chronic respiratory diseases — caused 60% of all deaths globally in 2005 (estimated at 35-million deaths). Low and middle-income countries are the worst affected by these diseases, which are largely preventable by modifying four common risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol.
The infectious diseases — especially the big killers such as diarrhoeal diseases, HIV, tuberculosis, neonatal infections and malaria — will become relatively less important on a global scale, says the WHO. This year about 2,2-million people worldwide are expected to die as a result of HIV/Aids. The death toll from this disease is expected to peak at 2,4-million in 2012, before declining to 1,2-million in 2030. This will make it the 10th leading cause of deaths worldwide.
Global demographic changes, as people living in the highly populous middle and lower-income countries start ageing, will help drive a “massive shift in the distribution of deaths in the coming 25 years” towards non-communicable disease, says the WHO.
The organisation predicts that about 67-million people will die in 2030, more than half from cancer, cardiovascular diseases and traffic accidents. In that year the four main causes of death will be ischaemic heart disease, strokes, chronic obstructive pulmonary disease and lower respiratory tract infections such as pneumonia.
Cancer-related deaths will rise from 7,4-million in 2004 to 11,8-million deaths in 2030 and mortality caused by cardiovascular diseases will rise from 17,1-million deaths in 2004 to 23,4-million by 2030.
Today the biggest single preventable cause of premature death is tobacco. The WHO estimates that tobacco users lose an average of 15 years of life and that tobacco use will account for 10% of deaths by 2030.
In 2005 about 22% of adults worldwide smoked tobacco, although the habit was much more prevalent in men than women. Globally about 36% of men and 8% of women smoke tobacco. In 2004 it was estimated that tobacco-related diseases caused about 5,4-million deaths and that this will rise to about 8,3-million in 2030.
South Africa has seen a decline in cigarette consumption because of higher taxes and other anti-tobacco measures such as bans on tobacco advertising and curbing smoking in public areas.
In a statement this week, ahead of World No Tobacco Day on May 31, the South African Medical Association described tobacco as “the only legal consumer product that kills one-third to one-half of those who use it as intended by its manufacturers”.
Globally, alcohol is the fifth leading risk factor for death and disability.
The 2008 report contains information on 73 health indicators from the WHO’s 193 member countries.
The latest report points out that every year about 100-million people worldwide are forced into poverty as a result of out-of-pocket spending on healthcare costs. Out-of-pocket payments include official and unofficial fees for services in both public and private healthcare providers and co-payments where insurance doesn’t cover the full cost of care. “In some cases [out-of-pocket payments] can be high enough to cause financial catastrophe and impoverishment, especially when there is severe illness or major injuries,” says the report.
Research covering almost 90% of the world population found that 150-million people worldwide or 2,3% of households “experience financial catastrophe due to health costs”. Unsurprisingly the problems of catastrophic healthcare spending is most severe and most common in low-income families.
The WHO report says that out-of-pocket payments are the main factor contributing to financial catastrophe caused by healthcare. A fundamental solution is to move away from out-of-pocket expenses to some form of prepayment, either through general taxation and governmentÂprovided healthcare or through private insurance arrangements. In 2005 WHO member states had called for the establishment of health financing systems that do not lead to risks of financial catastrophe when accessing healthcare.
Maternal mortality continues to reap its grim toll, especially in sub-Saharan Africa and southern Asia. These two regions account for about 85% of women’s deaths as a result of childbearing. For every 100 000 live births in sub-Saharan Africa, 900 women died as a result of childbirth or pregnancy. Globally, this maternal mortality ratio is 400, while in developed countries it is nine.
The report also highlights the number of deaths from breast cancer and the need for preventative screening. Breast cancer is the most common form of cancer among adult women and accounts for 16% of deaths in this group.
Mortality from breast, cervical, colorectal and some mouth cancers can all be reduced by proper screening and treatment. The WHO says mammography screening among women aged 50 to 69 can cut breast cancer deaths by up to a quarter. Despite this, looking at about two-thirds of the world’s population, only 22% of women in this age group had a mammogram in the previous three years.
Fuelled by economic growth and rising use of cars in developing countries, road accidents are estimated to become the fifth leading cause of death in 2030, up from the ninth in 2004.