Chronic diseases and health promotion

Part Two. The urgent need for action

Chapter One. Chronic diseases: causes and health impact

A vision for the future

Reducing deaths and improving lives

Recent progress in public health has helped people in many parts of the world to live longer and healthier lives. There is abundant evidence of how the use of existing knowledge has led to major improvements in the life expectancy and quality of life of middle-aged and older people. Yet as this chapter has shown, approximately four out of five chronic disease deaths now occur in low and middle income countries. People in these countries are also more prone to dying prematurely than those in high income countries.

The results presented in this chapter suggest that a global goal for preventing chronic disease is needed to generate the sustained actions required to reduce the disease burden. The target for this proposed goal is an additional 2% reduction in chronic disease death rates annually over the next 10 years to 2015. The indicators for the measurement of success towards this goal are the number of chronic disease deaths averted and the number of healthy life years gained. This target was developed based on the achievements of several countries, such as Poland, which achieved a 6-10% annual reduction in cardiovascular deaths during the 1990s (8). Similar results have been realized over the past three decades in a number of countries in which comprehensive programmes have been introduced, such as Australia, Canada, New Zealand, the United Kingdom, and the United States (9-11).

This global goal aims to reduce death rates in addition to the declines already projected for many chronic diseases - and would result in 36 million chronic disease deaths averted by 2015. This represents an increase of approximately 500 million life years gained for the world over the 10-year period. Cardiovascular diseases and cancers are the diseases for which most deaths would be averted. Most of the deaths averted from specific chronic diseases would be in low and middle income countries as demonstrated by the top figure, opposite (12).

Every death averted is a bonus, but the goal contains an additional positive feature: almost half of these averted deaths would be in men and women under 70 years of age (see figure below). Extending their lives for the benefit of the individuals concerned, their families and communities is in itself the worthiest of goals. It also supports the overall goal of chronic disease prevention and control, which is to delay mortality from these diseases and to promote healthy ageing of people everywhere. This goal is ambitious and adventurous, but it is neither extravagant nor unrealistic. The means to achieve it, based on the evidence and best practices from countries that have already made such improvements, such as the United Kingdom and the other countries referred to above, are outlined in Parts Three and Four of this report.