Part Two. The urgent need for action
Chapter Two. Chronic diseases and poverty
Chronic diseases and MDGs
In September 2000, the largest-ever gathering of Heads of State ushered in the new millennium by adopting the UN Millennium Declaration. The Declaration, endorsed by 189 countries, was then translated into a roadmap setting out goals to be reached by 2015. Health is central to the achievement of the Millennium Development Goals (MDGs), and three goals relate specifically to health issues: those concerned with reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other diseases.
The MDGs have successfully focused attention on the plight of the world's poorest children and mothers, and on some infectious disease epidemics. However, chronic diseases - the major cause of death in almost all countries - have not been included within the global targets; although as a recent WHO publication on health and the MDGs has recognized, there is scope for doing so within Goal 6 (Combat HIV/AIDS, malaria and other diseases). Health more broadly, including chronic disease prevention, contributes to poverty reduction and hence Goal 1 (Eradicate extreme poverty and hunger).
A recent World Bank study has found that the generic MDG targets are only of limited relevance for countries in eastern Europe and the former Soviet Union. The implications are relevant to many other countries that face a notable chronic disease burden. In the countries studied, reduction of adult mortality to the level found in the European Union would have the greatest impact on life expectancy at birth, with an average gain of eight years. The Russian Federation would gain more than 10 years. In contrast, health gains from reducing child and maternal mortality would be much more modest: reaching the levels prescribed by the MDGs would raise life expectancy at birth in the region by only 0.7-1.2 years, while reaching European Union levels would result in 0.9-2.0 years of gain.
According to the World Bank report, the greatest potential contributor to health gains in this region would be the reduction of deaths from cardiovascular diseases. The figure below shows the estimated impact of two scenarios: (1) reduction of infant, child and maternal mortality rates to the MDG levels; (2) reduction of mortality from cardiovascular diseases and external causes of death (injuries, violence and poisoning) to European Union levels, while keeping infant, child, and maternal mortality rates constant.
Chronic disease prevention and control can no longer be ignored as an important means of poverty reduction, and more generally, economic development. Investment in chronic disease prevention programmes is essential for many low and middle income countries struggling to reduce poverty. Several countries have adapted the MDG targets and indicators to include chronic diseases. These adaptations are needed to achieve Goal 6, on combating HIV/AIDS, malaria and other diseases, and a selection are featured in the table on the next page.