World Health Organization warns of growing "crisis of suffering"
Human and social costs of chronic diseases will rise unless confronted now, WHO Director-General says
Cancer, heart disease and other chronic conditions which already kill more than 24 million people a year will impose increasing burdens of suffering and disability on hundreds of millions of others, the World Health Organization warns in its annual report published today. The World Health Report 1997: Conquering suffering, enriching humanity says the number of cancer cases is expected to at least double in most countries during the next 25 years. There will be a 33% rise in lung cancers in women and a 40% increase in prostate cancers in men in European Union countries alone by 2005.
The incidence of some other cancers is also rising rapidly, especially in developing countries.
Heart disease and stroke, already the leading causes of death in richer nations, will become much more common in poorer countries. Globally, diabetes cases will more than double by 2025, and there will be a huge rise in some mental disorders, especially dementias.
WHO is calling for an "intensified and sustained" global campaign to encourage healthy lifestyles and attack the main risk factors largely responsible for many of the diseases - unhealthy diet, inadequate physical activity, smoking and obesity. Such a campaign requires top-level international collaboration and multisectoral cooperation, involving governmental institutions, health authorities, the community, mass media, nongovernmental organizations, medical and voluntary organizations and the private sector.
"The outlook is a crisis of suffering on a global scale," Dr Hiroshi Nakajima, Director-General of WHO says. "There is an urgent need to improve our ability to prevent, treat and, where possible, to cure these diseases, and to care for those who cannot be cured."
The report shows that at present:
- Circulatory diseases such as heart attacks and stroke together kill 15.3 million people a year.
- Cancer in all its forms kills 6.3 million people a year.
- Chronic obstructive pulmonary disease kills 2.9 million people a year.
These add up to 24.5 million deaths, or 47% of the annual global total of deaths from all causes.
Of the remainder, infectious and parasitic diseases account for 17.3 million, or 33%; deaths from perinatal and neonatal causes account for 3.5 million; there are 585 000 maternal deaths; and 6 million deaths from other and unknown causes, including accidents, violence, homicide and suicide.
The report says that tobacco-related deaths, primarily from lung cancer and circulatory disease, already amount to 3 million a year, or 6% of total deaths. Smoking accounts for one in 7 cancer cases worldwide. "If the trends of increasing consumption in many countries continues, the epidemic has many decades to run, and will surely be judged by future generations to have been one of the greatest health tragedies that has ever occurred in the history of mankind."
In 2020, at least 15 million people worldwide will develop cancer, compared to about 10 million cases annually now. The doubling of new cases will occur in developing countries, with about 40% increase in industrialized countries. Between 1995 and 2025, the number of people in the world with diabetes is expected to rise from about 135 million to 300 million.
The projected increases in these and other disabling conditions such as arthritis and the bone involutive condition, osteoporosis, are due to a combination of factors. The most important are population ageing, which puts more people at risk of developing chronic conditions late in life; global population growth; and the rising prevalence of unhealthy lifestyles - characterized particularly by inappropriate diet, inadequate physical exercise, and smoking.
A steadily ageing global population means there are more opportunities over time for these diseases to progress to a deadly or disabling stage in a larger number of people. Half a century ago, the great majority of the global population died before the age of 50. Today, most survive well beyond that age. Average life expectancy at birth globally reached 65 years in 1996. In many countries, it is now well over 70 years, and is approaching 80 years in a few others.
There are today an estimated 380 million people aged 65 years or more. By 2020, that number is expected to rise to more than 690 million. Also by then, it is predicted that chronic diseases will be responsible for a large proportion of deaths in the developing world. Cancers and circulatory diseases are already major causes of death in South-east Asia, one the world's most populous regions.
The report says that many countries will increasingly come under the "double burden" of both infectious and noncommunicable diseases. Industrialized nations are already facing bigger risks from infectious diseases, partly because of the globalization of travel, tourism and trade. Simultaneously, developing countries with fastgrowing economies are becoming increasingly exposed to conditions sometimes labelled as "diseases of affluence" while struggling to control their own, still continuing infectious epidemics.
"In the battle for health in the 21st century, infectious diseases and chronic diseases are twin enemies that have to be fought simultaneously on a global scale," Dr Nakajima says.
"We dare not turn our backs on infectious diseases, for they will return with a vengeance if we do. But neither can we ignore the growing burden in ill-health and disability imposed by noncommunicable diseases. This, too, is the plight of hundreds of millions."
Dr Nakajima calls for global efforts aimed at preventing, treating and curing noncommunicable diseases, and reducing disability caused by them. But such efforts must not mean a switch away from fighting infectious diseases, he says. Infectious agents play important roles in the development of some noncommunicable diseases, notably cancers of the cervix, liver and stomach.
"People in poorer countries are now acquiring many of the unhealthy lifestyles and behaviours of the industrialized world: sedentary occupations, inadequate physical activity, unsatisfactory diets, tobacco, alcohol and drugs. Populations in richer countries continue to live with all these risks."
Referring to dramatic increases in life expectancy in recent decades, Dr Nakajima points out: "In celebrating our extra years, we must recognize that increased longevity without quality of life is an empty prize, that is, that health expectancy is more important than life expectancy.
The ten leading killer diseases * = noncommunicable diseases
- Coronary heart disease* 7.2 million deaths
- Cancer (all sites)* 6.3 million deaths
- Cerebrovascular disease* 4.6 million deaths
- Acute lower respiratory infection 3.9 million deaths
- Tuberculosis 3.0 million deaths
- Chronic obstructive pulmonary disease* 2.9 million deaths
- Diarrhoea (including dysentery) 2.5 million deaths
- Malaria 2.1 million deaths
- HIV/AIDS 1.5 million deaths
- Hepatitis B 1.2 million deaths
"The majority of chronic diseases are preventable but cannot as yet be cured. The emphasis must therefore be on preventing their onset, delaying their development in later life, reducing the suffering they cause, and providing the supportive social environment to care for those disabled by them."
Dr Nakajima continues: "In identifying priorities for action, World Health Organization is looking towards key areas of chronic diseases that are major causes of death or avoidable ill-health and disability. These are areas in which actions or interventions that have a direct and tangible effect on individual health - that make a difference and make it sooner, rather than later - are possible."