World health report

Obesity, high blood pressure, high cholesterol, alcohol and tobacco: The World Health Organization’s response

Chronic diseases are now the major cause of death and disability worldwide, and increasingly affect people from developing as well as developed countries. Noncommunicable conditions, including cardiovascular diseases (CVDs), diabetes, obesity, cancers and respiratory diseases, now account for 59 per cent of the 56.5 million deaths annually and almost half (45.9 per cent) of the global burden of disease. Five of the top 10 selected global disease burden risk factors identified by World Health Report 2002: reducing risks, promoting healthy life – obesity, high blood pressure, high cholesterol, alcohol and tobacco – independently and often in combination, are the major causes of these diseases.

The scientific evidence is strong that a change in dietary habits, physical activity and tobacco control can produce rapid changes in population risk factors for these chronic diseases. Noncommunicable Diseases (NCDs) frequently involve overlapping risk factors and chronic conditions. Recognising this, WHO is adopting a broad-ranging approach. It has begun to formulate a Global Strategy on Diet, Physical Activity and Health, under a May 2002 mandate from the World Health Assembly (WHA). This extensive, population-wide, prevention-based strategy will be developed over the next two years and presented to the WHA in 2004. WHO will be consulting widely with all stakeholders during this process.

WHO is already responding in other ways to Member States’ calls for action. The Tobacco Free Initiative is well-advanced in facilitating development of the Framework Convention on Tobacco Control. (See Fact Sheet 273) And this year’s World Health Day theme “Move for Health” focused increased attention on the need for daily moderate-intensity physical activity to maintain good health, and reduce the risk of cardiovascular disease.

The Extent of the Problem
Many of the chronic disease risks, and the diseases themselves, overlap.
- We are facing a worldwide epidemic of obesity, a key risk factor in type II diabetes, cardiovascular diseases, high blood pressure and stroke, as well as various types of cancer. More than one billion adults worldwide are overweight, and at least 300 million of these are clinically obese.
- Heart attacks and strokes kill about 12 million people every year (7.2 million due to ischaemic heart disease and 5.5 million to cerebrovascular disease). In addition, 3.9 million people die annually from hypertensive and other heart conditions.
- About 75 percent of CVDs can be attributed to the majority risks: high cholesterol, high blood pressure, low fruit and vegetable intake, inactive lifestyle and tobacco.
- An estimated 177 million people are affected by diabetes, the majority by type II diabetes. Two-thirds of them live in the developing world. The top 10 countries, in numbers of sufferers, are India, China, USA, Indonesia, Russia, Japan, UAE, Pakistan, Brazil and Italy.

Why is this Happening?
Chronic diseases, which continue to dominate in lower-middle and upper income countries, are becoming increasingly prevalent in many of the poorest developing countries. There they create a double burden on top of the infectious diseases that continue to afflict these countries. This reflects a significant change in diet habits, physical activity levels, and tobacco use worldwide as a result of industrialization, urbanization, economic development and increasing food market globalization. People are consuming more energy-dense foods, including processed foods that are high in sugar and/or saturated fats, or excessively salty. And this nutrition transition and increasing physical inactivity is taking place in developing countries at a much faster pace than was the case for the developed world. Unless effective action is taken, the global burden of NCD disability and death will inexorably continue to increase.

What Can be Done?
Established scientific evidence suggests there are major health benefits in: - Eating more fruit and vegetables, as well as nuts and whole grains;
- Daily physical activity;
- Moving from saturated animal fats to unsaturated vegetable oil-based fats;
- Cutting the amount of fatty, salty and sugary foods in the diet;
- Maintaining a normal body weight (within the Body Mass Index (BMI) range of 18.5 to 24.9);
- Stopping smoking

While an optimal diet is critical, physical activity is well-established as an important determinant. Daily moderate-intensity physical activity, which helps lower blood pressure, reduce body fat and improve glucose metabolism, is essential to maintain good health, and reduces the risk of CVDs, colon and breast cancers and type II diabetes. Daily physical activity can also help reduce osteoporosis and falls among older people, has positive effects for mental health, and is important in maintaining a healthy weight.

A Multi-faceted Approach is Required
WHO recognises that the causes of NCDs are complex. Because of this, the response needs to be multi-faceted and multi-institutional. The evidence is overwhelming that prevention is possible when sustained actions are directed both at individuals and families, as well as the broader social, economic and cultural determinants of NCDs. The benefits of behavioural interventions in reducing the rates of CVDs, cancers and diabetes in populations have been well-proven in countries such as Finland, Japan and the Mauritius.

However, primary prevention is not enough. Demographic and epidemiological changes have steeply increased the need for long-term care of people of all ages suffering from NCDs. Cost-effective pharmacological treatments for high blood pressure, diabetes and raised cholesterol have life-saving impacts and should be routinely implemented at the primary health care level. WHR 2002 shows that countries in all epidemiologic settings will achieve major additional reductions in the disease burden by treating people identified to be at risk. Dietary, physical activity and smoking cessation programmes should also be integral to the management of these diseases. Ensuring good health demands a “Life Course” approach to eating and physical activity that begins with pre-pregnancy, includes breast feeding, and extends to old age.

A new joint WHO/FAO expert report, to be published in the first quarter of 2003 following extensive consultation, will recommend population nutrient and physical activity goals. The report is one of a number of planned inputs into developing the Global Strategy.

WHO has begun to engage constructively with all stakeholders in developing its Global Strategy. It believes that governments, health professionals, the food and advertising industries, and wider civil society should all contribute to making the easy choices the healthy choices, both for diet and physical activity.