[prakruti] The poor world is getting the rich world's diseases

[Guest guest]

At 02:00 AM 8/10/07, you wrote:

>Globalisation and health

>The maladies of affluence

>Aug 9th 2007

> From The Economist print edition

>The poor world is getting the rich world's diseases

>AFP

>IN 1619 an English captain sailing past Cape Cod reported that the

>Massachusetts shore was “utterly void”. The Indians “died in heapes as

>they lay in their houses” confirmed an English merchant. By killing much

>of the population of the Wampanoag confederacy, the epidemic that raged

>from 1616-19 made possible the first permanent European settlement in

>north America, that of the Pilgrim Fathers in 1620. The Indians had caught

>the illness, thought to have been viral hepatitis, from prior contact with

>Europeans, probably captured French sailors.

>Europeans have been exporting their maladies throughout history. They seem

>to be doing it again, but in a new way. In the past, the problem was

>infection. Now, illnesses associated with Western living standards are the

>fastest growing killers in poor and middle-income countries. Chronic

>disease has become the poor world's greatest health problem.

> For many in the West, diseases are a bit like birds: everyone gets them

> but poor countries have more exotic species. Rich-country maladies are

> things like heart disease, cancer and diabetes: “chronic” conditions

> often resulting from diet or physical inactivity. Developing countries

> suffer more lurid and acute infections: malaria, tuberculosis, measles,

> cholera. HIV/AIDS is unusual in that it affects rich and poor alike. But

> otherwise, poor countries are presumed to have their own health problems.

> The sixth of the United Nations' millennium development goals (a sort of

> ten commandments of poverty reduction adopted in 2000) is concerned with

> infections only—the ailments of poverty. The progress report issued last

> month half way through the millennium programme's 15-year course tracks

> HIV/AIDS, malaria and tuberculosis. Combating chronic disease is not part

> of what the UN calls its “universal framework for development”.

>

>Yet the distinction between illnesses of affluence and illnesses of

>poverty is misleading as a description of the world and doubtful as a

>guide to policy. Heart disease—supposedly an illness of affluence—is by

>far and away the biggest cause of global mortality. It was responsible for

>17.5m deaths worldwide in 2005. Next comes cancer, another non-infectious

>sickness, which caused more deaths than HIV/AIDS, tuberculosis and malaria

>put together (see chart 1). Chronic conditions such as heart disease took

>the lives of 35m people in 2005, according to the World Health

>Organisation (WHO)—twice as many as all infectious diseases.

>If you look at lower-middle income countries, such as China, or

>upper-middle income ones, like Argentina, you find that what kills people

>there is the same as in the West (see chart 2). Four-fifths of all deaths

>in China are from chronic sicknesses. That is also true of countries as

>varied as Egypt, Jamaica and Sri Lanka.

>The main difference between these countries and rich ones is that chronic

>illnesses are more deadly there. Five times as many people die of heart

>disease in Brazil as in Britain, though Brazil is not five times as

>populous. Rich countries have become better at dealing with chronic

>conditions: death rates from heart disease among men over 30 have fallen

>by more than half in the past generation, from 600-800 per 100,000 in 1970

>to 200-300 per 100,000 now.

>

>This has not happened in middle-income countries. In 1980 the death rate

>for Brazilian men was below the rich-country average (300 compared with

>500-600). Its death rate has not changed—and is now higher than all but a

>few rich countries. Russia is worse off. In 1980 its death rate was 750

>per 100,000. Now it is 900, about four times as high as most rich countries.

>It may not seem surprising that upper-middle income places such as Russia

>suffer from “Western” ailments. But chronic diseases are mass killers in

>the poorest nations, too. Indeed, the only unusual thing about these

>countries is that they suffer from infections as well as chronic disease:

>a double burden. Chronic diseases were responsible for over 12m deaths in

>countries with annual incomes below $750 a head in 2005—almost as many as

>were caused by communicable ones. Africa is the only continent where

>infectious illnesses cause more deaths than the non-communicable kinds.

>Chronic diseases are becoming deadlier and more burdensome to the poor. By

>2015, says the World Bank, these ailments will be the leading cause of

>death in low-income countries. They already account for almost half of all

>illnesses there and impose substantial economic costs.

>People in poor countries get chronic diseases younger than in the West.

>There, chronic conditions bear heavily upon the old. Not so in poor and

>middle-income nations. Death rates for those between 30 and 69 years of

>age in India, Russia and Brazil are two or three times higher than in

>Canada and Britain. Almost half of deaths from chronic problems in

>developing countries occur in people below 70.

>As a result, the poor suffer from chronic illnesses longer and are more

>likely to die of them. The death rate from chronic disease in poor

>countries is obviously higher than in rich countries; more surprisingly,

>it is often higher than the death rate from infections. India, Pakistan,

>Nigeria and Tanzania all have roughly the same death rate for

>cardiovascular disease: 400 per 100,000. That is at least twice as high as

>the Western norm and, at least in India and Pakistan, more than four times

>the average death rate from infections (in Nigeria and Tanzania, HIV/AIDS,

>malaria and tuberculosis are still deadlier).

>Chronic disease bears down especially hard on working adults, imposing a

>heavy economic burden. Families in poor countries are much more likely

>than in the West to spend their savings looking after a chronically ill

>relative, or to pull children out of school to act as nursemaids.

>In short, developing countries suffer more from “rich world maladies” than

>the rich world itself. Overall in 2005, only a fifth of deaths

>attributable to “illnesses of affluence” (chronic conditions) actually

>took place in the most affluent nations. Three-quarters happened in poor

>or lower-middle-income ones.

>Death eaters

>Why are poor countries so vulnerable to the diseases of the rich? And why

>does public attention and aid money ignore them and focus on infections?

>The simplest explanation for chronic diseases' increasing importance is

>that people in poor countries now live long enough to suffer them. Thanks

>to better sanitation, more food and improved public health, average life

>expectancy in low and middle-income countries has risen from 50 in 1965 to

>65 in 2005. The increase in the poorest countries was proportionately

>greater: from 47 to 63. There are now more old people around to be

>vulnerable to chronic maladies.

>At the same time, because of increased health spending and safer water,

>infectious diseases have declined relative to chronic ones. International

>financing for malaria control has increased more than tenfold in the past

>decade. The Bill and Melinda Gates Foundation, with its $33 billion

>endowment, concentrates largely on infections. As a result, the incidence

>of tuberculosis, measured by the number of new cases per 100,000, has

>fallen slightly. In Africa fatal malaria cases among children under five

>(the main victims) fell between 1960 and 1995, though the decline has

>since levelled off. The WHO reckons that deaths from infections will

>decline by 3% over the next ten years. So more people in poor places will

>survive infections in their dangerous childhoods to reach an age when they

>are susceptible to heart attacks and cancer.

>Since chronic disease among the poor is not the preserve of old age,

>another part of the explanation for its increasing importance must lie in

>the harmful things middle-aged folk do. Of these, smoking and unhealthy

>eating are most important.

>Around 300m Chinese men smoke. In China, Egypt, Indonesia and Russia,

>people spend 5-6% of their household income on cigarettes—far more than

>the share in rich countries. Smoking and its associated ailments are still

>rising in poor countries, even while they fall in rich ones.

>Middle-income countries are also experiencing extraordinary levels of

>obesity. According to one study, half of all households in Brazil contain

>at least one obese person; the share is three-quarters in Russia.

>According to another, Mexico is the second fattest nation among the 30

>(mostly rich) countries of the Organisation for Economic Co-operation and

>Development, after America. It has the highest rate of diabetes among

>large countries, with 6.5m diabetics in a population of 100m. Not

>coincidentally, Mexicans are among the biggest swiggers of fizzy drinks in

>the world. Coke and tacos, anyone?

>Obesity affects rich countries, of course: it is a symptom of affluence

>and urbanisation. But it is occurring much earlier than anyone had

>expected in middle-income places. Obesity among children there used to be

>unheard of. Last year China's vice-minister for health, Wang Longde, said

>more than a fifth of Chinese children between seven and 17 who live in

>cities are overweight—a proportion that presumably reflects not only the

>wealth of China's urban elite but the amount of money they lavish on their

>“little emperors” (the single children they are limited to by China's

>one-child policy).

>Yet despite all the evidence that chronic disease is the world's biggest

>health problem, most poor countries focus on infectious disease and their

>health policies are usually based on the idea that infections should be

>controlled before chronic conditions. These choices no doubt partly

>reflect bureaucratic inertia at health ministries and investment in

>fighting infections by medical charities and drugs firms.

>Not just statistics

>It is true that there are better reasons why poor countries might want to

>concentrate on infections despite the growth of chronic disease.

>Infectious illnesses are usually simpler to deal with than chronic ones,

>requiring inoculation campaigns rather than long-term care, changes of

>lifestyle and the uphill work of public education. Moreover, if you

>inoculate a child against malaria, you considerably reduce his or her

>chances of dying from that disease, since most deaths from malaria occur

>among children under ten. If you lower someone's risk of getting a heart

>condition at 50, you might well find they get it at 60. The disease can

>only be managed.

>Still, it can be managed better: the contrast between death rates from

>heart attacks (falling in the West, rising elsewhere) shows that. Stalin

>said a single death is a tragedy, a million deaths, a statistic. But

>millions of avoidable deaths are millions of tragedies. Chronic disease is

>already the biggest problem for poor and middle-income countries. To

>concentrate so much on infections is to add to the health burden of the

>next generation in what are already the world's poorest, unhealthiest places.

>

> The Economist Newspaper Limited 2007. All rights reserved.

>

>

 

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