The Growing Urgency of Killer Chronic Diseases

[wtr-time]As tragic as was the death of eight people in a terror attack in New York City on Tuesday, another scourge killed approximately 6,404 Americans on the same day. As a percentage of the current population of New York, the nation’s largest city, that would translate to about 169 deaths.

More sedentary lifestyles, unplanned urban growth, tobacco use, and excess consumption of alcohol and low-nutrient, calorie-dense foods are driving an epidemic of chronic disease.

Visual: Sebastian LP/Unsplash

Chronic diseases — a term that primarily refers to cardiovascular disease, cancer, diabetes, and chronic respiratory disease — are responsible for 88 percent of all U.S. deaths and 70 percent of all deaths worldwide per year, according to the World Health Organization. Yet they receive far less media attention and public health dollars than infectious disease.

Deaths from these conditions, collectively referred to as non-communicable diseases, or NCDs, are concentrated in low- and middle-income countries, the health agency estimates. And their global impact is increasing as regions improve economically and adults live longer on average worldwide, as revealed in a 2016 report by the Institute for Health Metrics and Evaluation.

“NCDs are the world’s largest disease epidemic, just by sheer number of people affected,” Silvana Luciani, chief of the Noncommunicable Diseases Unit at the Pan American Health Organization, said on October 28 at the World Conference of Science Journalists, in San Francisco. “Each year, 40 million people around the world die by NCDs. 40 million. If that was an infectious disease, we would all be writing about this every single day.”

The main drivers of the epidemic are well known — an aging global population, a more sedentary lifestyle, unplanned urban growth, tobacco use, excess consumption of alcohol, and easy access to low-nutrient, calorie-dense foods. To illustrate the latter points, public health legal scholar Lawrence Gostin asked the conference audience what they’d see if they did a 360-turn in any major city in the world, such as New York, Delhi, Johannesburg, Shanghai, or Hanoi.

“You’re going to see the same thing. You’ll see McDonald’s, you’ll see Burger King, Dunkin Donuts, you’ll see alcohol advertisements, tobacco and the like,” said Gostin, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown Law. “And that’s what the problem is. The problem is that the forces of multinational corporations and the forces of globalization and marketing, and even the entertainment business — movies, theaters — they all fan this epidemic.”

For their part, alcohol, beverage, food, and tobacco corporations and their advocates typically deny any role in the epidemic, try to mitigate any perceived effects, or fund research that diminishes their role in unhealthy outcomes. Sometimes these industries will oppose public health regulations that they find threatening to their business models.

Of course, blaming the food and beverage industries is too simplistic, with the health care and pharmaceutical industries, federal and local governments — as well as consumers themselves — playing a role. In 2011, heads of state and health ministers from United Nations member states met and ultimately agreed to reduce premature mortality from chronic diseases by 25 percent by 2025. Measures to achieve that included targets for healthier lifestyles, increasing access to medication for high blood pressure, and improving health care systems.

At this point, Gostin is unimpressed. “Didn’t make a darn difference,” he said.

Still, evidence shows that governments can do better. A recent review of research by Gostin and his colleagues shows that legal and regulatory measures put in place in the Eastern Mediterranean region and beyond offer a cost-effective and affordable way to reduce chronic disease. That means approaches such as taxes on unhealthy food, beverages, and tobacco, public education campaigns to bust myths that items such as granola bars are healthy, and building more safe playgrounds and bicycle paths to encourage more activity among children.

Some conservative critics raise concerns about a “nanny state,” but such cries are inconsistent. Over time, after all, the U.S. public has come to accept regulations on cigarettes, seatbelt use, and air travel.

With that in mind, Gostin suggested that both the science, and the path forward, are clear. “What you want to do is change the environment in which people live to allow people to make the healthy choice,” he said. “Right now, the choice that is the easiest, easiest, easiest one is to really get fat and not be good to yourself.”