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Chronic Diseases Series

Carol Adelman

It is encouraging to see The Lancet take a forthright stand on the coming pandemic of chronic diseases.1 The World Bank has tried to draw attention to illnesses such as cardiovascular diseases and cancers for almost two decades now. The global health community, however, has focused on WHO’s list of ten neglected diseases. These, including tuberculosis, malaria, dengue, leprosy, and six tropical diseases, constitute only slightly more than 5% of global mortality.

Non-communicable diseases have a disproportionately high effect on the working-age population that every country depends on for national productivity and international competitiveness. These diseases are the predominant drain on national health resources in developing countries, since they often require hospital admission and disability payments.

The effect of non-communicable diseases has been studied for some time. Almost 10 years ago, the World Bank, the WHO, and the Harvard School of Public Health collaborated on a landmark book, The global burden of disease.2 One of its main findings was: “Adults under the age of 70 in Sub-Saharan Africa today face a higher probability of death from a noncommunicable disease than adults of the same age in the Established Market Economies.” By 2010, ischaemic heart disease will replace lower respiratory infections and diarrhoeal diseases as the leading cause of death.

The WHO has finally recognised that 400 million people could die from chronic diseases in the next decade. It must also acknowledge that its prime clients in developing countries—the ministries of public health—have not been able to prevent this onslaught of untimely death because they focus mainly on preventive programmes. The burden for treating and caring for a rising number of chronically ill people, however, will fall on ministries of higher education, which control the medical schools, teaching hospitals, professional medical societies, and the curative care sector in general.

Foreign aid is concentrated in ministries of public health, many of which are now overwhelmed with projects they cannot implement effectively. Donors and global health agencies will need to fund the parts of the health-care system that are treating non-communicable diseases. Ideally, developing countries should, like western nations, integrate preventive and curative care into a comprehensive delivery system.

It is good that the WHO is finally focusing on the right problem. Let us hope it can now help fix it in the right way.

We declare that we have no conflict of interest.

1 The Lancet chronic diseases series. (accessed Jan 10, 2006)
2 In: Murray CJL, Lopez AD, eds. The global burden of disease. Cambridge: Harvard University Press, 1996.

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