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Chronic diseases: a 21st century epidemic

July - August, 2009 | Volume 8, Issue 4

Noncommunicable diseases - primarily cardiovascular, lung, some cancers and type 2 diabetes - account for more than half of deaths worldwide, of which 80 percent occur in low- and middle-income countries. Each year, more than 35 million people worldwide die from chronic noncommunicable diseases.

Ironically, as scientific advances have begun to blunt the growth of infectious disease epidemics in developing countries and people live longer and become more productive, they run the risk of succumbing to chronic diseases often associated with the better off.

"Aging has changed the research portfolio for global health in the 21st century," says Dr. Roger I. Glass, director of the Fogarty Center, which is partnering with other institutes at NIH to apply knowledge about cancer, cardiovascular disease, lung disease and diabetes in low- and middle-income countries.

Photo: Indonesian man smokes a cigarette
Photo by David Snyder

Cigarettes in Indonesia are among the
cheapest in the world and are a prime
cause of rising rates of chronic diseases
in the developing world.

"These diseases affect everyone, everywhere," Glass explains. "To make real progress is going to take international collaboration — bringing evidence about prevention and treatment to developing countries while at the same time learning about how others are addressing diseases we have at home."

In June, Fogarty became a founding member of the Global Alliance for Chronic Diseases (GACD), a collaboration among national health agencies in some of the biggest countries in the world.

The Center also is making initial grants in its Millennium Promise Awards program to train researchers in chronic diseases. (See article on Fogarty's Millennium Promise Awards.) In addition, a program that has sent third-year medical students and postdoctoral fellows abroad has expanded to encompass cardiologists, trauma specialists, cancer researcher and others pursuing chronic disease specialties. (See article on New Career Trajectories for Fogarty fellows.)

About Chronic Diseases

  • Chronic diseases—mainly cardiovascular
    diseases, diabetes, cancer and chronic
    respiratory diseases—caused an estimated
    35 million deaths in 2005.
  • Chronic diseases account for 60 percent
    of all deaths around the world.
  • Of these deaths, 80 percent occur in low-
    and middle-income countries.
  • About 16 million people who die each year
    from chronic diseases are under 70 years old.
  • Every year, 4.9 million people die as a result
    of tobacco use, 2.6 million people die as
    a result of being overweight or obese,
    4.4 million people die as a result of high
    cholesterol and 7.1 million people die as a
    result of high blood pressure

-- World Health Organization

The GACD comprises the six world agencies that supply about 80 percent of all public research funding in the world: the NIH represented by the National Heart, Lung and Blood Institute and Fogarty, Australia's National Health Medical Research Council, Canadian Institutes of Health Research, China's Ministry of Health in association with the Chinese Academy of Medical Sciences, the Indian Council of Medical Research and the United Kingdom's Medical Research Council.

Its stated purpose is to coordinate research activities on prevention and treatment of chronic diseases on a global scale, and "collectively seek to identify common approaches to develop the evidence base needed to guide policy, develop and share best practices for fighting chronic diseases, and foster a sustainable and significant reduction of illness, disability and death around the world."

Other funders, including philanthropies, will be invited to join in the future, and the GACD will consider the World Health Organization 2008-2013 action plan for setting priorities to combat chronic diseases.

"In reality, low and middle income countries are at the center of both old and new public health challenges," the WHO plan said. "While they continue to deal with the problems of infectious diseases, they are in many cases experiencing a rapid upsurge in chronic disease risk factors and deaths, especially in urban settings. These risk levels foretell a devastating future burden of chronic diseases in these countries."

Global Alliance Priorities


The Global alliance priorities are:

  • Large-scale international clinical trials of the polypill for preventing heart disease
  • Public health measures for the control of obesity
  • Description of major risk factors and the development of control measures for chronic obstructive airways disease
  • Implementation research of interventions to address the above three priorities

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