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See Inside December 2010

A Global Call to Action on Cancer and Heart Disease

Most deaths from cancer and heart disease now occur in the poorer parts of the world

The global health community has won many victories against infectious disease in the poorer parts of the world—eradicating smallpox in the 1970s and beating down the number of reported polio cases. Now it is turning to cancer and heart disease. The Institute of Medicine (IOM) in Washington, D.C., recently released a report warning that the rising tide of cardiovascular disease in low- and middle-income countries is threatening those nations’ economic well-being. And a group of physicians and celebrities (including cycling champion Lance Armstrong and Princess Dina of Jordan) has published a call to action in Lancet to expand cancer care and control in poorer countries.

The renewed attention reflects major changes in disease trends. Cancer and heart disease are not limited to developed countries. According to the International Agency for Research on Cancer in Lyon, France, more than half of all people who were newly diagnosed with cancer in 2008 were in developing countries such as Nigeria, Egypt and Brazil—compared with just 15 percent in 1970. The IOM’s 2010 study reported that 80 percent of deaths from heart attacks, stroke and other cardiovascular diseases around the world now occur in the developing world.

In some respects, the rising proportion of cancer cases is a side effect of success. People are living longer (cancer is more common the older you get), and fewer people are dying of infectious diseases (you have to die of something). Similarly, the increase in cardiovascular disease is linked to aging populations, but adopting a Western-style diet and getting less exercise also play important roles. Treating cancer in the poorest parts of the world is not necessarily expensive; many older treatments that Westerners have replaced with pricey ones are still highly effective. The same is true for treating heart disease. Unfortunately, the older medications are often not broadly available in poor countries, and physicians, nurses and other health care workers are often lacking.

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