In 2000 the United Nations issued its eight Millennium Development Goals for poorer nations, including the eradication of extreme poverty. As soon as children stop dying from pneumonia and malnutrition, however, new problems come into focus. "As the same children survive to slightly older ages they start getting hit by chronic disease," says population health researcher Majid Ezzati of Harvard University. "In many places it already has become the dominant cause" of illness, Ezzati notes, with sub-Saharan Africa being the primary exception. People in India, other countries in south Asia and impoverished parts of Latin America all suffer from significant rates of chronic disease, in part from a withering trinity of cheap high-calorie food, tobacco and alcohol, he says.
During the last quarter century the rate of diabetes alone has nearly quadrupled in most east and south Asian countries, including China and India, according to South Korean researchers who reviewed past studies in the November 10 Lancet. These countries now have similar rates of diabetes to that in the U.S., where the disease afflicts 8 percent of the population. But the condition is even more of a problem in Asia. People there contract it at a younger age and a lower weight than those in other regions, and as a result they experience longer-lasting complications and die sooner from the disease, the group reports.
Even when it doesn't lead to diabetes, which kills a million people annually, high blood sugar causes 2.2 million deaths globally from heart disease and stroke every year, Ezzati and his colleagues observe in another report from the same Lancet. The researchers attribute these deaths to blood glucose based on health data gathered from 52 countries around the world.
The economic consequences of such health problems may be considerable, according to a report published November 8 by the Oxford Health Alliance, a public health group. In low- and middle-income countries, about 80 percent of the total burden incurred by chronic diseases falls on those of working age, 60 or younger, the report points out. "There's the assumption that chronic disease is only something to do with the elderly and therefore not of economic relevance," says co-author Marc Suhrcke, an economist for the World Health Organization in Vienna. Because chronic disease afflicts working age people, it could cut into savings and labor productivity, Suhrcke says.
Focusing more on chronic disease need not totally compete with efforts to control infection and malnutrition. Managing infectious and chronic disease alike requires a strong public health infrastructure, Ezzati notes. "If you have got the right institutions," he says, "they should both be handled together."