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Chronic diseases, the biggest killer

By Mirta Roses Periago

Sixty-two per cent (3.2 million) of the 5.2 million deaths reported in the region of the Americas in 2004 were due to chronic diseases —mainly cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes—exceeding the worldwide average of 60.2 per cent.

Most of these deaths occur prematurely (i.e., under the age of 70) and impact productivity and overall national development. But their damage extends more broadly. By causing disabilities and diminishing the quality of life, chronic diseases also imply a heavy and protracted load for both the people suffering them and their families —although this burden is often overlooked.

As a consequence, there is a strong association between Chronic Non-communicable Diseases (CNCDs) and poverty, given their catastrophic economic impact on the patients and their families as well as the high burden faced by the health care systems.

The situation will get worse before it becomes better. Due to demographic, social and economic changes as well as the transformation in the epidemiological and nutrition patterns of these countries, the proportion of deaths attributable to chronic diseases will likely increase over the next coming years.

High blood pressure and tobacco use lead the list of chronic disease risk factors, while overweight and obesity are an intensifying problem in the Americas. The number of obese persons 15 years of age or older will have grown by the end of this year to 289 million (39 per cent of the population) from 139 million (25 per cent of population) just five years ago.

It is estimated that currently there are 145 million smokers in the region.

Fortunately, we have proven interventions to address the chronic diseases challenge. After considering the effectiveness, cost, acceptability, and feasibility of some interventions, the World Health Organisation (WHO) concluded that in low- and middle-income countries 40 per cent of the deaths due to chronic diseases could be prevented by implementing a salt reduction strategy and the four elements of WHO Framework Convention on Tobacco Control. This could be done at a cost of less than US$0.40 per person/year in low—and lower middle-income counties, and US$0.50-1.00 in upper middle-income countries (in 2005 US dollar value).

Those actions would save 1,280,000 lives every year in our region—half a million of them being saved due to tobacco use control. It is outrageous that tobacco companies, in the blind pursuit of short-term profits, are bringing punishing lawsuits against countries that, like Uruguay and others, are just trying to protect their citizens' health and lives.

For that reason, the 50th Directing Council of the Pan American Health Organisation (PAHO) on September 29, expressed its solidarity with Uruguay, and also vowed to "oppose attempts by the tobacco industry or its allies to interfere with, delay, hinder or impede the implementation of public health measures designed to protect the population from the consequences of tobacco consumption and exposure to second-hand smoke". This action prompted a cascade of support to the country by concerned NGOs worldwide.

The Summit of Caricom Heads of Government on CNCDs, held in Trinidad and Tobago in September 2007, was the first to declare the fight. And the United Nations Secretary General has announced a UN CNCDs Summit for next year, including actions on risk factors like unhealthy diets and physical inactivity, tobacco and alcohol use, as well as urban planning and transportation.

There is a strong alliance between governments, non-governmental, faith-based, civil society, professional and patient organisations, private sector and industry which are committed to be part of, and contribute to, curbing the pandemic of chronic diseases.

No matter how tough is the battle for a tobacco-free world, we will continue fighting head-on against all risk factors for chronic diseases that affect overall development and imply a heavy burden for the families of the Americas.

• Dr Mirta Roses Periago is Director of the Pan American

Health Organisation

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