Global noncommunicable diseases--where worlds meet.

L climate change, the relentless worldwide spread of noncommunicable diseases offers an opportunity for low-, middle-, and high-income countries to join forces in addressing a major global challenge that threatens health and economies alike. A recent report from the World Health Organization1 identified six risk factors associated with noncommunicable diseases as the leading global risk factors for death: high blood pressure, tobacco use, high blood glucose levels, physical inactivity, overweight or obesity, and high cholesterol levels. Together, these factors contribute to a large proportion of the deaths resulting from cardiovascular diseases, metabolic causes, and cancer (see table). Moreover, they pervade countries of all income levels: even in lowincome countries, 6 of the top 10 risk factors are associated with noncommunicable diseases. The prevalence and impact of noncommunicable diseases continue to grow. Chronic diseases account for 60% of all deaths worldwide, and 80% of these deaths occur in lowor middleincome countries, where the toll is disproportionate during the prime productive years of youth and middle age.2,3 Trends also suggest that the major risk factors for noncommunicable diseases — hypertension, high glucose levels, obesity, and inactivity — are on the rise, especially in developing countries. The long-term costs of treatment and the negative effects on productivity take devastating tolls on the economic situations of individuals, families, and societies. According to the World Economic Forum’s 2009 report, noncommunicable diseases are among the most severe threats to global economic development, more likely to be realized and potentially more detrimental than fiscal crises, natural disasters, or pandemic influenza. It is projected that in the next 10 years, China, India, and Britain will lose $558 billion, $237 billion, and $33 billion, respectively, in national income as a result of largely preventable heart disease, strokes, and diabetes.2,3 In the United States, cardiovascular disease and diabetes together cost the country $750 billion annually. Noncommunicable diseases are intricately linked to globalization, urbanization, and demographic and lifestyle transitions — all ubiquitous forces. Increasingly, such diseases are also linked to poverty and socioeconomic disparity and are no longer “diseases of affluence.” There are also complex but measurable associations between early life circumstances (e.g., maternal and childhood nutrition) and the risk of noncommunicable disease in adulthood; hence, many developing countries now find themselves at a stage of epidemiologic and behavioral transition in which they face a growing burden of noncommunicable disease on top of the ongoing hazards of undernutrition and communicable disease. Persons with a noncommunicable disease are also vulnerable to common infectious diseases, such as tuberculosis and community-acquired pneumonias — and therefore to the poorer outcomes associated with these complications. Furthermore, owing to burdensome health care costs, disability, absenteeism, and forgone income, noncommunicable diseases result in poverty, thus contributing to a vicious cycle. Because of their multiple interacting causes and complications, as well as their lifelong nature, noncommunicable diseases challenge current paradigms of health care organization and delivery. Confronted by the ever-increasing threat of such diseases, high-, middle-, and low-income countries alike are struggling to find solutions at the levels of policy, health care delivery, health communication, and education.2 But this common set of challenges also offers opportunities for global cooperation. There is a paradox that complicates efforts to address noncommunicable diseases globally: modern processes of production and globalization are key components of economic development worldwide that have brought about many improvements in health, yet the negative effects of globalization (including increased incidence of noncommunicable diseases) contribute to poverty and widening disparities. Current political and economic incentives favor industry and other interest groups at the expense of health: consider the subsidies paid for corn-based agriculture and massproduced processed foods, the tobacco revenue generated in coun-