In 2005, WHO re-emphasised the importance of chronic (non-communicable) diseases as a neglected global health issue.1 Chronic diseases—mainly cardiovascular disease, cancer, chronic respiratory diseases, and diabetes—were estimated to cause more than 60% (35 million) of all deaths in 2005; more than 80% of these deaths occurred in low-income and middle-income countries. We previously projected that, in 2015, 41 million people will die from chronic diseases without concerted prevention and control action.2 Achievement of the global goal of reducing chronic disease death rates by an additional 2% every year would avert 36 million deaths between 2005 and 2015.
Most of these averted deaths will be in low-income and middle-income countries, and just less than half will be in people younger than 70 years.2 Moreover, in most countries the poorest people have the highest risk of developing chronic disease and they are least able to cope with the resulting financial consequences.3 When the costs to individuals are summed, the loss to the economy can be substantial. For example, one study for the UK4 suggested that a total of £1·7 billion (about US$3 billion) was spent on prevention or treatment of heart disease in 1999. The investigators argued that people who were ill lost £2·9 billion (about $5·2 billion) in potential earnings, and they valued the time spent by informal carers at a further £2·4 billion (roughly $4·3 billion).4
Although there are now many estimates of the economic effects of different types of chronic diseases, they are not directly comparable because inconsistent methods are used and because different societies have different ways of delivering and financing health services, which directly impinge on costs.5, 6, 7, 8, 9, 10 Accordingly, the overall objective of this Series is to assess more accurately the effect of chronic diseases on health and economic wellbeing with consistent methods, and to provide empirical evidence for possible strategies to reduce their harmful effects, to support low-income and middle-income countries as they respond to the chronic disease epidemics.
In the first paper in this Series, we estimate the burden and loss of economic output associated with chronic diseases in 23 selected countries (figure 1). These countries were selected as leading countries collectively accounting for around 80% of the total mortality burden attributable to chronic diseases in developing countries. We summarise the latest projections of the effect of chronic diseases on mortality in low-income and middle-income countries, focusing on these 23 countries. We then estimate the effect of premature deaths from chronic diseases on the countries' national income, which is measured in gross domestic product (GDP) losses per working-age population. We aggregate estimates from coronary heart disease, stroke, and diabetes, since these disorders represent the greatest burden of the entire group of chronic diseases. All estimates are projected between 2005 and 2015. Finally, we estimate potential gains in GDP that are achievable through meeting the global goal of a 2% additional yearly reduction in mortality rates from chronic diseases.
Key messages
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In 23 selected countries, which account for around 80% of the total chronic disease mortality burden in developing countries, chronic diseases are responsible for 50% of the total disease burden
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Age-standardised death rates for chronic diseases are more than 50% higher in the 15 of these countries with death registration data than in high-income countries
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If nothing is done to reduce risk of chronic diseases, an estimated US$84 billion of national income will be lost from heart disease, stroke, and diabetes alone in the 23 selected countries between 2006 and 2015
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As little as a 2% yearly additional reduction in mortality rates from chronic diseases would avert 24 million deaths, with almost 80% of the life-years gained coming from deaths averted in people younger than 70 years, and save almost 10% of the expected loss in income and around $8 billion collectively for the 23 countries by 2015
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Governments have a key role in stimulating the generation of information to reduce the risk of chronic diseases and in ensuring access to preventive and treatment services, especially for poor people