Global status report - WHO

1 Tobacco use diabetes cancers unhealthy diets physical inactivity harmful use of alcoholcardiovascular diseaseschronic respiratory diseasesunhealthydietsGlobal status report on noncommunicable diseases 2010 tobacco use diabetes cancers unhealthy diets physical inactivity harmful use of alcoholcardiovascular diseaseschronic respiratory diseasesGlobal status report on noncommunicable diseases 2010 The Global status report on Noncommunicable Diseases is the fi rst report on the worldwide epidemic of cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, along with their risk factors and determinants. Noncommunicable diseases killed 36 million people in 2008, and a large proportion of these deaths occurred before the age of 60, so during the most productive period of life.

2 The magnitude of these diseases continues to rise, especially in low- and middle-income countries. This report reviews the current status of noncommunicable diseases and provides a road map for reversing the epidemic by strengthening national and Global monitoring and surveillance, scaling up the implementation of evidence-based measures to reduce risk factors like tobacco use, unhealthy diet, physical inactivity and harmful alcohol use, and improving access to cost-effective health-care interventions to prevent complications, disabilities and premature death. This report , and subsequent editions, also provide a baseline for future monitoring of trends and for assessing the progress Member States are making to address the epidemic. The Global status report on Noncommunicable Diseases was developed as part of the implementation of the 2008 2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases, which was endorsed by the World Health Assembly in status report on noncommunicable diseases 2010tobaccouseesphysicalinactivityarmful useofalcoholcardiovasculardiseaseschroon nicrespiratorydiseeaassesdiabetescancers unhealthydietshaGlobal statusreport on noncommunicable diseases nicable dise20102010 ISBN 978 92 4 156422 9 WHO2000200320042008 Global Strategy for the Prevention and Control of Noncommunicable DiseasesWHO Framework Convention on Tobacco ControlGlobal Strategy on Diet.

3 Physical Activity and HealthAction Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases2010 Global Strategy to Reduce the Harmful Use of AlcoholThe world has a sound vision and a clear road map to address NCDsWHO Library Cataloguing-in-Publication DataGlobal status report on noncommunicable diseases disease - prevention and control. disease - epidemiology. disease - mortality. of illness. of health Health 978 92 4 156422 9 (NLM classifi cation: WT 500)ISBN 978 92 4 068645 8 (PDF) World Health Organization 2011 Reprinted 2011 All rights reserved. Publications of the World Health Organization are available on the WHO web site ( ) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: Requests for permission to reproduce or translate WHO publications whether for sale or for noncommercial distribution should be addressed to WHO Press through the WHO web site ( ).)

4 The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full mention of specifi c companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied.

5 The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The Editor and principal writer of this report was Dr Ala Alwan, Assistant Director-General, Noncommunicable Diseases and Mental Health. The members of the core writing and coordination team were Ala Alwan, Tim Armstrong, Douglas Bettcher, Francesco Branca, Daniel Chisholm, Majid Ezzati, Richard Garfi eld, David MacLean, Colin Mathers, Shanthi Mendis, Vladimir Poznyak, Leanne Riley, Kwok Cho Tang and Christopher were also made by Tsouros Agis, George Alleyne, Francisco Armada, Nick Banatvala, Robert Beaglehole, John Beard, Monika Bloessner, Elaine Borghi, Ties Boerma, Freddie Bray, Eric Brunner, Vera da Costa e Silva, Melanie Cowan, Manuel Dayrit, Goodarz Danaei, Michael Engelgau, Ibtihal Fadhil, Farshad Farzadfar, Mariel Finucane, David Forman, Silvia Franceschi, Gauden Galea, Luis Galvao, Hassan Ghanam, Jim Gogek, Vilius Grabauskas, Regina Guthold, Tieru Han, Corinna Hawkes, Hendrik Hogerzeil, James Hospedales, Samer Jabour, Gauri Khanna, Jacob Kumaresan, Richard Laing, Jerzy Leowski, John Lin, Alan Lopez, Haifa Madi, Gabriel Masset, Robert Moodie.

6 Jai Narain, Chizuru Nishida, Sania Nishtar, Mercedes de Onis, Sameer Pujari, Pekka Puska, J rgen Rehm, Dag Rekve, Sylvia Robles, Manuel Jean Baptise Roungou, Badara Samb, Boureima Sambo, Rengaswamy Sankaranarayanan, Shekhar Saxena, Joachim Sch z, Eduardo Seleiro, Hai-Rim Shin, Gitanjali Singh, Gretchen Stevens, Edouard Tursan d Espaignet, Annemiek Van Bolhuis, and Cherian Varghese. Advice and support were received from WHO Regional Directors and Assistant Directors-General. Other individuals provided technical assistance throughout the preparation of the report : Virginia Arnold, Alexandra Cameron, Barbara Campanini, Xuanhao Chan, Li Dan, Alexandra Fleischmann, Edward Frongillo, Louis Gliksman, Iyer Krishnan, Branka Legetic, Belinda Loring, Allel Louazani, Reynaldo Martorell, Timothy O Leary, Armando Peruga, Camille Pillon, Gojka Roglic, Margaret Rylett, Kerstin Schotte, Cecilia Sepulveda, Raj Shalvindra, Mubashar Sheikh, Jonathan Siekmann, David Stuckler, Andreas Ullrich, Godfery Xuereb, Ayda Yurekli, and Evgeny Zheleznyakov.

7 Tim France was copy editor of the report . Design and layout by Graphi printing of this publication was made possible through the generous fi nancial support of the Government of in status report on noncommunicable diseases 2010iiiContentsForeword vIntroduction viiExecutive summary 1 Chapter 1. Burden: mortality, morbidity and risk factors 9 Chapter 2. NCDs and development 33 Chapter 3. Monitoring NCDs and their risk factors: a framework for surveillance 41 Chapter 4. Reducing risks and preventing disease : population-wide interventions 47 Chapter 5. Improving health care: individual interventions 61 Chapter 6. Tackling NCDs: the capacity of countries to respond 72 Chapter 7. The way forward: taking action based on evidence and lessons learnt 84 Annexes 90 Annex 1. Methods used for country estimates in Chapter 1 and Annex 4 90 Annex 2. List of countries by WHO Regions and 2008 World Bank Income Groups 92 Annex 3. Maps showing the Global distribution of estimated NCD-related mortality and selected risk factors 95 Annex 4.

8 Country estimates of NCD mortality and selected risk factors, 2008 100 NCD mortality: 2008 comparable estimates of NCD mortality (total NCD Deaths in 000s; % of NCD Deaths occuring under the age of 70; and age-standardized death rate for NCDs per 100 000) 100 Tobacco: 2008 comparable estimates of prevalence of current daily tobacco smoking and current daily cigarette smoking 108 Physical inactivity: 2008 comparable estimates of prevalence of insuffi cient physical activity 116 Alcohol: 2008 comparable projected estimates of adult per capita consumption in litres of pure alcohol 124 Raised blood pressure: 2008 comparable estimates of prevalence of raised blood pressure 128 Raised blood glucose: 2008 comparable estimates of prevalence of raised blood glucose 136 Overweight and obesity: 2008 comparable estimates of prevalence of overweight and obesity 144 Rasied total cholesterol: 2008 comparable estimates of prevalence of raised total cholesterol 152 Annex 5.

9 Core indicators for consideration as part of the framework for NCD surveillance 160 Annex 6. Recommended approaches to implementing effective and sustainable multisectoral action on health 161 ForewordvForewordThis report sets out the statistics, evidence and experiences needed to launch a more forceful response to the growing threat posed by noncommunicable diseases. While advice and recommendations are universally relevant, the report gives particular attention to conditions in low- and middle-income countries, which now bear nearly 80% of the burden from diseases like cardiovascular disease , diabetes, cancer and chronic respiratory diseases. The health consequences of the worldwide epidemic of obesity are also report takes an analytical approach, using Global , regional and country-specifi c data to document the magnitude of the problem, project future trends, and assess the factors contributing to these trends. As noted, the epidemic of these diseases is being driven by powerful forces now touching every region of the world: demographic ageing, rapid unplanned urbanization, and the globalization of unhealthy lifestyles.

10 While many chronic conditions develop slowly, changes in lifestyles and behaviours are occurring with a stunning speed and sweep. The consequences for societies and economies are devastating everywhere, but most especially so in poor, vulnerable and disadvantaged populations. These people get sicker sooner and die earlier than their counterparts in wealthier societies. In large parts of the developing world, noncommunicable diseases are detected late, when patients need extensive and expensive hospital care for severe complications or acute events. Most of this care is covered through out-of-pocket payments, leading to catastrophic medical expenditures. For all these reasons, noncommunicable diseases deliver a two-punch blow to development. They cause billions of dollars in losses of national income, and they push millions of people below the poverty line, each and every the positive side, much has been learnt about these diseases during the past three decades, especially as their initial burden was greatest in affl uent societies with strong research and development capacities.