Chronic diseases cause 75 percent of all deaths globally. The toll is likely to rise.
We are entering a new era of global health.
It starts with some good news: Around the world, the number of people dying from infectious diseases every year is falling. Fewer women are dying in childbirth. More infants are surviving to childhood, and the average lifespan is increasing in many places. The result is billions of people are living lives that, in decades past, would have been cut short.
But here’s the bad news: With more people living longer, noncommunicable diseases — conditions not passed from person to person, like most cancers, diabetes, and heart disease — are becoming more common. In 2019, the most recent year for which data is available, noncommunicable or chronic diseases killed almost 41 million people, an increase of about 10 million since 2000. That accounts for about 75 percent of all deaths globally, making its rise an international crisis.
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Wealthy countries — beset by an aging population and sharp increases in obesity and physical inactivity — have been dealing with these problems for decades, with varying levels of success. But they have modern health systems to treat people. Low- and middle-income countries — where the number of people with chronic diseases is rising faster than in developed countries — lack the same health infrastructure to prevent and treat these diseases. Almost 80 percent of all deaths from noncommunicable diseases are in low- and middle-income countries. The burden of chronic diseases is rising the fastest in these countries.
And while many of these poorer countries have made great strides against infectious diseases, threats from the likes of malaria or tuberculosis remain high. This dual burden of chronic and infectious diseases will only further strain health systems and even set back national and global economics gains.
To understand the sheer global scale of noncommunicable diseases and the challenges low- and middle-income countries, in particular, face, here are four charts that show just how urgently we need increased funding and society-wide solutions.
The global burden of noncommunicable diseases
The most common noncommunicable diseases globally are cardiovascular disease, cancer, chronic respiratory diseases, and diabetes.
Each year 18 million people die from cardiovascular diseases that affect the heart and blood vessels and can lead to heart attacks, stroke, or heart failure. About 9 million people die each year from cancers, 4 million from chronic respiratory diseases such as asthma or COPD, and 2 million from diabetes. But both the burden of disease and access to modern health care are disproportionately distributed.
Low- and middle-income countries including Uzbekistan, Afghanistan, Yemen, Egypt, and Syria have the highest incidence and mortality rates. Air pollution, tobacco use, excessive alcohol consumption, poor diet, and older age increase the risk for cardiovascular disease. Stress and post-traumatic stress disorder may also raise the risk of cardiovascular disease, which may explain why the burden is so high in war-affected countries.
Cancer incidence is highest in Australia and New Zealand, where more than 400 people per 100,000 have some form of cancer. Denmark, the United States, Norway, Canada, Ireland, and other high-income European countries follow. The lowest cancer rates, adjusted for age, are in Sierra Leone, Gambia, the Congo, Nepal, Qatar, Yemen, Rwanda, and Niger — all low-income countries with the exception of Qatar.
The global cancer burden is more concentrated in developed countries, but the burden of diabetes is more evenly spread and rising faster in developing countries. The International Diabetes Foundation estimates 537 million adults were living with diabetes in 2021, and 75 percent of them lived in a low- or middle-income country. About 18 percent of adults in the Middle East and North Africa had diabetes in 2021, the highest share for any global region.
Between 2000 and 2021, the rate of diabetes has nearly tripled in the western Pacific and roughly doubled in southeast Asia, the Middle East and North Africa, and south and central America. Countries in sub-Saharan Africa had the lowest burden in 2021, with only about 5 percent of adults having diabetes, but that rate has increased fivefold since 2000.
Older age, obesity, and physical inactivity are known risk factors for diabetes. African nations are home to the world’s youngest, most active, and least obese populations, so it makes sense that they have the lowest rates of diabetes.
But in many African countries, that is starting to change. People are flocking en masse to rapidly developing urban city centers where they are more likely to find higher quantities of poor-quality food, be less active, and live longer.
Challenges treating noncommunicable diseases in developing countries
Many of the same challenges developing countries face in preventing and treating infectious diseases — like weak health care systems, lack of access to medicines, and insufficient funding — are also barriers to high-quality care for noncommunicable diseases.
But, in many ways, treating noncommunicable diseases is more complicated than treating people with infectious diseases.
For one, patients with noncommunicable diseases need to be treated for years or even decades, whereas people with infectious diseases typically need immediate but relatively short-term care. And people with noncommunicable diseases often require multi-faceted care; a cancer patient may need radiology, chemotherapy, and surgery, not to mention palliative care or pain management.
These services are typically offered only in a handful of health facilities located in capital cities and urban centers. Such treatments are also costly, and the vast majority of people in developing countries don’t have health insurance, public or private. Many people therefore either skip care altogether or go into catastrophic medical debt. Families in Africa are more likely to spend in excess of 25 percent of their total household budget on health compared to other regions.
Social stigma around noncommunicable diseases and gender inequity is another obstacle to proper treatment. For example, in Bangladesh, social taboos around breast cancer screening prevent early detection. In some countries, once a woman is diagnosed with breast cancer, there is often a stigma that she is being punished for immorality and consequently, often faces abuse or abandonment from her family.
Despite the growing toll, noncommunicable diseases are not always a public health priority. In 2021, 143 of the 194 countries for which data was available had a dedicated department within its national health agency. However, 41 countries, including many in Africa, did not.
Global health spending has also not kept pace; only about 2 percent of all spending for global health is earmarked for noncommunicable diseases. Developing countries are now facing a dual threat from infectious and chronic diseases, stretching already overburdened and under-resourced health and public health systems.
The historical siloed approach to addressing global health won’t be sufficient in this new age of public health challenges. What’s needed are solutions that truly strengthen the way health care systems operate. This includes improving health financing, expanding access to specialized services, and ensuring that patients trust the health care system and seek care even before they are sick.