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Heart disease and strokes - the new epidemic in developing countries

By Stephen Leeder - posted Monday, 10 May 2004

Heart attack and stroke, thought to be quintessential Western diseases, are fast becoming major threats in developing countries. They cause two to three times more deaths in mothers in developing countries than childbirth and HIV/AIDS combined. HIV/AIDS accounts for three million deaths a year, while stroke and heart attack cause 17 million. Yet international agencies committed to improving global health have overlooked heart disease and stroke.

The exciting has displaced the serious.

In the US, there are 116 deaths per 100,000 men aged 35-59 from heart disease and stroke each year; in Russia, there are now 576. India and China each have three million deaths a year from these causes. Australia has a similar profile to that of the US. Developing economies are witnessing devastation to their workforces that Australia and the US and other Western countries experienced 50 years ago but have since escaped.


These rumbles mark the beginning of the storm. As working people move from rural to city living they are eating more food. City food is cheap and high in fats, salt and sugars. The car supplants the bicycle and the foot. With prosperity comes the unwanted side effect of an epidemic: of overweight and obesity - even where under-nutrition persists in poorer quarters, high levels of diabetes, heart disease and stroke lie ahead. There are no pro-Ebola or pro-SARS lobbies but a tidal wave of globalised commercial greed propels tobacco consumption into the poorest nations.

We recognise the aging of the population in industrially advanced societies as life expectancy increases and birth rates stabilize or decline. A generation of old baby boomers will challenge our social security system and medical care facilities. But now, this dramatic reshaping of the age structure of populations is occurring everywhere. World Bank projections show that, while people aged 65+ in the world now number about 500,000,000, they will tip one billion by 2020. Heart disease and stroke will be the principal causes of death in older people, and will account for one-third of all disability.

Fortunately, there is good news to counter these dark prophesies. In Australia, New Zealand, the US and parts of Europe, the death toll from heart disease and stroke has tumbled by 60 per cent since 1960. Better diet, less smoking, better drugs for blood pressure and cholesterol, exercise and improved medical and surgical care have reduced the death toll and transferred these diseases from middle age into the later years. In Australia in 1968, 50 per cent of deaths from heart disease and stroke occurred among people aged 75+. Today the figure is 76 per cent. Deaths among those aged 55-64 have fallen by two-thirds, and among the 64-75 year olds, by one half.

Smokers who quit cut their risk of heart disease and stroke by a half within two years. Treatment of raised blood pressure and blood lipids radically reduces risk in those otherwise in peril. Governments can cut tobacco consumption by taxes and eliminating advertising. They can plan pro-walking cities and earmark recreational space. They can ensure that all citizens have access to clinics where health personnel measure their risk and offer long-term treatment if needed.

To delay serious action about the epidemic of these two diseases incurs both family and economic tragedy now. They are already pushing families into poverty in developing countries as young breadwinners and mothers die. These breadwinners are highly productive members of the workforce and are among those who determine investment and future prosperity.

But many developing countries have yet to create programs to control these diseases. Control measures include long-term changes in macroeconomic policies: that dismantle agricultural subsidies and implement the WHO Framework Convention on Tobacco Control; and health care policies that provide effective clinical care. Prevention programs must be locally tailored and sustainable. Developing countries should take the first step in program development themselves, because success will require a twenty-year collaborative effort from all elements in civil society and professional capability in prevention and treatment.


Countries need the encouragement that strong vocal advocacy for change that agencies such as the World Health Organization and the World Bank can provide. Commitment from the highest levels of government in these countries is essential for comprehensive heart disease and stroke prevention. Heart Foundations and national NGO’s can lobby for change in social policies to assist prevention and treatment. Corporations also, can be part of the solution through their investment in preventive programs for their workers. Medical associations and other professional bodies, both national and international, should be at the table to assist in planning disease control programs.

International aid agencies should open their agendas to work with developing countries to contain these urgent and heavy threats to global health, national prosperity and international family life.

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Article edited by Fiona Armstrong.
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This article was first published in The Sydey Morning Herald on 3 May 2004.

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About the Author

Stephen Leeder is professor of public health and community medicine at the University of Sydney, and co-director of the Menzies Centre for Health Policy.

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