No longer just diseases of affluence

Heart attack and stroke, thought to be quintessential Western diseases, are fast becoming major threats in developing countries.

The 24,000 cardiologists and other health professionals gathered in Barcelona last week for the World Congress of Cardiology heard how these disorders now cause four times as many deaths in mothers in most developing countries than do childbirth and HIV-AIDS combined. Worldwide, HIV-AIDS causes three million deaths a year: stroke and heart attack cause 17 million. Yet heart disease and stroke have attracted virtually no interest from international agencies committed to improving global health. It is time for that to change.

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. Developing economies are seeing devastation to their workforces that the US and other Western countries experienced 50 years ago but have since escaped.

Troubling as these patterns are in developing countries, they are but the first rumbles of the storm. The worldwide shift of working people from rural to city living parallels rising levels of prosperity, but also brings pressures to consume more food. City food is cheap and carries a heavy freight of fats, salt and sugars. The car supplants the bicycle and the foot.

A worldwide epidemic of overweight and obesity, even where undernutrition persists in poorer quarters, presages high levels of diabetes, heart disease and stroke ahead. Meanwhile tobacco consumption is increasing in the developing world. There are no pro-Ebola or pro-SARS lobbies, but a tidal wave of commercial greed pushes tobacco consumption forward, causing five million deaths each year.

Data presented in Barcelona confirm that smoking only one cigarette a day increases the risk of heart attack by 20 per cent, a risk buried by tobacco advertising.

In North America, Australia, New Zealand and parts of Europe, the death toll from heart disease and stroke has tumbled by more than 60 per cent since the 1960’s; only 10 per cent of those deaths now occur among those aged less than 65. Compare this with Brazil, where 28 per cent of heart attack and stroke victims are young.

Fortunately, we can prevent and treat much heart disease and stroke. Smokers who quit halve their risk of heart disease and stroke within two years. Treatment of raised blood pressure and blood lipids with drugs radically reduces risk. Governments can assist by taxing tobacco and promoting healthy diet, exercise, and other good lifestyle habits, planning cities that encourage walking and recreation, and ensuring that all citizens have easy access to clinics where health personnel can measure their risk and where they can receive treatment if needed.

The World Health Organization has shown commendable leadership in relation to global tobacco control and now has its sights set on nutrition and exercise. These strategies, while global, can assist individual countries to strengthen their local efforts.

To wait until heart disease and strike decimate workforces before we take seriously the global epidemic of heart disease and stroke would be both a health and economic tragedy. Heart disease and stroke are already propelling families into poverty in developing countries as young breadwinners and mothers die. Economically these breadwinners are also the most productive members of the workforce and their efforts determine future prosperity and investment.

Many developing countries have yet to create programs to control these diseases through long-term changes in macroeconomic policies that dismantle agricultural subsidies and implement the WHO Framework Convention on Tobacco Control, and by providing effective clinical care. Prevention programs must be locally sustainable for 20 years or more, and so developing countries should be encouraged to take the first step themselves, now.

Developing countries should take the first step in program development themselves, remembering that success would require a sustainable 20-year collaborative effort built on commitment from all elements in civil society and professional capability in prevention and treatment.

Countries need the encouragement that stronger vocal advocacy for change by the World Health Organization and the World Bank can provide, to prod governments and donors into action. Corporations can be part of the solution through investment in preventive programs for their workers. Medical associations, non-government organisations, Heart Foundations and other professional bodies, both national and international, should be at the table to assist program planning.

International aid agencies should add to their agendas serious efforts to work with developing countries to contain these urgent and heavy threats to global health, national prosperity and family life in the developing world.

Commitment from the highest levels of government in these countries is essential for comprehensive heart disease and stroke prevention. But ultimately, communities must endorse action for heart disease prevention and combine all forces - civil, commercial, professional and governmental - to avoid a massive problem in the coming decades.