- The Washington Times - Sunday, October 9, 2005

Special correspondent John Zarocostas interviewed Dr. Robert Beaglehole, director of chronic diseases at the World Health Organization (WHO), Friday in Geneva on the agency’s new report, “Preventing chronic diseases: a vital investment.” Dr. Beaglehole, 60, a New Zealand public-health physician, studied medicine in New Zealand, at the London School of Hygiene & Tropical Medicine and at the University of North Carolina at Chapel Hill.

Question: WHO has set a new target to reduce the global death rate from chronic diseases by 2 percent per year through 2015. Why this new target?

Answer: Well, the reasons for the target is that we think the prevention and control of chronic diseases — heart disease, stroke, cancer, diabetes, chronic respiratory diseases — has been neglected at many national levels and at the global level. And given the huge toll of chronic diseases — 35 million deaths this year, 400 million between now and 2015 — we think it important to propose a target to focus attention and focus resources on the prevention and control of chronic diseases.

Q: For the first time, drawing on case studies from nine countries, the report shows large potential savings for countries if they can reduce chronic diseases.

A: We have estimated for heart disease, for stroke and for diabetes alone, only a subset of chronic diseases, that the impact on national economies is huge. For example, in China, we estimate that the losses for the next 10 years to the national economy will be $558 billion and that if the goal of reducing death rates by 2 percent per year is reached, then China will save $36 billion. Our estimates of the impacts of chronic diseases on economies are conservative, and our goal is achievable.

Q: How big are costs and potential savings for other developing countries like India and for industrialized countries?

A: For countries like India, the costs will be $237 billion; for the Russian Federation $300 billion; and for Brazil, it will be approximately $50 billion. And the savings over the next 10 years are $15 billion for India, $20 billion for Russia and perhaps $3 [billion] or $4 billion for Brazil. So, there are large savings to be made through the prevention and control of chronic diseases.

Q: Despite the fact that this year about 35 million people will die from chronic diseases — a 60 percent share of the estimated 58 million total deaths reducing deaths from chronic diseases was not part of the Millennium Development Goals. Was this an oversight?

A: I think it can probably be explained by the fact the MDGs, although accepted five years ago, came out of the international discussions of the 1980s and 1990s, and then the focus was on infectious diseases, on matters relating to maternal and child health. An oversight, understandable. A pity, because 80 percent of all deaths from chronic diseases do occur in lower-income countries, and half of the deaths from chronic diseases are of young people.

Q: The report projects a 17 percent increase in chronic diseases, yet at the same time, for infectious diseases, only a 3 percent increase.

A: Yes, these are projections, these are the best estimates.

There’s no question epidemics will increase if we do nothing, and the expectation is that as increasing attention is brought to bear on HIV/AIDS, TB and malaria — the major causes of infectious diseases — and as more attention is brought to bear on infectious diseases of children, the infectious-disease epidemic will be contained and the growth will slow. …

Q: At the public-health policy level, what should ministers, top officials and health staff in medical centers around the world be doing to address the chronic-disease problem?

A: A very important first step is for … governments in general to recognize this is a critically important issue for individuals, for families, communities, for national economies.

And second, to recognize that the governments, ministries of health, have a leadership role in preventing and controlling these conditions. Then they must set up a mechanism to develop and implement policy. There needs to be a group within the ministry who will take the leadership on this; there needs to be a budget line for the ministry.

We also suggest that they adopt a stepwise approach, that they don’t try to do everything at once and that they try to start on cheap — and effective — and high-return interventions that cover the needs of individuals, communities and countries.

Q: Some of these interventions, the report says, are cheap. Yet it also says the number of people overweight is going to skyrocket from 1 billion in 2005 to over 1.5 billion people in 2015. How can people look after themselves better?

A: Well, people do need to look after themselves better. But particularly helpful for people is an environment which makes the healthier choices. This is illustrated by the problem of obesity in children. Perhaps 22 million children under the age of 5 are obese — a hugely important and escalating problem in all countries of the world, both rich and poor.

Now, children don’t get obese because they make a conscious decision to go out and eat unhealthy food. They get obese because the opportunities they have for eating healthy food — plenty of fruits and vegetables — are limited, and they get obese because physical activity opportunities are limited. …

Q: Although chronic diseases have been increasing worldwide, are there any success stories of reversing the trend?

A: Yes, there are some important success stories. Now, many of these are in wealthy countries such as Finland, or the United States, where there has been a huge decline in death rates from heart disease and stroke — probably over two-thirds in the last three decades, due to a combination of actions directed at the population as a whole and also people who are at high risk.

More recently, and more encouraging even, is the success in Poland, which is clearly not a wealthy country. But following changes in the socioeconomic structure at the end of the 1980s, subsidies on dairy fats — butter — were removed. The price of butter went up, consumption went down, more vegetable oils were consumed, and this, together with a greater consumption of fruit and vegetables, seems to be responsible for a very dramatic decline of 10 percent in adults under the age of 45 and 6 percent a year in adults between 45 and 65.

And there was also effective smoking- and tobacco-control policy — things that don’t actually cost the government a lot, but have very beneficial effects on the health of the population.

Q: While Poland is a success story, the report indicates Russia is going the other way.

A: Russia, from a chronic-disease point of view, is in a dreadful situation. Death rates from chronic disease are the highest in the world. Extremely high in middle-aged people, with huge impacts on the national economy. There is no question that achieving economic growth goals in Russia will be difficult as long as the middle-age work force continues to be decimated by chronic diseases. So, it’s a country that has a serious problem and needs help, advice and encouragement to take action.

Q: The report says obesity and diabetes are also rising fast in poor countries.

A: This is, I think, one of the most challenging and tragic developments in terms of the risk factors. Of course, tobacco consumption is increasing in many countries because of the activities of the multinational tobacco companies, and this needs to be stopped.

But the growth of obesity in countries that are also suffering from malnutrition does complicate the issues facing ministries of health. They have to ensure that children are growing up with enough food, they have to get the balance right. This … is one that we have to confront, because we know that children who grow up in a malnourished environment, when they start to grow, they are at increased risks of chronic diseases. …

Q: Quite a few drugs are now available to contain blood pressure and to lower high cholesterol. If these drugs were affordable, would this help poor countries in particular?

A: No question that there are plenty of effective and relatively cheap drugs that are now available for people at high risk — particularly of cardiovascular disease.

I’m thinking of aspirin, for a variety of vascular conditions; statins for reducing cholesterol levels and improving lipid profiles; beta-blockers and other drugs for lowering blood pressure levels. There are many forms of these drugs, and the earliest versions, which are actually very effective, are all off patent now. These drugs, some people have suggested that they be combined into one pill, the so-called “polypill.” We think that might be premature, but it is clearly the direction science is moving. …

And it’s worth pointing out: There are many people in rich countries who do not have access to drugs when they are in need. So there are many gains to be made in the short term by making sure that people who need these drugs have access to them, and they should be cheap.

Q: Is [high] blood pressure the biggest silent killer?

A: Blood pressure is a critically important risk factor, and responsible for 6 [million] or 7 million deaths per year. In and of itself, it is bad.

But when it’s in combination with tobacco, obesity and abnormal cholesterol levels, it is particularly important, and sometimes only becomes apparent when a stroke first hits somebody. …

Q: What about cancers and the importance of early detection?

A: Early detection is important, but actually there is a lot more to be gained from the prevention of cancers. We know that all the tobacco-induced cancers — lung cancer, bladder cancer — are preventable and shouldn’t be occurring. It will take some time. A whole variety of cancers are caused by tobacco consumption.

Skin cancers are preventable and are being prevented in some parts of the world by low-cost interventions.

Liver cancer is probably going to be preventable through vaccinations against hepatitis agents. Stomach cancer, decreasing in many parts of the world, is now probably preventable, too. And breast and bowel cancers can be detected early. So there are opportunities both for prevention and early detection.

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