Major killers of Asia

June 28, 2012

Heart disease, cancer, stroke, lung diseases, and diabetes – they are the leading causes of illness and death today. And they have a lot in common. They are expensive – Economic burden caused by these illnesses in the national economy in the Asia Pacific region is very significant. For example, China will lose the national income amounted to US$558 billion caused by these illnesses.

They come in clusters – accumulations of plaque in arteries lead to heart attacks but also can lead to strokes and predispose to Alzheimer’s disease. Diabetes can lead to heart disease, stroke and even cancer. Smoking can lead to chronic obstructive pulmonary disease as well as cancer and heart disease, which in turn predisposes to Alzheimer’s.

And the outlook for them is improving – people are getting the diseases later in life, and death rates are falling. Yet, in many instances, patients are undertreated or treated inappropriately. In some cases, science has not offered answers, but in others, the medical system has been unable to turn proven remedies into everyday care.

In 2008, 36.1 million people died from heart disease, stroke, chronic lung disease, cancer and diabetes, with 80% of cases occuring in low- and middle-income countries.

Cardiovascular diseases account for most chronic noncommunicable diseases (NCD) deaths, or 17 million people annually, followed by cancer (7.6 million), respiratory disease (4.2 million), and diabetes (1.3 million). These four groups of diseases account for around 80 percent of all NCD deaths, and share four common risk factors:

Tobacco use.
Physical inactivity.
Harmful use of alcohol.
Poor diets.

The rapidly growing burden of NCDs in developing countries is driven by a few factors, said the World Health Organisation.

Firstly, the negative effects of globalization such as rapid and unplanned urbanization have led to unhealthy lifestyles characterized by reduced physical activity and other unhealthy vices. This is further aggravated due to irresponsible marketing by tobacco and junk food companies looking to expand their businesses in these developing markets. Vulnerable populations within society such as children, adolescents and women are seen as easy targets for these companies.

Secondly, people from developing nations tend to consume energy dense foods. This practice was necessary for the labour-intensive occupations they once held. But with the rapid economic growth in some of these countries, peasants who would otherwise have settled for a life of farming now have more career options open to them. These people move into cities in droves and take up occupations such as driving taxis and clerical jobs which are not as physically demanding. This is when their staple of energy dense foods becomes a problem.

Overwhelmed with the speed of growth, many governments are already struggling to deal with more pressing issues such as the need for infrastructure. As such, interventions such as anti-smoking laws, promoting physical activity and healthy eating get relegated on their list of priorities.

Thirdly, the aging populations across Asia due to increased life expectancies and reduced birth rates mean that people are living long enough to develop NCDs.

How can Government help prevent NCDs

Reducing tobacco use – The most cost effective way to reduce tobacco use is by increasing taxes on tobacco products, as this deters many would-be buyers and forces consumers to cut down on their consumption. The revenue from the tobacco tax could even help subsidize health care. Implementing policies that result in smoke-free work and public places reduce second hand smoke, which in turn reduces the incidence of lung cancers from passive smoking. Smokers looking to cut down or quit smoking will also benefit from this policy. No health intervention is complete without public education. Studies have shown that graphic warnings on tobacco packages and regular mass media campaigns are effective in reducing demand.

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Promoting physical activity – Numerous studies have shown that regular physical activity is protective against cardiovascular disease and various types of cancer. Exactly how much physical activity is recommended? 60 minutes of moderate- to vigorous-intensity physical activity every day for those aged 5-17. For adults 18 and above, 150 minutes of moderate-intensity aerobic physical activity throughout the week, or at least 75 minutes of vigorous-intensity aerobic physical activity, or an equivalent combination of the two, is recommended. This policy is particularly effective if schools and workplaces are targeted. Exercise should be incorporated into daily life at a young age, and schools can help achieve this by implementing a physical activity component taught by trained teachers in a supportive environment. Workplaces that provide space for fitness and involve workers in program planning and implementation tend to do well in increasing the physical activity levels of their employees.

Reducing harmful alcohol use – This can be achieved through the following measures.

Increasing excise taxes on alcoholic beverages.
Regulating availability of alcoholic beverages, including minimum legal purchase age, restrictions on outlet density and on time of sale, and, where appropriate, governmental monopoly of retail sales.
Restricting exposure to marketing of alcoholic beverages through marketing regulations or comprehensive advertising bans.
Drink-driving countermeasures including random breath testing, sobriety check points and blood alcohol concentration (BAC) limits for drivers at 0.5 g/l, with reduced limits or zero tolerance for young drivers.
Treatment of alcohol use disorders and brief interventions for hazardous and harmful drinking.

Promoting health diets – Unhealthy diets increase the risk of NCDs including cardiovascular disease, some cancers and diabetes. Eating habits are, and always will be, a personal choice. While a government can educate its population on healthy eating, the reality is that fast food tastes good and junk food is cheap. To struggling families on a tight budget, it is an attractive option despite what the health boards say. To tackle this issue, governments need to raise taxes on unhealthy foods while reducing taxes on healthy options. Studies have shown these measures to be particularly effective in lower-income populations.

Achieving a balance between energy intake from food, and energy expenditure from physical activity to maintain a healthy weight.
Limiting energy intake from total fat (not to exceed 30 percent of total energy intake), and shifting fat consumption away from saturated fat to unsaturated fat, and towards elimination of trans-fatty acids.
Limiting intake of free sugars.
Limiting sodium consumption from all sources and ensuring that salt is iodized.
Increasing consumption of fruits, legumes, whole grains and nuts.

Jakarta’s growing obesity problem

Source: WHO

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