Aware of the rising costs and burden of chronic disease, countries across the WHO European Region are taking a comprehensive approach to curbing the epidemic. As many chronic diseases are closely linked to lifestyles, an estimated 80% of heart disease, stroke and type 2 diabetes, and 40% of cancer, could be avoided if common lifestyle risk factors were eliminated. Without the engagement of a wide range of sectors and stronger health systems for better prevention and control, large numbers of people will continue to die every year from mostly preventable diseases.
Ministers of health will debate a European strategy for the prevention and control of noncommunicable diseases at the annual session of the WHO European governing body, which takes place this week in Copenhagen, Denmark. The strategy aims to make healthier choices easier choices, to strengthen health systems and to widen the use of effective interventions to make people’s lifestyles healthier.
Today, noncommunicable diseases cause 86% of deaths and 77% of the disease burden in the WHO European Region. This group of conditions includes cardiovascular diseases, cancer, mental health problems, diabetes mellitus, chronic respiratory disease and musculoskeletal conditions. Cardiovascular diseases are the number-one killer, causing more than half of all deaths across the Region, with heart disease or stroke the leading cause of death in all countries.
Links to lifestyle
Seven leading risk factors – high blood pressure, tobacco, alcohol, high cholesterol, overweight, low fruit and vegetable intake and physical inactivity – account for almost 60% of all ill health in the Region. The leading risk factors are high blood pressure for death, and tobacco for ill health. Alcohol is the leading risk factor for both ill health and death in the Region’s young people, experts stress.
High costs to health and social systems
Noncommunicable diseases challenge health systems, and absorb substantial amounts of resources. For example, chronic conditions are estimated to account for 70-80% of health care expenses in Denmark and comprise 8 of the top 11 causes of hospital admission in the United Kingdom.
The economic impact of noncommunicable diseases goes beyond the costs to health services. Indirect costs, such as those from lost productivity, can match or sometimes exceed the direct costs. In addition, a significant proportion of the total cost of care falls on patients and their families. In Sweden, 90% of the total costs of musculoskeletal conditions have been calculated to be indirect: 31.5% for sick leave and 59% for early retirement.
The premature deaths of main wage earners and skilled workers affect both households’ income and countries’ economies. Noncommunicable diseases were estimated to reduce gross domestic product (GDP) in the Russian Federation by 1% in 2005, with heart disease, stroke and diabetes causing an estimated loss to national income equivalent to US$ 11 billion.
People die from all chronic diseases at dramatically younger ages in the central and eastern countries in the Region than in western ones. An ageing Europe presents additional challenges. By 2050, more than one quarter of the Region’s population is expected to be over 65 years. At least 35% of men aged over 60 have been found to have two or more chronic conditions. Health services must be able to cope with these long-term conditions.
Potential health gain from reducing differences between socioeconomic groups
Within countries, noncommunicable diseases and their causes concentrate among the poor and vulnerable. People in low socioeconomic groups have at least twice the risk of serious illness and premature death as those in high socioeconomic groups. When improvements occur, the benefits are unevenly distributed. People in high socioeconomic groups often respond better and benefit more from health interventions.
What can be done
Overall, a comprehensive strategy offers the greatest potential in the fight against noncommunicable diseases. Such a strategy would help countries’ health systems promote health and prevent disease in the whole population, actively target people at high risk and improve the care of those already suffering. Action to reduce inequalities in health needs to be an integral part of all measures.
"Investing in prevention and improved control of noncommunicable diseases will improve the quality of life and well-being of people and societies," says Dr Marc Danzon, WHO Regional Director for Europe. "Action needs to be scaled up now. The burden on people, societies and health systems is unsustainable. Effective interventions already exist, but not everyone gets a share of the benefits. The greatest potential for gain lies in scaling up prevention through better and more adequate health systems. If stronger health systems manage to eliminate such major risk factors as alcohol, tobacco, obesity, etc., it is estimated that 80% of heart disease, stroke and type II diabetes, and 40% of cancer, could be avoided."
The proposed European strategy, which is expected to be adopted today, contains a series of effective measures for the prevention and control of noncommunicable disease.
Most countries have already developed key areas of their capability to respond to the crisis. The web site of the WHO Regional Office for Europe features examples and offers more information on noncommunicable diseases in the WHO European Region.
