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Obesity, Heart Disease Now Major Developing World Problems, Report Says

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    Obesity, Heart Disease Now Major Developing World Problems, Report Says

    Obesity, Heart Disease Now Major Developing World Problems, Report Says
    (More than 12 million lives being lost annually, U.N. health agency
    says) (2810)

    A global health assessment shows that cardiovascular (CV) disease and
    the risk factors that cause it are more widespread in the developing
    world than previously thought. The World Health Organization (WHO)
    finds that more than 12 million people die each year as a result of
    heart disease and strokes, according to an October 17 press release.
    About half of those deaths could be prevented with wider availability
    of drugs and greater promotion of healthy lifestyles and preventive
    health care, the report says.

    "The world once thought of CV disease as a Western problem, but
    clearly this is not the case," said Anthony Rodgers, M.D., Ph.D., of
    the University of Auckland, New Zealand and a WHO consultant who is
    one of the report's main writers. "We can no longer frame diseases in
    terms of where they occur but, rather, with what frequency they occur
    in any given population."

    The findings on CV disease are part of the WHO's annual World Health
    Report 2002, which is to be released in its entirety later this month.

    Wider use of commonly available drugs could accomplish a great deal in
    reducing the death toll, but preventive measures are most effective
    and less expensive, the report says. It recommends broad health
    promotion campaigns to reduce smoking, increase exercise and lessen
    salt and fat in the diet.

    "Prevention is the key to lowering the global disease burden of heart
    attacks and strokes," says Dr Gro Brundtland, director-general of WHO.
    "The ideal strategy for many countries would be to devote many more
    resources to introduce broad measures that can benefit the whole
    population and at the same time target those at elevated risk with the
    combination of pills."
    In tandem with the WHO recommendations, the Bush administration is
    making preventive health care a priority, allocating $20,000 million
    to such programs in the 2003 budget. In a September speech, Secretary
    of Health and Human Services Tommy G. Thompson said, "Poor eating
    habits and inactivity are self-destructive. They shorten the
    life-span. They erode the quality of life. And they burden our health
    care system that in many ways is already stretched far too thin."
    Following is the text of the WHO press release:

    (begin text)


    Cardiovascular Death And Disability Can Be Reduced More Than 50

    More people at risk than previously thought, particularly in
    developing world Conditions could be controlled quickly with medical,
    social interventions

    More than 50 percent of deaths and disability from heart disease and
    strokes, which together kill more than 12 million people world-wide
    each year, can be cut by a combination of simple, cost effective
    national efforts and individual actions to reduce major risk factors
    such as high blood pressure, high cholesterol, obesity and smoking,
    the World Health Organization (WHO) says.

    Most of the benefits from these combined interventions can be achieved
    within five years of their implementation, since the progression of
    cardiovascular (CV) disease is relatively easily interrupted.

    If no action is taken to improve cardiovascular health and current
    trends continue, WHO estimates that 25 per cent more healthy life
    years will be lost to cardiovascular disease globally by 2020. The
    brunt of this increase will be borne by developing countries.

    These findings come from the first-ever global analysis of disease
    burden due to major CV risks: high blood pressure, high cholesterol,
    tobacco, obesity, physical inactivity and low consumption of fruits
    and vegetables. They are contained in the upcoming World Health Report
    2002: reducing risks, promoting healthy life, to be released at the
    end of this month.

    One major finding of the report is that blood pressure alone causes
    about 50 percent of CV disease world-wide. Cholesterol causes about
    one-third. Inactive lifestyles, tobacco use and low fruit and
    vegetable intake account for 20 percent each. (These percentages add
    up to more than 100 percent because some risks overlap. One individual
    could be at risk from cholesterol alone, while another could be at
    risk from cholesterol and blood pressure together.) It was estimated
    that about nine million deaths and more than 75 million lost healthy
    life years annually were due to unfavourable levels of blood pressure
    or cholesterol.

    Overall approximately 75 percent of CV disease can be attributed to
    the established risks assessed in the report, far higher than the
    one-third to one-half commonly thought. The burden is about equally
    shared among men and women.

    In total, 10-30 percent of adults in almost all countries suffer from
    high blood pressure, but a further 50-60 percent would be in better
    health if they had lower blood pressure. Even small reductions in
    blood pressure for this "silent majority" would reduce their hearth
    attack and stroke risk. A very similar pattern occurs for cholesterol.

    "The global disease burden due to blood pressure is twice as much as
    previously thought," says Gro Harlem Brundtland, M.D.,
    Director-General of WHO. "This reflects recent findings on how
    strongly blood pressure is linked to disease in many diverse
    populations around the globe and the realization that most people have
    sub-optimal levels."

    The most immediate improvements in cardiovascular health can be
    achieved with a combination of drugs -- statins for cholesterol
    lowering and low-doses of common blood pressure lowering drugs and
    aspirin -- given daily to people at elevated risk of heart attack and
    stroke. This highly effective combination therapy could be much more
    widely used in the industrialized world, and is increasingly
    affordable in the developing world.

    "This drug combination could cut death and disability rates from CV
    disease by more than 50 percent among people at risk of cardiovascular
    disease," says Christopher Murray, MD, Ph.D., Executive Director of
    the Cluster on Evidence and Information Policy at WHO. "More people at
    elevated risk for CV disease should start taking the combination now,
    before they have heart attacks or strokes."

    This drug combination would cost less than US$14 to treat each person
    annually. Although this is a very low cost, it might not be affordable
    to poor countries facing the traditional burdens posed by communicable
    diseases and the growing burden of non-communicable and chronic
    diseases. New resources would need to be found if the opportunities
    presented by this combination are to be fully realized. The recent WHO
    Commission on Macroeconomics and Health highlighted the need for major
    new injections of resources from high income countries. The World
    Health Report 2002 also urges countries to adopt policies and programs
    to promote population-wide interventions like reducing salt in
    processed foods, cutting dietary fat, encouraging exercise and higher
    consumption of fruits and vegetables and lowering smoking.

    The fact that the vast majority of adults world-wide have blood
    pressure and cholesterol that are not optimal for health has clear
    implications for governments, which have the capacity to address the
    root causes with population-wide measures. Such efforts will also
    require increased access to cost-effective medications for those at
    elevated risk.

    "Prevention is the key to lowering the global disease burden of heart
    attacks and strokes," says Dr Brundtland. "The ideal strategy for many
    countries would be to devote many more resources to introduce broad
    measures that can benefit the whole population and at the same time
    target those at elevated risk with the combination of pills."

    "Our new research finds that many established approaches to cutting CV
    disease risk factors are very inexpensive, so that even countries with
    limited health budgets can implement them and cut their CV disease
    rate by 50 per cent,” says Derek Yach, M.D., Executive Director of
    the Cluster on Non-communicable Diseases and Mental Health. "In
    addition, established drug treatments are increasingly affordable in
    middle and low-income countries, as effective drugs come off patent."

    WHO has developed a first-ever system of identifying and reporting
    cost-effective health interventions consistently across settings that
    it calls CHOICE (CHOosing Interventions that are Cost-Effective).
    Various CHOICE options are contained in a new statistical database
    that is also a part of the World Health Report 2002. These
    interventions can be implemented on an a la carte basis, depending on
    each country's individual circumstances.

    CV Disease: No Longer a "Western" Problem

    The Report shows for the first time that most of the global burden due
    to CV risks occurs in the developing world. This is a result of
    already high and increasing risk factor levels (e.g. high cholesterol)
    and large and ageing populations. Tobacco, blood pressure and
    cholesterol are leading risks in industrialized countries, together
    accounting for more than a quarter of lost healthy life years. But
    they also feature prominently in the top risks in middle income
    countries and are beginning to appear in the leading risks of poorer
    developing countries.

    "We are seeing that conditions like high blood pressure and high
    cholesterol are much more prominent in developing countries than
    previously thought and contribute significantly to their overall
    disease burden," says Anthony Rodgers, M.D., Ph.D., of the University
    of Auckland, New Zealand and a WHO consultant who is one of the
    report's main writers. "The world once thought of CV disease as a
    Western problem, but clearly this is not the case. We can no longer
    frame diseases in terms of where they occur, but rather with what
    frequency they occur in any given population."

    "The need to control CV disease is especially important in poor
    countries, because its places a double burden on national health
    systems, which must simultaneously deal with the infectious diseases
    found primarily in these countries as well as newer cardiovascular
    conditions," says Dr. Brundtland. "In the new mega-cities of the
    developing world, we see massive illness due to under-nutrition side
    by side with poor cardiovascular health."

    The trend toward increased CV disease in developing countries may be
    particularly dangerous to the lower end of the socio-economic
    spectrum. In industrialized countries, CV disease once afflicted
    wealthier people in disproportionate numbers. However, as knowledge of
    cardiovascular health increased, the wealthy were able to reduce the
    frequency that they suffer from these conditions while incidence of CV
    disease increased among the poor and minorities. If this trend repeats
    in the developing countries, the very poorest of the world's poor will
    be the ones most at risk.

    Population-Wide Interventions Should be Given Priority

    While very effective, the combination of pills alone should not be
    considered the exclusive or even the primary means of reducing
    cardiovascular risks. Population-wide interventions are the most
    cost-effective methods of reducing risk among an entire population.
    They should be the first to be considered in all settings.

    In many countries, too much focus is being placed on one-on-one
    interventions among people at medium risk for CV disease, Dr. Murray
    says. A much better use of resources would be to focus on those at
    elevated risk and to use other resources to introduce population-wide
    efforts to reduce risk factors through multiple economic and
    educational policies and programs.

    The WHO report also questions the accepted common threshold labels
    such as "hypertension." The report outlines the increasingly clear
    evidence that health risks are not restricted to those above these
    thresholds. Rather, the vast majority of people would benefit from
    lower levels, as the risks are continuous. In fact, cholesterol and
    blood pressure measurements that are considered "average" are actually
    usually too high for good health.

    "CV disease risk often falls along a standard bell curve, with the
    vast majority of the population at some elevated risk of CV disease
    and only a few with very high or very low risk," says Dr. Rodgers.
    "The most inexpensive means of reducing CV disease in a given country
    is to move the entire population to a lower risk zone through public
    education and government-led interventions. This is particularly true
    in poor countries that may have more difficulty affording widespread
    medical treatments, despite their decreasing costs."

    Modern-day conditions frequently mean that individuals, particularly
    the poor in developing world cities, often have little control
    themselves over the major risk factors. For example, urban poor often
    can only buy high-fat and high-salt processed foods. Many processed
    foods -- breads, soups, meats, etc. -- have salt concentrations
    approaching or even exceeding that found in seawater.

    For example, when their sodium content is compared to that of
    seawater, which has 1g of sodium per 100g:

    --Bread and crackers are about 50 percent as salty;

    --Cornflakes are about 100 percent as salty;

    --Soups are up to 300 percent as salty;

    --Sausages are 50-150 percent as salty;

    As a result, salt intakes are usually very high and, in industrialized
    countries, more than 75 per cent is usually from processed foods.

    Targeted Medical Interventions: Inexpensive, Yet Powerful

    An "absolute risk approach" to managing blood pressure and cholesterol
    is also very cost-effective in all regions and has the potential to
    lead to dramatic reductions in ischaemic heart disease and stroke.
    This involves people at elevated risk of vascular disease being
    provided with "low dose combination treatment" -- a combination of
    multiple drugs including blood pressure lowering pills, statins and
    aspirin. This reflects recent evidence that such therapy benefits all
    groups at elevated risk, even those with average or below average
    blood pressure or cholesterol.

    Side effects from these drugs exist, but they are less than generally
    perceived, and can be minimized with low-dose combinations. The
    benefits will considerably outweigh any harm in those at elevated risk
    of vascular disease.

    This report will likely challenge current priorities for health
    systems in many countries:

    Few governments have yet to develop successful collaboration with the
    food industry to reduce salt and high fat in processed food.

    The report calls for new strategies and new thinking. It is
    increasingly clear that people at elevated risk benefit from combined,
    multi-modal treatment, largely irrespective of what initially caused
    their risk to be high, and what their current risk factor levels are.
    This is a paradigm shift for many doctors.

    WHO also suggests that the large resources now devoted to detecting,
    treating and monitoring people at comparatively low risk of heart
    disease or stroke be reduced, while greater resources be given to
    those with multiple risk factors who are at the highest risk, who are
    now often under-treated.

    CHOICE: Finding the Most Cost-Effective Method

    The WHO CHOICE project reports that several established approaches to
    CV disease risk factor management easily meet international standards
    for cost-effectiveness, even in the poorest countries of the world.
    "Take tobacco taxes, for example," says Dr Murray. "Countries that
    raise their tobacco taxes dramatically witness an almost immediate
    reduction in tobacco use and have corresponding improvements in
    cardiovascular health very quickly. A seven-dollar pack of cigarettes
    will go a long way toward persuading smokers to quit and non-smokers
    not to start."

    Governments, industry and civil society can work together to enable
    the behavioural changes necessary to reduce risk among entire
    populations. The best approaches will be different from country to
    country, and many lessons can be learned from past experiences. Some
    of the successes include:

    -- In the United Kingdom, a government-promoted program in consort
    with the food and drink manufacturing industry successfully reduced
    salt content in almost a quarter of manufactured foods. This occurred
    gradually over several years and examples included an agreement among
    members of the Bakers Federation and reductions within products
    produced by several major supermarket chains.

    -- In Mauritius, cholesterol reduction was achieved largely by a
    government-led effort switching the main source of cooking oil from
    palm to soya bean oil.

    -- Korea has worked to retain elements of the traditional diet. Civil
    society and government initiatives led mass media campaigns, such as
    television programs, to promote local foods, traditional cooking
    methods and the need to support local farmers.

    -- In Japan, government-led health education campaigns and increased
    blood pressure treatment have reduced blood pressure population-wide,
    and stroke rates have fallen by more than 70 percent.

    -- In Finland, community based interventions, including health
    education and nutrition labelling, led to population-wide reductions
    in cholesterol and many other risks, closely followed by a precipitous
    decline in heart disease. 4

    -- In the USA, a decrease in saturated fat intake in the late 1960s
    began the large decline in coronary heart disease (CHD) deaths seen in
    the last few decades there.

    -- In New Zealand, introduction of a recognizable food labelling logos
    for healthier foods led many companies to reformulate their products.
    The benefits included large decreases in the salt content of processed

    "If we consider the dramatic improvement in cardiovascular health
    that, for example, the Japanese and the Finns have experienced in the
    last few decades, we can see that entire populations have been able to
    significantly improve their situations without any change in their
    gene pool," says Dr Murray. "Clearly diet, exercise and a reduction in
    tobacco and alcohol intake are the most important factors to

    The World Health Report 2002 is focusing on risks to health. It will
    rank the top global risk factors and outline cost effective measures
    for reducing risks, showing in detail the reductions in death and
    disability that can result from a risk-focused approach to health
    issues. The Report will be launched 30 October.

    Copyright 2002 World Health Organization

    (end text)

    (Distributed by the Office of International Information Programs, U.S.
    Department of State. Web site:

    This site is produced and maintained by the U.S. Department of State's Office of International Information Programs ( Links to other Internet sites should not be construed as an endorsement of the views contained therein.

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