1. Noncommunicable Diseases: An Overview
Dr Ala Alwan
Assistant Director General
World Health Organization

2. Scope Noncommunicable diseases (NCDs):
Cardiovascular diseases (e.g. heart diseases, stroke)
Cancers
Diabetes
Chronic respiratory diseases (e.g. asthma)
Risk factors for noncommunicable diseases:
Tobacco use
Unhealthy diet
Physical inactivity
Harmful use of alcohol

3. Topics
WHO Global Burden of Disease (2004 update published in October 2008)
WHO Global Health Risks (published in October 2009)
Further analysis on the burden of noncommunicable diseases based on the WHO Global Burden of Disease

4. Distribution of age at death and numbers of global deaths (2004)

5. Per cent distribution of age at death by WHO region (2004)

6. Please download at:

7. Total number of deaths (2004)
The global magnitude of deaths from noncommunicable diseases (2004)
70 million
60 million
10%
5.8M
31%
50 million
35.0M
40 million
59%
30 million
20 million
18.0M
Source:
10 million
Total number of deaths (2004)
Group III - Injuries
Low-income countries
Group II – Deaths from noncommunicable diseases
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

8. Global projections (2004 to 2030)12
Cancers 10
Ischaemic HD
Stroke 8
Deaths (millions) 6
Acute respiratory infections 4
Road traffic accidents
Perinatal 2
HIV/AIDS TB
Malaria
2000
2005
2010
2015
2020
2025
2030

9. Global projections (2004 to 2030)
Intentional injuries
Other unintentional 25
Road traffic accidents
Other NCD 20
Cancers
Deaths (millions) 15
CVD 10
Mat//peri/nutritional 5
Other infectious
HIV, TB, malaria
2004
2015
2030
2004
2015
2030
2004
2015
2030
High-income
countries
Middle-income
countries
Low-income
countries

10. Distribution of deaths in the world by sex (2004)

11. Distribution of deaths in the world by cause and sex (2004)

12. Mortality rates among men and women aged 15–59 years (2004)

13. Adult mortality rates (2004)

14. Age-standardized DALYs for noncommunicable diseases (2004)

15. Breakdown of deaths from NCDs (2004) in the League of Arab States
(oPT: no estimates available)
100%
80%
60%
40%
20% 0%
Qatar
UAE
Iraq
Oman
Egypt
Libya
Syria
Bahrain
Kuwait
Algeria
Djibouti
Jordan
Sudan
Morocco
Tunisia
Lebanon
Comoros
Somalia
Yemen
Mauritania
Saudi Arabia
High-income
Middle-income
Low-income
Other non-communicable diseases
Mental health conditions
Diabetes
Chronic respiratory diseases
Cancers
Cardiovascular diseases
Source: Global Burden of Disease 2004

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17. The 10 leading risk factor causes of death (2004)

18. Key findings
High blood pressure is the leading risk factor for mortality, responsible for 13% of deaths globally
Low fruit and vegetable intake, lack of exercise, alcohol and tobacco use, high BMI, high cholesterol, high glucose, and high BP are responsible for more than half of the deaths due to heart disease
Tobacco is responsible for 5.1 million deaths. Almost 1 in 8 deaths of adults over the age of 30 is due to smoking
Being overweight or obese is the fifth leading risk for death, responsible for 7 per cent of deaths globally
Unsafe sex, which leads to transmission of human papillomavirus, is responsible for deaths due to cervical cancer. Cervical cancer is the leading cause of cancer death in Africa.

19. Attributable Mortality Attributable DALYs
Leading causes of attributable global mortality and burden of disease (2004)
Attributable Mortality
Attributable DALYs %
High blood pressure
Tobacco use 8.7
High blood glucose
Physical inactivity
Overweight and obesity
High cholesterol
Unsafe sex
Alcohol use 3.8
Childhood underweight
Indoor smoke from solid fuels 3.3
59 million total global deaths in 2004 %
Childhood underweight 5.9
Unsafe sex 4.6
Alcohol use 4.5
Unsafe water, sanitation
High blood pressure 3.7
Tobacco use 3.7
Suboptimal breastfeeding 2.9
High blood glucose 2.7
Indoor smoke from solid fuels 2.7
Overweight and obesity 2.3
1.5 billion total global DALYs in 2004

20. Deaths attributed to 19 leading factors (2004)

21. Percentage of DALYs attributed to 19 leading risk factors (2004)

22. Percentage of deaths over age 30 caused by tobacco (2004)

23. Tobacco Rising production and consumption in developing countries
It is a shifting epidemic where both production and consumption of tobacco are progressively increasing in developing countries. The industry is skilful in marketing strategies and many countries are unfortunately doing very little to counteract.. 23

24. Tobacco: The poor and uneducated are the ones who smoke the most
Smoking prevalence in Bangladesh (1995)
We also know that smoking prevalence is influenced by social determinants. Here is an example of the impact of education and income The poor and uneducated are the ones who smoke the most
Source: Sen, B & Hulme D, 2004

25. Overweight and obesity in people over 15 selected countries
Just to provide examples of other risk factors-overweight and obesity are now showing very high rates in both industrialized and developing nations. This shows selected countries with very high rates which are still increasing particularly in LMICs. Around 22 million children under 5 are overweight today. Unlike most adults, children cannot choose the environment in which they live in or the food that they eat. You can see here countries of the regions with the highest rates of overweight and obesity

26. The global burden of non-communicable diseases (based on the 2004 update of the Global Burden of Disease)

27. Total number of deaths (2004)
The global magnitude of deaths from noncommunicable diseases (2004)
70 million
60 million
10%
5.8M
31%
50 million
35.0M
40 million
59%
30 million
20 million
18.0M
Source:
10 million
Total number of deaths (2004)
Group III - Injuries
Low-income countries
Group II – Deaths from noncommunicable diseases
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

28. Total number of deaths (2004)
The global magnitude of premature deaths from NCDs (2004)
70 million
60 million
10%
5.8M
50 million
31%
19.2M
40 million
32%
30 million
15.8M
20 million
18.0M
27%
Source:
10 million
Total number of deaths (2004)
Low-income countries
Group III - Injuries
Group II – Other deaths from non-communicable diseases
Group II – Premature deaths from non-communicable diseases (below the age of 70), which are preventable
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

30. High-income countries
The global magnitude of deaths from noncommunicable diseases (2004)
25 million
20 million
6.1M
15 million
10 million
6.0M
Source:
1.9M
1.9M
High-income countries
Upper middle-income
Lower middle-income
Low-income countries
Low-income countries
Group III - Injuries
Group II – Other deaths from non-communicable diseases
Group II – Premature deaths from non-communicable diseases (below the age of 70), which are preventable
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

31. Deaths in Africa* (2004) 7% 0.9 0.9 17% 1.4M 2.2M 2.2M (<70)
14,000,000 7%
12,000,000
0.9
0.9
17%
1.4M
2.2M
10,000,000
2.2M (<70)
11% (<60)
1.4M (<60)
65%
8,000,000
8.1M
8.1M
Lower margin
6,000,000 7%
11%
4,000,000
17% (<70)
Source:
2,000,000
65%
Upper margin
Lower margin
Upper margin
Low-income countries
Group III - Injuries
Group II – Other deaths from non-communicable diseases
Group II – Premature deaths from non-communicable diseases (below the age of 60 (left) or 70 (right))
Group I – Communicable diseases, maternal, perinatal and nutritional conditions
* Data set includes AFRO Member States, as well as Djibouti, Egypt, Libya, Morocco, Somalia, Sudan and Tunisia

32. Total number of deaths in low- and middle-income countries (2004)
The magnitude in 144 low- and middle-income countries
60 million
10%
50 million
5.3 M
34%
28%
40 million
14.2 M
30 million
14.0 M
28%
20 million
17.4 M
Omitted from the MDGs:
14.0 million premature deaths from non-communicable diseases
10 million
Source:
Total number of deaths in low- and middle-income countries (2004)
Low-income countries
Group III - Injuries
Group II – Other deaths from non-communicable diseases
Group II – Premature deaths from non-communicable diseases (below the age of 70), which are preventable
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

33. The magnitude in 144 low- and middle-income countries
18,000,000
16,000,000
14,000,000
12,000,000
10,000,000
8,000,000
6,000,000
4,000,000
2,000,000
Africa
Americas
Middle-East
Europe
South-East Asia
Western Pacific
Group III - Injuries
Group II – Other deaths from non-communicable diseases
Group II – Premature deaths from non-communicable diseases, which are preventable
Group I – Communicable diseases, maternal, perinatal and nutritional conditions

34. Low- and middle-income countries
Breakdown of deaths from non-communicable diseases 6% 6% 4% 3% 3% 3%
12%
13%
50%
49%
27%
25%
All countries
Low- and middle-income countries
Cardiovascular diseases
Cancers
Respiratory diseases
Diabetes
Mental health conditions
Other NCDs

35. 70% of the global burden of premature deaths from NCDs (22 countries)
Low- and middle-income countries which are most affected
70% of the global burden of premature deaths from NCDs (22 countries)
Afghanistan
Bangladesh
Brazil
China
DR Congo
Egypt
Ethiopia
India
Indonesia
Iran
Mexico
Myanmar
Nigeria
Pakistan
Philippines
Russian Federation
South Africa
Thailand
Turkey
Sudan
Ukraine
Vietnam

36. Eastern-Mediterranean
Prevalence of obesity, ages 30+ (2004)
male
female
South-East Asia
Western Pacific
Africa
Eastern-Mediterranean
Europe
Americas
30%
20%
10% 0%
10%
20%
30%
Source:

37. Prevalence of obesity, ages 30+ (2015)
male
female
46%
29%
30%
13% 9% 6%
32%
21%
12% 5% 3%
Americas
Europe
Eastern-Med
Africa
West Pac
SEA

38. What will happen if nothing is done now?
Projections of estimated deaths from noncommunicable diseases (millions)
Africa
The Americas
Eastern Med.
Europe
South East Asia
Western Pacific
World
2004
2.8
4.7
2.2
8.1
7.7
9.4
35.0
2015
3.5
5.5
2.7
8.6
9.5
11.4
41.2
2030
4.9
7.1
3.8
8.5
12.6
14.6
51.6
Source: 38

39. What will happen if nothing is done now?
Death from noncommunicable diseases
Increases (in percentage and millions) in 2015 vs 2004
30%
2.5M
25%
2.0M
20%
1.5M
15%
1.0M
10%
Source:
0.5M 5% 0%
Africa
Americas
Eastern
Med
Europe
South-
East
Asia
Western
Pacific
Africa
Americas
Eastern
Med
Europe
South-
East
Asia
Western
Pacific

40. 10 leading causes of deaths in females (2004)
WHO report on Women and Health (launched on 9 November 2009)
10 leading causes of deaths in females (2004)

41. Download at:

42. Diabetes in the world at a glance

43. Top-10 number of people with diabetes (20-79 years) (2010 and 2030)

44. Top-10 prevalence (%) of diabetes(20-79 years) (2010 and 2030)-IDF Atlas
Comparative prevalence 44

45. Prevalence (%) estimates of diabetes (20-79 years) (2010) –IDF Atlas
Comparative prevalence 45

46. Prevalence (%) estimates of diabetes (20-79 years) (2030)
Comparative prevalence 46

47. Macro-economic impact
Oil and gas price spike
Retrenchment from globalization
Asset price collapse
NCDs
Fiscal crisis
Flu pandemic
World Economic Forum: Global Risk Assessment 2009
Food crisis
Infectious disease

48. Why low- and middle-income countries are disproportionally affected

49. Socio-economic impact at household level
Poverty at household level
Populations in low- and middle-income countries
Globalization
Urbanization
Population ageing
Increased exposure to common modifiable risk factors:
Unhealthy diets
Physical inactivity
Tobacco use
Harmful use of alcohol
Non-communicable diseases:
Cardiovascular diseases
Cancers
Diabetes
Chronic respiratory diseases
Loss of household income
from unhealthy behaviours
Loss of household income
from poor physical status
Limited access to effective and equitable health-care services
which respond to the needs of people with non-communicable diseases
14 million people die prematurely each year
in developing countries from non-communicable diseases
Loss of household income
from high cost of health care

50. The cost per year of diabetes care at household level
The poorest people in developing countries are often affected the most
The cost of caring for a family member with diabetes can be more than 20 per cent of low-income household incomes in developing countries
The cost per year of diabetes care at household level
Insulin
Syringes
Testing
Consultation
Travel
Total cost
% of per capita Income
Mali (2004)
38%
34% 8% 7%
12%
$339.4
61%
Mozambique (2003) 5%
24% 1% 9%
$273.6
75%
Nicaragua (2007) 0%
73%
27%
$74.4
Zambia (2003)
63% 6%
$199.1
21%
Vietnam (2008)
39% 3%
46%
$427.0
51%

51. The poorest people in developing countries are often affected the most
The poorest people smoke the most, often spending more than 10 per cent of their household income on tobacco 45
Smoking prevalence
Lowest household income quintiles 40 35 30 25
Highest household income quintiles % 20 15 10 5
Low-income countries
Lower-middle
Upper-middle-income
High-income
Income

52. WHO report on the global tobacco epidemic, 2009

53. WHO report on the global tobacco epidemic, 2009

54. Key messages
NCDs are already leading health problems in almost all countries and their magnitude is still increasing
Shared risk factors
Premature deaths
The poor are disproportionately affected
Negative impact on socioeconomic development
As countries continue to develop, market forces will further promote unhealthy patterns.
Action is urgently needed

55. (premature death below 60)
What is the magnitude in 36 countries?
14 M
1.5 M
1.5 M
12 M
3.4 M
2.3 M
10 M
3.0 M
(premature death below 70)
8 M
1.9 M
(premature death below 60)
6 M
6.7 M
6.7 M
4 M
Source:
2 M
2004 deaths in 36 partner countries
2004 deaths in 36 partner countries
Low-income countries
Group III - Injuries
Group II – Other deaths from non-communicable diseases
Group II – Premature deaths from non-communicable diseases (below 60 or 70), which are preventable
Group I – Communicable diseases, maternal, perinatal and nutritional conditions