Visualising the slow march to a chronic disease apocalypse

Edmond Ng
Image: Cigarettes in ash tray

People living in 35 industrialised countries can look forward to longer lives, a recent Lancet study suggests. The research showed that women in South Korea are expected to have a better than 50/50 chance of breaking the 90-year barrier by year 2030 - a remarkable feat that was not considered possible by many at the turn of the 21st century.

The prospect of increased longevity in these areas reflect improvements in areas such as education and healthcare. However, while we should celebrate these achievements, it’s worth remembering that those extra years may come at a cost.

In our later lives many of us will experience poor health, perhaps suffering from multiple long-term conditions or ‘co-morbidities’. Once thought to be challenges for affluent countries alone, chronic conditions or non-communicable diseases (NCDs) like cancer, cardiovascular disease and diabetes, are now among the leading causes of death and disability in low and middle income countries. These diseases are enormous economic and human burdens to society. 

Most chronic conditions are preventable. Bold political commitment and multi-sectoral action is needed to prevent the slow-motion crash towards a global NCD apocalypse. Communication tools that help convey the scale, severity and urgency of the problem can provide vital clues for policymakers, and be a catalyst for changes which could combat the global rise of these conditions.

Global health funders are increasingly committed to making research outputs such as health estimates, datasets and publications more widely accessible - the Open Research by the Wellcome Trust and the Open Access policy of the Bill & Melinda Gates Foundation are prime examples. In doing so, researchers are encouraged to utilise them for their own analysis and to look at health issues from their own unique perspectives.

Using time series data courtesy of the Global Health Data Exchange and NCD Risk Factor Collaboration, we have produced animations that chart the rise and spread of diabetes and obesity. They highlight the seemingly unstoppable shift of the global burden of these conditions.

The number of adults in the world with diabetes (type 1 and 2) increased from approximately 108 million in 1980, to 422 million in 2014. American Samoa was reported to have the highest age-standardised (which assumes the same age structure across all countries) prevalence of diabetes, more than 30% of the population in both sexes. Globally, the age-standardised prevalence of obesity increased from an estimated 3·2% in 1975 to 10·8% in 2014 for men, and from 6·4% to 14·9% in women.

At 2010 levels, the chance of halting the rise in diabetes by 2025, one of the global targets of NCDs, was estimated to be around 1% for both men and women if the post-2000 trends continue. The likelihood of reaching the global target for obesity is nearly impossible.

It’s not all doom and gloom. One animation shows that smoking prevalence - the percentage of the population that smokes everyday - has decreased globally. With tobacco smoking a major risk factor for coronary heart disease and other major health conditions such as cancer, stroke and chronic respiratory disease, there is a glimmer of light at the end of the tunnel when it comes to one of the world’s greatest risks to health.

Of course there is still huge work to do. Although large reductions of daily smoking have been observed in the majority of countries since 1980, the total number of smokers worldwide continues to rise through population growth.

Furthermore, the estimated prevalence in 2012 remained persistently high at more than 50% in some eastern and central European countries, as well as in Oceania (excluding Australia and New Zealand). As the authors of a 2014 JAMA report highlight the greatest health risks, unsurprisingly, are likely to be faced by countries with lots of smokers who smoke a lot. China, Greece, Ireland and Italy beware.

Never have we had more tools and data to track, measure and visualise changes in global health. These visualisations are a graphic warning for the future and a stark wake-up call for politicians and decision-makers. But, as the smoking prevalence graphic shows, they can also serve as an inspiration by highlighting what can be achieved.

The march towards a global chronic disease apocalypse is clear to see but it can be stopped, if we act now. Let’s hope by 2030, the global target for Sustainable Development Goals to be achieved, new images will paint a different picture – then we will know if progress has really been made.

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