Chronic diseases, acute challenges

by December 1, 2010

Guest post by Zach Kuehner

It is often assumed that chronic diseases – heart disease, cancers, diabetes, arthritis – are the special afflictions of the developed world. They are seen as diseases of wealth: the price we pay for affluence and greater life expectancy. Acute or infectious diseases – HIV/AIDS, malaria – by contrast, are typically viewed as afflictions of developing nations that have yet to achieve the standard of living necessary to take on the chronic disease burden. And while few would deny the significant toll that infectious diseases have taken on nations in Africa, Asia, and parts of Central and South America (malaria alone is responsible for approximately one million deaths each year, with ninety per cent from Africa), the relationship between chronic disease and the developing world is often ignored or dismissed, despite evidence that such diseases weigh heavily on developing nations as well (80% of deaths from cardiovascular disease, for example, occur in low- and middle-income countries).

A recent series of papers featured in The Lancet this month sheds light on the many faces of the chronic disease problem, and asks why infectious diseases receive the bulk of the publicity even though chronic diseases appear to be the true wasters of resources (human and otherwise). Reasons for this neglect are thought to range from political will to the power of vested interests. But as another of the papers points out, even if it were possible to overcome these political barriers and convince the world to leave cigarettes, fast food, and refined sugar behind, the changes to agricultural production and trade caused by a mass transition to healthy diets could seriously hamper the economic progress of many low- and middle-income countries:

Reduction of the burden of chronic disease through consumption of healthier diets than are consumed at present will probably benefit the health of millions of people, especially the poorest. However, such improvement will necessitate changes in agricultural production and trade worldwide, resulting in various winners and losers between sectors of the economy, rural and urban communities, and regions and countries. Awareness of the effects and tradeoffs between policy sectors is a central challenge for decision makers in a globalising world.

We show the importance of connection of these perspectives by estimating both how the adoption of a healthy diet (achieved through reduction of consumption of foods from animal sources in a population to meet international dietary guidelines for saturated fat intake) will affect population health through reduction in risk of non-communicable diseases, and also the potential effect of such a policy on agricultural production, trade, the economy, and livelihoods.

Read a summary of the series here or register to view full articles (for free, including the one above) at The Lancet.

Zach Kuehner lives and works in Toronto, Ontario. His educational background includes health science as well as international relations and politics. He can be reached at