Invisible epidemic: Why chronic diseases are our main enemy
living conditions on the planet have changed a lot: climate change, migration, new technologies - all this and more influences, directly or indirectly, on human health. Now WHO and the UN are seriously concerned about the so-called invisible epidemic - and this is not about exotic infections. Specialists say that non-infectious chronic diseases, including diabetes and cardiovascular, oncological, and respiratory diseases, are turning into an epidemic. Together with the WHO representative in Russia, Dr. Melita Vuinovich, we tried to understand the forecasts and what can be done to protect our health.
The prevalence of noncommunicable diseases is increasing throughout the world, and, according to a WHO expert, Russia is no exception. Every year around the world, 41 million people die from non-communicable diseases - these are 71% of all deaths, in our country these very diseases are the main cause of death and disability. A few decades ago, it was believed that chronic diseases were “the burden of the rich”: they were characteristic of countries where people could afford to move a little, overeat and spend money on cigarettes and alcohol. But the situation has changed: more than 80% of deaths from chronic diseases occur in low- and middle-income countries, where people used to die mainly from causes related to malnutrition and infectious diseases. Local health systems do not cope: in many countries they were created with a focus on fighting infections, and there is simply no money for lifelong treatment of chronic diseases.
An important global trend is the relocation of people from rural areas to cities. Now more than fifty percent of the world's population live in cities, and by 2050 this figure will be two-thirds. Urbanization is fastest in Africa and Asia; in Japan and Russia, it is even expected that in the coming decades the pace of urbanization will slow down. In countries with weak economies, cities are growing rapidly, and people do not have access to good medical care, and sanitary conditions leave much to be desired. In addition, moving to the city is a change of lifestyle: urban people eat more high-calorie food, move less, smoke more and breathe polluted air. Aggressive marketing of tobacco, food and alcohol concerns only contributes to the spread of unhealthy habits.
Large studies are usually carried out in America, Europe, including Russia, Japan - and scientists note that outside of these countries, chronic diseases behave somewhat differently. For example, type 2 diabetes mellitus is usually associated with older age and obesity - but in low- and middle-income countries, it is increasingly being diagnosed in slender people and in younger people. There was a theory that children born to women who were starving or malnourished were especially sensitive to overeating all their lives - their cells "remember" about the famine suffered by their mother, therefore the endocrine system simply cannot cope with large amounts of glucose.
Of course, the global aging of the population also plays a role. Most of the history, the share of older people did not exceed 5%, but now it has reached 15%, and by the middle of the century will be about 25%. This trend is most pronounced in Japan and the countries of Europe, but gradually the demographics are changing throughout the world. This means that chronic diseases will be more and more new types of them may appear. The picture is grim, but still about 80% of cases of diabetes and cardiovascular diseases are preventable, like a third of oncological diseases, and the risk factors for many of them are the same: smoking, alcohol abuse, unhealthy diet and lack of physical activity.
One of the measures that WHO and other international organizations recommend is the complete cessation of tobacco at the global level. According to scientists, smoking by 2030 will kill about 8 million people a year. Many countries act decisively: Finland is going to completely abandon tobacco by 2040, Scotland - by 2034, and New Zealand - by 2025 already.
Melita Vuinovic says that Russia joined the WHO Framework Convention on Tobacco Control ten years ago. A national anti-tobacco law was developed (and adopted in 2013). Now it is forbidden to smoke in bars, restaurants, stadiums, at the entrance to the subway, in trains, hotels, schools, universities, hospitals. The sale of cigarettes to minors, the sale in kiosks and stalls or near educational institutions is prohibited, and now a gradual increase in the price of tobacco has begun. According to the global tobacco consumption survey (GATS), the measures were quite effective: from 2009 to 2016, the prevalence of smoking in the country decreased by 21.5%, including 16% among men and 34% among women.
Alcohol abuse is a risk factor with special significance for our country, measures are taken gradually - and, according to a WHO expert, they work. Today they include limiting the time and places for selling alcohol, reducing the number of alcohol advertisements in the media, toughening up the punishment for driving drunk. As a result, from 2006 to 2016, Russians began to drink significantly less - from 17.1 liters of alcohol per person per year to 11.1 liters.
Scientists have long discussed whether drinking alcohol in small doses is beneficial for the body. It is proven that drinking alcohol in moderation reduces the risk of myocardial infarction - but in large quantities alcohol increases mortality. Alcohol abuse is associated with the risk of certain cancers (cancer of the esophagus, liver, intestines, breast), as well as death due to injury and violence. People who drink alcohol are advised by doctors to stick to moderate use - and non-drinkers are not recommended to start doing it for “health.”
Melita Vujnović stresses that health workers alone cannot fight against non-communicable diseases - the interaction with food production and with the media is important here. In some countries (for example, in Hungary) there are measures aimed at the production of products with a lower sugar content: according to WHO recommendations, an adult should receive less than 10% of total calories from sugar, and ideally less than 5%. Another problem is excess sodium, which enters the body not only from salt, but also from such processed foods as bread, biscuits or cheese sticks. To reduce the risk of hypertension and heart disease, it is recommended to eat no more than 5 grams of salt per day. You can limit yourself on your own - or you can, as in Portugal, raise taxes on ready-made salty snacks like chips and crackers. WHO also recommends replacing trans fats with polyunsaturated fats - this is a very effective preventive measure. Denmark, Switzerland, Austria and some other countries have already introduced a legislative ban on trans fats.
When the global fight against chronic diseases was just beginning, the largest food corporations declared that they were ready to change the composition of products, responsibly approach marketing and help promote healthy lifestyles - but everything turned out to be more difficult. Critics point out that many food concerns are really trying to promote a healthy lifestyle, but they are shifting emphasis - for example, they emphasize the importance of physical activity. It is known that the main risk factor for obesity is not hypodynamia, but an excess of calories in food.
A healthy lifestyle is both simple and difficult, scientists are looking for other methods of prevention that could be applied to most people, including in low-income countries. We are talking about "polypyls" - a universal pill containing several types of medicines for the treatment and prevention of cardiovascular diseases. Such a drug could be prescribed to all people from the risk group (for example, to all who have obesity, elevated blood glucose levels, elevated blood pressure); ideally, the cost of such treatment should be much lower than the cost of a combination of individual drugs.
Another pharmacological prophylaxis method is vaccination. Despite the fact that oncological diseases belong to the non-infectious group, the cause of some tumors (including cervical cancer) is HPV infection, and liver cancer can be a consequence of hepatitis virus infection. Although vaccines against HIV and malaria do not yet exist, it is possible to protect against many other risks with vaccines. Yes, and infectious diseases can not be written off as defeated so far.
This year, WHO included "X-Disease" in the list of infections requiring priority research. This means that the emergence of new dangerous infections, the causative agents of which are not yet familiar to science. There are millions of unexplored viruses, half of which can be dangerous. Recent histories with the Ebola and Zika viruses show that known pathogens can suddenly change their behavior: it has been known about the Zika virus since 1947, about the Ebola virus since 1976.
It is believed that global warming will also continue to affect our health: there will be droughts and floods, hurricanes and storms on Earth. This will lead to migration and possible conflicts - which means there will be more injuries, the spread of infections will increase, and the psyche may suffer due to heightened stress. Mankind is able to cope with many global threats - but this requires that international organizations, scientists, governments, representatives of various industries and ordinary people act together and remember that we are all dependent on each other. And despite the unhealthy tendencies imposed by advertising, each of us can lead an active lifestyle, eat healthy foods and avoid bad habits.
Photo: Jacek Fulawka - stock.adobe.com, asayenka - stock.adobe.com