Global Report on Noncommunicable Diseases

Noncommunicable diseases (NCDs) are the leading global causes of death, causing more deaths than
all others causes combined, and they strike hardest at the world’s low- and middle-income populations.
These diseases have reached epidemic proportions, yet they could be signifi cantly reduced, with
millions of lives saved and untold suffering avoided, through reduction of their risk factors, early
detection and timely treatments. The Global status report on noncommunicable diseases is the fi rst
worldwide report on the state of NCDs and ways to map the epidemic, reduce its major risk factors and
strengthen health care for people who already suffer from NCDs.

This report was prepared by the WHO Secretariat under Objective 6 of the 2008–2013 Action Plan for
the Global Strategy for the Prevention and Control of NCDs. It focuses on the current global status of
NCDs and will be followed by another report to assess progress in 2013. One of the main objectives
of this report is to provide a baseline for countries on the current status of NCDs and their risk factors,
as well as the current state of progress countries are making to address these diseases in terms of
policies and plans, infrastructure, surveillance and population-wide and individual interventions. It
also disseminates a shared vision and road map for NCD prevention and control. Target audiences
include policy-makers, health offi cials, nongovernmental organizations, academia, relevant non-health
sectors, development agencies and civil society.

Of the 57 million global deaths in 2008, 36 million, or 63%, were due to NCDs, principally
cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. As the impacts of NCDs
increases, and as populations age, annual NCD deaths are projected to continue to rise worldwide, and
the greatest increase is expected to be seen in low- and middle-income regions.

While popular belief presumes that NCDs affl ict mostly high-income populations, the evidence tells a
very different story. Nearly 80% of NCD deaths occur in low-and middle-income countries and are the
most frequent causes of death in most countries, except in Africa. Even in African nations, NCDs are
rising rapidly and are projected to almost equal communicable, maternal, perinatal, and nutritional
diseases as the most common causes of death by 2020.

Mortality and morbidity data reveal the growing and disproportionate impact of the epidemic in lowerresource
settings. Over 80% of cardiovascular and diabetes deaths, and almost 90% of deaths from
chronic obstructive pulmonary disease, occur in low- and middle-income countries. More than two
thirds of all cancer deaths occur in low- and middle-income countries. NCDs also kill at a younger
age in low- and middle-income countries, where 29% of NCD deaths occur among people under the
age of 60, compared to 13% in high-income countries. The estimated percentage increase in cancer
incidence by 2030, compared with 2008, will be greater in low- (82%) and lower-middle-income
countries (70%) compared with the upper-middle- (58%) and high-income countries (40%).
A large percentage of NCDs are preventable through the reduction of their four main behavioural risk
factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet. The infl uences
of these behavioural risk factors, and other underlying metabolic/physiological causes, on the global
NCD epidemic include:

Tobacco: Almost 6 million people die from tobacco use each year, both from direct tobacco use and
second-hand smoke. By 2020, this number will increase to 7.5 million, accounting for 10% of all deaths.
Smoking is estimated to cause about 71% of lung cancer, 42% of chronic respiratory disease and nearly
10% of cardiovascular disease. The highest incidence of smoking among men is in lower-middle-income
countries; for total population, smoking prevalence is highest among upper-middle-income countries.

Insuffi cient physical activity: Approximately 3.2 million people die each year due to physical inactivity.
People who are insuffi ciently physically active have a 20% to 30% increased risk of all-cause mortality.
Regular physical activity reduces the risk of cardiovascular disease including high blood pressure, diabetes,
breast and colon cancer, and depression. Insuffi cient physical activity is highest in high-income countries,
but very high levels are now also seen in some middle-income countries specially among women.

Harmful use of alcohol: Approximately 2.3 million die each year from the harmful use of alcohol,
accounting for about 3.8% of all deaths in the world. More than half of these deaths occur from NCDs
including cancers, cardiovascular disease and liver cirrhosis. While adult per capita consumption is
highest in high-income countries, it is nearly as high in the populous upper-middle-income countries.

Unhealthy diet: Adequate consumption of fruit and vegetables reduces the risk for cardiovascular
diseases, stomach cancer and colorectal cancer. Most populations consume much higher levels of
salt than recommended by WHO for disease prevention; high salt consumption is an important
determinant of high blood pressure and cardiovascular risk. High consumption of saturated fats and
trans-fatty acids is linked to heart disease. Unhealthy diet is rising quickly in lower-resource settings.
Available data suggest that fat intake has been rising rapidly in lower-middle-income countries since
the 1980s.

Raised blood pressure: Raised blood pressure is estimated to cause 7.5 million deaths, about 12.8% of
all deaths. It is a major risk factor for cardiovascular disease. The prevalence of raised blood pressure
is similar across all income groups, though it is generally lowest in high-income populations.

Overweight and obesity: At least 2.8 million people die each year as a result of being overweight or
obese. Risks of heart disease, strokes and diabetes increase steadily with increasing body mass index
(BMI). Raised BMI also increases the risk of certain cancers. The prevalence of overweight is highest
in upper-middle-income countries but very high levels are also reported from some lower-middle
income countries. In the WHO European Region, the Eastern Mediterranean Region and the Region
of the Americas, over 50% of women were overweight. The highest prevalence of overweight among
infants and young children is in upper-middle-income populations, while the fastest rise in overweight
is in the lower-middle-income group.

Raised cholesterol: Raised cholesterol is estimated to cause 2.6 million deaths annually; it increases
the risks of heart disease and stroke. Raised cholesterol is highest in high-income countries.

Cancer-associated infections: At least 2 million cancer cases per year, 18% of the global cancer burden,
are attributable to a few specifi c chronic infections, and this fraction is substantially larger in low-income
countries. The principal infectious agents are human papillomavirus, Hepatitis B virus, Hepatitis C virus
and Helicobacter pylori. These infections are largely preventable through vaccinations and measures to
avoid transmission, or treatable. For example, transmission of Hepatitis C virus has been largely stopped
among high-income populations, but not in many low-resource countries.

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