Emerging powers like Brazil, Russia, China and India will face mounting health threats diabetes and other diseases. Photo by Flickr user ML_Duong
NEW YORK | They are the new generation of economic powers, the nations whose economic growth put the world on notice. Now, Brazil, Russia, India and China, nicknamed the BRIC countries, are also facing a health threat that is killing off citizens, hurting their work forces and could slow progress.
These middle-income nations all boast huge populations that helped power their ascent, but changes in lifestyle, urbanization, lack of exercise and diets that now include processed foods are causing swift increases in non-communicable diseases.
Annual losses in national income from heart disease, stroke and diabetes are estimated at $18 billion in China, $11 billion in Russia, $9 billion in India and $3 billion in Brazil for 2005, and those numbers are only set to increase with current trends, according to the World Health Organization. The four countries lose more than 20 million productive life years annually to non-communicable conditions, according to a recent analysis by the World Economic Forum.
The international attention now being paid to these diseases at a U.N. high-level meeting wrapping up Tuesday in New York is in no small part due to their impact on these rising powers, Gene Bukhman, director of global non-communicable disease and social change program at Harvard Medical School, told the NewsHour ahead of the meeting.
Any political agreement to come out of Tuesday’s meeting will rely heavily on countries to take the initiative to prevent and treat these diseases themselves — setting no hard targets and outlining no resource commitments — so health experts are watching these countries closely.
“The economic and social well being of [these] countries will depend largely on tackling these non-communicable diseases,” Dr. Patricio Marquez, a health specialist at the World Bank said. “They have a role to play to push forward the agenda on the international level.”
Take a look at what BRIC representatives had to say at the meeting about their priorities going forward.:
*Estimated non-communicable disease deaths in 2008: 1.7 million
Percentage of NCD deaths considered premature: 23*
Russia is the only BRIC country that didn’t address the U.N. meeting from the podium. A representative from the country did comment during one of the round-table side sessions, noting that men of working age in the country are at greatest risk from cardiovascular disease due to very high levels of alcohol consumption.
The World Bank’s Marquez, whose expertise is in Russia, Europe and Central Asia, said that Russia’s burden of non-communicable disease is caused in large part by high levels of alcohol abuse, which account for nearly one-third of all deaths in the country, as well as widespread smoking and poor diet. Russia’s population is actually declining, causing a demographic crisis, and the situation is dire, he said.
“In essence what you are having right now is that the NCD epidemic is leading to premature mortality and is driving the demographic decline in Russia,” he said. “The size of the labor force is shrinking rapidly.”
The country estimates 500,000 people die from alcohol related reasons in Russia annually, prompting President Dmitry Medvedev to call the situation “a national disaster” earlier this year. Russia has set a goal of cutting alcohol consumption in half by 2020, through public information campaigns, advertising restrictions and crackdowns on illegal markets.
Russia has also taken steps to implement the WHO Framework Convention on Tobacco Control, including increasing taxes on cigarettes, and is targeting the youth population with campaigns to promote better life styles, Marquez said. About 41 percent of Russians smoke daily, the highest among BRIC countries.
While the high levels of alcohol and tobacco abuse are well-known non-communicable disease risk factors in Russia, the country also suffers from extremely high rates of obesity and high blood pressure. About 48 percent have high blood pressure and 27 percent of the population is considered obese.
*Estimated non-communicable disease deaths in 2008: 8 million
Percentage of NCD deaths considered premature: 20*
“Governments should attach as much importance to health as they do to economic development,” China’s Minister of Health Chen Zhu told the high-level meeting at the U.N. He advocated not only implementing the set of prevention and treatment steps suggested in the political agreement, but also pushed for the inclusion of non-communicable diseases in the Millennium Development Goals, which would be a strong move to hold countries accountable to specific targets of disease reduction.
Chen Zhu has good reason to be concerned: “NCDs have become the number 1 threat to the health of the Chinese people,” currently affecting 260 million citizens and responsible for 85 percent of deaths in the country, he said. China has very high rates of tobacco use, 26 percent of the population lights up daily, which is second only to Russia within the BRICs. More than 38 percent of China’s population has elevated blood pressure.
Chen said the country is trying to reduce non-communicable disease burden through an ongoing health system reform to provide basic universal care. The country has also set a target of increasing average life expectancy by one year in its new five-year plan, and is running a “healthy cities” campaign to promote more healthful lifestyles. But the country’s tobacco industry is also government run and health experts have criticized the country for not taking necessary step to make cigarette products more expensive and educate the population about the health effects.
“The rapid growth of NCDs will lead to a decline in labor supply, erosion of quality of life, an increase in…social economic burden,” Chen Zhu said. “NCDS have become an enormous potential obstacle to the economic and social development of China, we should loose no time to prevent and control such diseases.”
*Estimated non-communicable disease deaths in 2008: 5.2 million
Percentage of NCD deaths considered premature: 35*
“We are faced with a triple burden of communicable disease, new and emerging infections and the increasing incidence of non-communicable disease,” Ghulam Nabi Azad, minister of health and family welfare of India, told the U.N. meeting. Among the BRIC countries India best illustrates the challenges faced by countries that still have large populations suffering from infectious disease, while also seeing non-communicable diseases rise, particularly in cities and among richer populations. Just over half of India’s deaths are from non-communicable disease, while 37 percent are still from infectious disease, the WHO reports.
India also has the world’s largest diabetic population, and getting insulin can be very hard for the majority of the population. Diabetes care can cost low-income households about one third of their incomes, reports the WHO.
Azad said the country is making moves to combat the swell, starting a $275 million pilot project this year for prevention and treatment of of cancer, diabetes and stroke. The program covers 150 million people in 100 of the country’s least accessible districts. India aims to screen 150 million people for hypertension and diabetes by 2012.
“This would be the largest such exercise attempted anywhere in the world,” Azad said.
He emphasized the role Indian companies have played in getting affordable medicines and technologies to countries around the world and advocated increased access to drugs for non-communicable diseases.
“We must therefore address the issue of trade barriers which restrict access to affordable and newly developed medicines,” he said.
*Estimated non-communicable disease deaths in 2008: 894,000
Percentage of NCD deaths considered premature: 29*
The only president of a BRIC country to address the U.N. meeting, Dilma Rousseff spent much of her time at the podium emphasizing the need for wider access to medications, touting her own government’s moves to make drugs for heart disease and diabetes available free of charge to populations that can’t afford them.
“Brazil advocates access to medications as part and parcel of the human right to health. We know that it is a strategic element in fostering social inclusion, building equality and strengthening public health care systems,” she said.
About 74 percent of all deaths in Brazil are due to non-communicable diseases, and the country has the highest percentage of deaths caused by diabetes among the BRIC countries, at 5 percent of mortality. The country also has the highest proportion of population considered physically inactive — nearly half of adults don’t get enough exercise.
Dilma Rousseff said the government is working with private companies on voluntary agreements to cut sodium and rid foods of transfats. Brazil is also taking steps to build environments that encourage more activity, especially in cities.
“We are promoting the redesigning of urban spaces and large urban centers,” she said.
Especially in rural areas of the country, Rousseff said efforts are being undertaken to provide more screening and treatment for breast cancer and cervical cancer.