The Lancet Early Online Publication, 5 December 2007
The Lancet DOI:10.1016/S0140-6736(07)61698-5
Series, Chronic Diseases
Chronic disease prevention: health effects and financial costs of
strategies to reduce salt intake and control tobacco use
Perviz Asaria MPH a,
Dr Dan Chisholm PhD
c
,
Colin Mathers PhD d,
Majid Ezzati PhD e
and
Robert Beaglehole DSc b
Summary
In 2005, WHO set a global goal to reduce rates of death from chronic (non-communicable) disease by
an additional 2% every year. To this end, we investigated how many deaths could potentially be
averted over 10 years by implementation of selected population-based interventions, and calculated
the financial costs of their implementation. We selected two interventions: to reduce salt intake in the
population by 15% and to implement four key elements of the WHO Framework Convention on
Tobacco Control (FCTC). We used methods from the WHO Comparative Risk Assessment project to
estimate shifts in the distribution of risk factors associated with salt intake and tobacco use, and to
model the effects on chronic disease mortality for 23 countries that account for 80% of chronic
disease burden in the developing world. We showed that, over 10 years (2006–2015), 13·8 million
deaths could be averted by implementation of these interventions, at a cost of less than US$0·40 per
person per year in low-income and lower middle-income countries, and US$0·50–1·00 per person per
year in upper middle-income countries (as of 2005). These two population-based intervention
strategies could therefore substantially reduce mortality from chronic diseases, and make a major
(and affordable) contribution towards achievement of the global goal to prevent and control chronic
diseases.
Affiliations
a.
Kings Fund, London, UK
b.
University of Auckland, Auckland, New Zealand
c.
Department of Health System Financing, World Health Organization, Geneva, Switzerland
d.
Department of Measurement and Health Information Systems, World Health Organization, Geneva,
Switzerland
e.
Harvard School of Public Health, Boston, USA
Correspondence to: Dr Dan Chisholm, Department of Health Systems Financing, World Health Organization, 1211
Geneva 27, Switzerland
The Lancet Early Online Publication, 5 December 2007
The Lancet DOI:10.1016/S0140-6736(07)61699-7
Series, Chronic Diseases
Prevention of cardiovascular disease in high-risk individuals in lowincome and middle-income countries: health effects and costs
Stephen S Lim PhD
Srinath Reddy DM d e,
ab
,
Thomas A Gaziano MD c,
Farshad Farzadfar MD f,
Emmanuela Gakidou PhD a b,
Rafael Lozano MD g
and
Prof K
Prof Anthony Rodgers PhD h
Summary
In 2005, a global goal of reducing chronic disease death rates by an additional 2% per year was
established. Scaling up coverage of evidence-based interventions to prevent cardiovascular disease in
high-risk individuals in low-income and middle-income countries could play a major part in reaching
this goal. We aimed to estimate the number of deaths that could be averted and the financial cost of
scaling up, above current coverage levels, a multidrug regimen for prevention of cardiovascular
disease (a statin, aspirin, and two blood-pressure-lowering medicines) in 23 such countries.
Identification of individuals was limited to those already accessing health services, and treatment
eligibility was based on the presence of existing cardiovascular disease or absolute risk of
cardiovascular disease by use of easily measurable risk factors. Over a 10-year period, scaling up this
multidrug regimen could avert 17·9 million deaths from cardiovascular disease (95% uncertainty
interval 7·4 million–25·7 million). 56% of deaths averted would be in those younger than 70 years,
with more deaths averted in women than in men owing to larger absolute numbers of women at older
ages. The 10-year financial cost would be US$47 billion ($33 billion–$61 billion) or an average yearly
cost per head of $1·08 ($0·75–1·40), ranging from $0·43 to $0·90 across low-income countries and
from $0·54 to $2·93 across middle-income countries. This package could effectively meet threequarters of the proposed global goal with a moderate increase in health expenditure.
Affiliations
a.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
b.
School of Population Health, University of Queensland, Brisbane, QLD, Australia
c.
Division of Cardiovascular Medicine and Division of Social Medicine and Health Inequalities, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, USA
d.
Public Health Foundation of India, New Delhi, India
e.
Department of Cardiology, All India Institute of Medical Services, New Delhi, India
f.
Harvard School of Public Health, Cambridge, MA, USA
g.
Ministry of Health, Mexico City, Mexico
h.
Clinical Trials Research Unit, School of Population Health, Faculty of Medical and Health Sciences,
University of Auckland, Auckland, New Zealand
Correspondence to: Stephen Lim, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
98102, USA
The Lancet Early Online Publication, 5 December 2007
The Lancet DOI:10.1016/S0140-6736(07)61700-0
Series, Chronic Diseases
Prevention of chronic diseases: a call to action
Prof Robert Beaglehole DSc
MA d
and
a
,
Prof Steve Leeder MD e,
Prof Shah Ebrahim DM b,
Prof Srinath Reddy MD c,
Janet Voûte
on behalf of the Chronic Disease Action Group
Summary
Chronic (non-communicable) diseases—principally cardiovascular diseases, cancer, chronic respiratory
diseases, and diabetes—are leading causes of death and disability but are surprisingly neglected
elements of the global-health agenda. They are underappreciated as development issues and
underestimated as diseases with profound economic effects. Achievement of the global goal for
prevention and control of chronic diseases would avert 36 million deaths by 2015 and would have
major economic benefits. The main challenge for achievement of the global goal is to show that it can
be reached in a cost-effective manner with existing interventions. This series of papers in The Lancet
provides evidence that this goal is not only possible but also realistic with a small set of interventions
directed towards whole populations and individuals who are at high risk. The total yearly cost of the
interventions in 23 low-income and middle-income countries is about US$5·8 billion (as of 2005). In
this final paper in the Series we call for a serious and sustained worldwide effort to prevent and
control chronic diseases in the context of a general strengthening of health systems. Urgent action is
needed by WHO, the World Bank, regional banks and development agencies, foundations, national
governments, civil society, non-governmental organisations, the private sector including the
pharmaceutical industry, and academics. We have established the Chronic Disease Action Group to
encourage, support, and monitor action on the implementation of evidence-based efforts to promote
global, regional, and national action to prevent and control chronic diseases.
Affiliations
a.
University of Auckland, Auckland, New Zealand
b.
London School of Hygiene and Tropical Medicine, London, UK
c.
Public Health Foundation of India, New Delhi, India
d.
World Heart Federation, Geneva, Switzerland
e.
School of Public Health, The University of Sydney, Sydney, Australia
Correspondence to: Professor R Beaglehole, 42 Albert Road, Devonport, Auckland 0624, New Zealand