Noncommunicable Diseases

Abstract

The United Nations has held only two meetings of heads of state on a health-related issue.The first, in 2001, was on human immunodeficiency virus infection and the acquired immunodeficiency syndrome.The second, in September 2011, was on noncommunicable diseases.Although noncommunicable diseases were ignored during the framing of the Millennium Development Goals in 2000, their leading and growing contribution to preventable deaths and disability across the globe has compelled policymakers to pay attention and initiate action.The United Nations and the World Health Organization (WHO) have called for a 25% reduction by 2025 in mortality from noncommunicable diseases among persons between 30 and 70 years of age, in comparison with mortality in 2010, adopting the slogan "25 by 25." 1,2 We review the burden of noncommunicable diseases and issues in prevention, detection, and treatment that must be addressed in order to meet this goal. Dise a se a nd Ec onomic Bur dens Disease BurdenNoncommunicable diseases have been a difficult group to define.Even the term "noncommunicable diseases" is a misnomer, because it includes some diseasesnotably, cancers of the liver, stomach, and cervix -that are at least partly caused by infectious organisms, and it usually excludes mental illnesses, despite their large contribution to long-term disability.However, four common behavioral risk factors (tobacco use, excessive alcohol consumption, poor diet, and lack of physical activity) are associated with four disease clusters (cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes) that account for about 80% of deaths from noncommunicable diseases.3 According to WHO estimates, noncommunicable diseases contributed to 36 million deaths globally in 2008, accounting for 63% of 57 million total deaths (Fig. 1). 4 The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) estimated that mortality due to noncommunicable diseases (with the use of a somewhat different definition of noncommunicable diseases than that used by the WHO) increased from 57% of total mortality in 1990 to 65% in 2010.3,5 About 80% of deaths related to noncommunicable diseases occur in low-and middle-income countries, which also have a high proportion of deaths in middle age; such countries account for 90% of the 9 million noncommunicable disease-related deaths that occur before 60 years of age (Fig. 2).6 This staggering toll of noncommunicable diseases and premature mortality in low-and middleincome countries sometimes surprises those who suppose that mortality in these countries is still dominated by maternal and child deaths and deaths due to infectious diseases.Cardiovascular diseases account for the largest fraction of deaths related to noncommunicable diseases, followed by cancer, chronic obstructive pulmonary disease (COPD), and diabetes (Fig. 3A and interactive graphic, available with the full text of this article at NEJM.org).7 Proportional mortality from noncommunicable diseases is An interactive graphic showing the global burden of noncommunicable diseases over time is available at NEJM.org