Forty-seven trillion dollars.
That number, $47-trillion (U.S.), is so staggeringly large as to be almost inconceivable. But that is how much five chronic illnesses will cost the global economy over the next 20 years, according to a new study commissioned by the World Economic Forum.
The research is a sobering reminder that the five conditions – cancer, diabetes, mental illness, heart disease and respiratory illness – do not merely pose health challenges for individuals but an economic challenge for the world for decades to come.
Today, the big five kill 36 million people a year (of the 57 million deaths in total). By 2030, non-communicable diseases (NCDs) will claim 52 million or 80 per cent of all deaths. But mortality is merely the tip of the iceberg. Hundreds of millions more are living with disabling chronic illnesses that often leave them unable to work and participate fully in society, and many more will join their ranks.
The world needs a plan to counter this epidemic.
So the United Nations has convened a high-level summit to tackle the problem of NCDs – the two-day event began Monday in New York.
These meetings are anti-climactic because the final declaration is more or less agreed to well in advance. So we know what will come out of this meeting: a “declaration of commitment” in which wealthy countries such as Canada make vague promises to do more to stem the tide of disease in the developing world, and developing countries make equally vague commitments to implement prevention measures.
But that’s not the important part. The benefit of the summit is that it will help shatter some myths and shift views about NCDs.
The predominant view is that chronic illnesses are the rich man’s burden. Only the wealthy, the thinking goes, live long enough to die in large numbers of cancer and heart disease. (We tend to think a lot less about the other two big killers in Western society, diabetes and chronic obstructive pulmonary disease.) The flip-side of this view is that the poor, those in developing countries, are ravaged by infectious diseases such as HIV-AIDS, malaria, tuberculosis and childhood killers such as measles and diarrheal illnesses, so they don’t have the “luxury” of dying of chronic illnesses.
But the reality is a lot more complex.
It is true that in countries such as Canada we have dramatically reduced the burden of infectious disease with investments in sewage, water filtration, vaccination (though we are backsliding on the latter) and screening that allows early intervention.
But non-communicable diseases are becoming more common and deadly because of our lifestyle excesses such as poor diet, sedentary behaviour, smoking and excessive alcohol consumption, not to mention our overreliance on expensive treatments rather than cheap prevention tools.
In the developing world, on the other hand, they have a double burden: Infectious diseases are being much better controlled (in large part as a result of childhood vaccination campaigns by groups such as Unicef) but there is still a lot of deadly disease spread through unclean water and lack of sanitation.
At the same time, NCDs are rising at a dizzying rate because of a combination of lifestyle, environmental threats and poor access to basic care.
Shifting wealth and food supply patterns mean that as many people now die of excess food consumption as malnutrition.
Similarly, while smoking is on the decline in the developed world, rates continue to rise in the developing world. And while cervical cancer is rare in Western countries with Pap testing, it is one of the leading killers of women worldwide.
In fact, the poor – and poor women specifically – are now the principal victims of NCDs, particularly in emerging economies such as China and India.
In India, new-found wealth has created a huge market for Western-style packaged foods (rife with salt, sugar, trans fats etc.) and helped engineer activity out of daily living. This, in turn, has fuelled an epidemic of high blood pressure, and troubling rates of diabetes and heart disease.
While China’s factories crank out consumer goods for the planet, workers in these plants – who often toil in horrible conditions – are seeing their rates of respiratory illness and cancer soar. The Chinese government also relies heavily on revenues from tobacco sales, which exceed $76-billion a year.
Those realities make it difficult to get buy-in for the simple measures that are required to slow the rate of chronic illnesses.
But we know what those needed measures are: higher taxes on tobacco and alcohol, legislating smoke-free workplaces and public spaces, reducing salt intake, promoting physical activity and better diet, screening for high blood pressure and cervical cancer, immunization against hepatitis B and improving access to basic medications (such as diuretics for high blood pressure, which cost pennies).
The World Health Organization estimates that these measures would cost about $1.20 a person a year on a planetary scale. Yet, as it stands, very little foreign aid goes to health care measures (about 3 per cent of the total) and, in these times of economic turmoil, wealthy countries have little interest in spending more.
In fact, according to a report in the Canadian Medical Association Journal, Canada was instrumental in watering down the statement that will emerge from the summit on NCDs – notably calling for the removal of a guarantee of basic health care – because of fears it would increase foreign aid budgets.
That is a short-sighted approach. Continuing as we are will result a social and economic burden we can scarcely imagine.
Of course, we’re all going to die some day. Those who live a long life will invariably succumb to a non-communicable disease.
But the goal here is not to help people live forever. Rather, it is to stave off the ravages of illness and disability as long as possible to ensure a good life before a good death.
The only way to do that successfully is to invest in prevention, to invest in people, not diseases. Billions spent wisely today will save trillions tomorrow.