The Health Transition

In the health transition, accompanying demographic ageing, non-communicable diseases (NCD) assume a progressively greater significance in low and middle income countries (LAMIC). NCDs are already the leading cause of death in all world regions apart from sub-Saharan Africa. Of the 35 million deaths in 2005 from NCDs, 80% will have been in LAMIC (1). This is partly because most of the world's older people live in these regions - 60% now rising to 80% by 2050. However, changing patterns of risk exposure also contribute. Latin America exemplifies the third stage of health transition. As life expectancy improves, and high fat diets, cigarette smoking and sedentary lifestyles become more common, so CVDs have maximum public health salience - more so than in stage 2 regions (China and India) where risk exposure is not yet so elevated, and in stage 4 regions (Europe) where public health measures have reduced exposure levels (2). The INTERHEART cross-national case-control study suggests that risk factors for myocardial infarction operate equivalently in all world regions, including Latin America and China (3).

1. Fuster V, Voute J. MDGs: chronic diseases are not on the agenda. Lancet 2005 Oct 29;366:1512-1514.
   
   
2. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. [Review]. Circulation 2001 Nov 27;104:2746-2753.
   
   
3. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.[see comment]. Lancet 2004 Sep 11;364:937-952.