Chronic diseases account for a large proportion of the global burden of disease and are the major cause of death in almost all countries. It is estimated that diabetes, cardiovascular disease, cancer and other chronic, noncommunicable diseases caused 35 million deaths in 2005. Total deaths from infectious diseases, maternal and perinatal conditions and nutritional deficiencies are projected to decline by 3% by 2015. At the same time, deaths due to chronic diseases are projected to increase by 17%. According to the recent report from the World Health Organization, Preventing Chronic Disease: a vital investment, each year at least 4.9 million people die as a result of tobacco use, 2.6 million people die as a result of being overweight or obese, 4.4 million die as a result of raised total cholesterol levels and 7.1 million die as a result of raised blood pressure.

The same report stresses that common and modifiable risk factors that underlie the major chronic diseases are widespread, and that the global response to address them is inadequate. The inadequate response is in large part due to misconceptions regarding the major chronic diseases and their shared risk factors. Chronic diseases do not affect only rich people. In all but the least-developed countries, poor people are more likely to develop chronic diseases and more likely to die from them. Chronic diseases are increasingly affecting younger people. Childhood obesity is a growing problem even in poor countries and the incidence of type 2 diabetes in children and adolescents is increasing.

Although we have been extremely vigilant towards the spread of infectious diseases, such as SARS and avian influenza in recent years, we have failed to keep in check the ‘silent killers’ like diabetes, cardiovascular disease and cancer. These are widely perceived to be the result of voluntary choice of an unhealthy lifestyle. However, the choice of lifestyle is very limited among the young and the poor, and government action is needed to improve every person’s access to a healthy life.

The world has also been slow to recognize that there are interventions that have been proven cost-effective in chronic disease prevention and control. Many of these interventions are feasible and inexpensive, even in the poorest countries. The World Health Organization is developing a framework for assisting diverse countries in developing, implementing and evaluating national policies and programmes for the prevention and control of chronic diseases. It supports an integrated, comprehensive, stepwise and multisectoral approach focused on the common risk factors. An integrated approach to public health prevention and control of chronic disease is necessary to achieve the global goal of reducing death rates by 2 % per year over the next 10 years; achievement of this goal will prevent 36 million premature deaths by 2015.

Diabetes presents major challenges to patients, health systems and national economies. The World Health Organization together with the International Diabetes Federation is working to raise awareness of diabetes worldwide along with improving the quality of care. This latest edition of the Diabetes Atlas is a welcome update of the trends in the global burden of diabetes and its related economic implications. It also spotlights recently-documented dimensions of the disease — such as the increase in diabetes in children and the often underestimated mortality attributable to diabetes. I am confident that the Diabetes Atlas will continue to be a valuable resource for advocates, policy-makers, researchers and healthcare providers.


Robert Beaglehole
Director
Department of Chronic Diseases and Health Promotion
Noncommunicable Diseases and Mental Health Cluster
World Health Organization
Geneva