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# WHO lists “best buys” for cutting deaths from non-communicable disease

BMJ 2011; 342 (Published 27 April 2011) Cite this as: BMJ 2011;342:d2648
1. John Zarocostas
1. 1Geneva

Non-communicable diseases, the leading causes of death worldwide, are projected to significantly rise further in prevalence in the coming decades without cost effective interventions such as reducing risk factors, early detection, and timely treatment, says a report from the World Health Organization.

The agency says that non-communicable diseases—primarily cardiovascular illnesses, diabetes, cancers, and chronic respiratory diseases—caused 63% of the 57 million deaths in 2008. Nearly 80% of these deaths were in low and middle income countries. Ala Alwan, WHO’s assistant director general for non-communicable diseases and mental health, said, “Without action the NCD [non-communicable diseases] epidemic is projected to kill 52 million people annually by 2030.”

The report asserts that the global epidemic of non-communicable diseases “can be reversed through modest investments in effective population-wide approaches.” It says that a large proportion of non-communicable diseases can be prevented by reducing major risk factors such as tobacco use, physical inactivity, misuse of alcohol, and unhealthy diet.

Many interventions may be cost effective, it says, but some are considered “best buys”: those that should be implemented immediately “to produce accelerated results in terms of lives saved, diseases prevented, and heavy costs avoided.”

Margaret Chan, WHO’s director general, says in a foreword to the report that these best buys “are known to be effective, feasible, and affordable in any resource setting.”

The best buys identified by the report include tobacco control measures, such as banning smoking in public places, enforcing bans on tobacco advertising and sponsorship, and raising taxes on tobacco products. Other best buys include enforcing advertising bans and raising taxes on alcohol, reducing salt intake, replacing trans fats in food with polyunsaturated fat, and promoting public awareness about diet and physical activity.

One study of the effect of tobacco price increases and bans in 23 countries estimated that 5.5 million deaths could be avoided at a cost of less than $0.40 per person in low and lower middle income countries and between$0.05 and \$1.00 in upper middle income countries.

Similarly, it says, enough evidence exists on the link between salt intake and raised blood pressure, a major cause of mortality, to make salt reduction a best buy prevention. In 2008 the overall global prevalence of high blood pressure in adults aged 25 years or over was estimated at around 40%.

Studies have shown that if salt consumption were reduced to the recommended level (no more than 6 g a day) as many as 2.5 million deaths could be prevented each year. The report says that countries with salt reduction initiatives such as France, Japan, and the United Kingdom have achieved positive results.

Cutting the marketing to children of foods and non-alcoholic beverages that are high in salts, fats, and sugar is also a cost effective action.

Vaccination against hepatitis B, a major cause of liver cancer, and against human papillomavirus, the main cause of cervical cancer, are also recommended, as is screening for breast and cervical cancer.

Dr Chan said that primary healthcare is clearly identified “as the best framework” for implementing recommended interventions on an adequate scale. “Current evidence unequivocally demonstrates that non-communicable diseases are largely preventable. These diseases can be effectively treated and controlled. We can turn the tide.”

## Notes

Cite this as: BMJ 2011;342:d2648

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