Intended for healthcare professionals


Managing chronic disease

BMJ 1999; 318 doi: (Published 24 April 1999) Cite this as: BMJ 1999;318:1090

Presents such challenges that the BMJ is devoting a special issue to it

  1. Ronald M Davis (, North American editor.,
  2. Edward H Wagner, Director,
  3. Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington, USA,
  4. Trish Groves, Primary care editor.
  1. BMJ
  2. Sandy MacColl Institute for Healthcare Innovation.
  3. BMJ

    Rapid improvements in health and longevity are dramatically changing the burden of illness throughout the world. In developed countries changes in lifestyle and improvements in the treatment of major causes of mortality have aged the population and increased the prevalence of chronic diseases. Poor countries that have achieved gains in life expectancy are also experiencing an increase in chronic disease as they proceed through the “epidemiological transition”—the changing pattern of health in which they inherit the problems of the rich.1

    The epidemiological transition (now called the “health transition”) has progressed substantially in several developing regions. This is shown clearly in the ratio of disability adjusted life years (DALYs; the number of years lost from premature death plus the years lived with a disability) caused by non-communicable diseases to DALYs caused by communicable, maternal, perinatal, and nutritional conditions (see figure).2 The established market economies and the formerly socialist economies of Europe have essentially completed the transition. Non-communicable diseases already predominate as a cause of DALYs in China and in Latin America and the Caribbean, while “other Asia and islands” and the Middle East are close to that transition point.

    Ratio of disability adjusted life years (DALYs) caused by non-communicable diseases to DALYs caused by communicable, …

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