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Global Health Thought Leader Uncategorized

The Double-Burden of Disease


Michael Nyenhuis, CEO and President of MAP International

Here is a quandary for those of us in Atlanta, and beyond, focused on improving health in the developing world: while we have been working to tackle the diseases of poverty, the diseases of wealthier countries have sneaked into the same populations we serve.

For instance, we implement large programs to reduce incidence of malaria. Meanwhile, diabetes is a fast-growing problem in those same program areas. We prioritize water/sanitation projects to cut down on diarrheal disease because it is still one of the biggest killers of children under the age of 5. And at the same time, hypertension is threatening to become a major killer in those same countries.

Across the globe, chronic diseases more common in wealthier nations like our own, are quickly becoming more prevalent in developing nations like those in sub-Saharan Africa and elsewhere. To make matters worse, these countries are concurrently suffering from the preventable diseases typical in conditions of extreme poverty.  This is one of the reasons that the World Health Organization focused this year’s World Health Day – marked on April 7th for the anniversary of the founding of WHO in 1948 – on the growing problem of high blood pressure globally.

We all know that high blood pressure – also known as hypertension – increases a variety of health risks, from heart attacks and strokes to kidney failure and blindness. We all know friends and family members treated with diet, exercise and medications for high blood pressure. We may be treated ourselves. Here are a few facts you might not know from the WHO report and a Lancet article on hypertension in the developing world:

  • One in three adults worldwide has high blood pressure.
  • Three-quarters of these adults – 639 million people – live in the developing world.
  • Prevalence of high blood pressure is highest in some low-income countries in Africa, with over 40% of adults in many African countries thought to be affected.
  • Between 1990 and 2020, mortality from heart disease in developing countries is expected to increase 120% for women and 137% for men.

All of that to say high blood pressure is an even bigger problem in some low-income countries than it is here in the U.S. And these are the same countries where people are at risk for malaria, intestinal worms, diseases with names like Dengue fever and Chagas and more.

That is why some call it the double-burden of disease. In addressing this problem, a WHO report says:

“Giving the rapidity with which traditional diets and lifestyles are changing in many developing countries, it is not surprising that food insecurity and undernutrition persist in the same countries where chronic diseases are emerging as a major epidemic. The epidemic of obesity, with its attendant comorbidities – heart disease, hypertension, stroke, and diabetes – is not a problem limited to industrialized countries”

Here in Atlanta, those of us engaged in global health and focusing on the traditional conditions and diseases of poverty, need to begin to consider, and address, this rising second burden – the burden of chronic disease.

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