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Epidemiological Bulletin
      Vol. 16, No. 4
 December 1995  


New Non-Comunicable Diseases Program at PAHO

the Global and Regional Predominance of Non-Comunicable Diseases

Estimates of global and regional cause-of-death patterns reveal that, by 1990, noncommunicable causes had superseded communicable, maternal and perinatal causes in all areas of the world except for Sub-Saharan Africa and the Middle Eastern countries (Table 1). If one includes former injuries among the non-communicable causes of death, then only in Sub-Saharan Africa (SSA) does the former category still dominate the mortality profile. (1) In all but SSA, noncommunicable diseases (NCDs) now dominate the age-specific mortality profile in all age groups over 14 years.


Table 1
Distribution of Deaths from Three Groups of Causes, by Region, 1990

  Number of Deaths (x1,000) Attributed to:  


Regiona		 I. Communicable,
Maternal and
Perinatal Causes		 II. Non-
Communicable
Causes

III. Injuries
Total,
all Causes
EME
FSE
CHN
LAC
OAI
MEC
IND
SSA		 439 (6.2)b
136 (3.6)
1,343 (15.1)
966 (32.3)
2,306 (41.8)
2,026 (46.2)
4,060 (43.3)
5,415 (68.2)		 6,238 (87.6)
3,264 (86.8)
6,519 (73.4)
1,733 (57.9)
2,736 (49.6)
1,966 (44.8)
4,700 (50.2)
1,898 (23.9)		 445 (6.2)
362 (9.6)
1,023 (11.5)
293 (9.8)
477 (8.6)
392 (8.9)
611 (6.5)
624 (7.9)		 7,121
3,762
8,885
2,992
5,519
4,384
9,371
7,937
World 16,690 (33.4) 29,055 (58.1) 4,227 (8.5) 49,971

        a. EME, Established Market Economies; FSE, Former Socialist Economies; CHN, China; LAC, Latin America and the Caribbean; OAI, Other Asia and Islands; MEC, Middle Eastern Crescent; IND, India; SSA, Sub-Saharan Africa.

        b. Figures in parentheses are percentages of deaths from all causes.

        Source: Murray CJL, Lopez AD: page 27, Table 2. Reference 1.

In Latin America and the Caribbean (LAC), estimated mortality from all causes in 1990 (in thousands) was 2,992. Of this, communicable, maternal and perinatal causes accounted for 966 (32.3%) and injuries for 293 (9.8%), while NCDs accounted for 1733 (57.9%). Within the NCD category, cardiovascular disease accounted for 786.7 (45.4%), malignant neoplasms 341.0 (19.7%), and diabetes mellitus 85.2 (4.9%).

The impact of morbidity from these cause groups has also been estimated for 1990 in terms of disability adjusted life years (DALYs). NCDs also dominate on this measure in LAC, accounting for 54.2% of the impact, followed by the communicable, maternal and perinatal cause group at 28.1% and injuries at 17.7% (Table 2).

Table 2
Percentage Distribution of YLDa According to Region, by Broad
Cause Group, 1990

  Cause Groupb  

Region c
I
II
III		 All
Causes
EME
FSE
CHN
LACd
OAI
MEC
IND
SSA		 0.9
0.4
4.1
2.7(28.1)
3.9
2.4
5.3
6.3		 8.0
4.1
12.1
5.2 (54.2)
8.0
5.7
12.2
6.1		 0.7
0.5
2.2
1.7 (17.7)
1.6
1.7
2.2
2.0		 9.6
5.0
18.4
9.6
13.6
9.8
19.7
14.4
All Regions 26.0 61.4 12.6 100.0

a. YLD are expressed as a percent of the global YLD. They refer to DALYs due to years of life lived with a disability.

b. Group I = Communicable, maternal and perinatal causes
Group II = Non-communicable causes
Group III = Injuries and poisonings

c. EME, Established Market Economies; FSE, Former Socialist Economies; CHN, China; LAC, Latin America and the Caribbean; OAI, Other Asia and Islands; MEC, Middle Eastern Crescent; IND, India; SSA, Sub-Saharan Africa.

d. Figures within parentheses refer to within-row percentages for LAC only.

Source: Adapted from Murray CJL, Lopez AD, page 61, Table 4. Reference 1.

Unlike Canada and the United States, where reductions on the order of 15% in the proportional mortality from diseases of the circulatory system were seen during the period 1980-90, many countries in LAC experienced an increase attributable to this cause group (2). Individual trends for selected countries are presented in Table 3.


Table 3
Proportional Mortality from Diseases of the Circulatory System
(% Based on Deaths from Defined Causes), Selected Countries, 1980 and 1990

Country 1980 1990
Argentina
Belize
Brazil
Canada
Chile
Colombia
Costa Rica
Cuba
Dominican Republic
Ecuador
El Salvador
Mexico
Panama
Paraguay
Peru
Puerto Rico
Suriname
Trinidad and Tobago
United States
Uruguay
Venezuela		 46.6
29.7
32.1
47.6
29.4
27.4
27.6
43.4
23.9
14.9
8.5
17.6
27.8
30.3
11.8
40.5
31.8
45.9
50.6
44.1
27.3		 46.4
24.7
34.4
40.1
29.0
30.9
28.9
43.5
27.2
20.7
20.6
20.3
29.3
36.9
19.4
34.0
33.5
38.4
43.3
41.4
29.3

Source: Adapted from Health Conditions in the Americas, 1994 Edition. Table 39, page 219, Reference 2.

The impact of cancer throughout the Americas has greatly increased (by 73% overall from the early 1960s to the late 1980s) as shown in a recent 25-year analysis (Table 4) (2).


Table 4
Estimated Annual Deaths from Malignant Neoplasms,
in the Americas, 1960-1964 and 1985-1989

Year Total Men Women
Region of the Americas
  1960-1964
  1985-1989

North America
  1960-1964
  1985-1989

Latin America and the Caribbean
  1960-1964
  1985-1989

 
520,000
900,000

 
315,000
540,000

 
205,000
630,000

  
270,000
470,000

 
170,000
290,000

 
100,000
180,000

  
250,000
430,000

 
145,000
250,000

 
105,000
180,000

Source: Health Conditions in the Americas, 1994 Edition, Table 48, page 230, Reference 2.

Proportional mortality from this cause group has increased in virtually every country, as illustrated in Table 5. Proportional mortality from external causes also increased in virtually all countries (see Table 6) (2).


Table 5
Proportional Mortality from Malignant Neoplasms
(% Based on Deaths from Defined Causes),
Selected Countries, 1960-1964 and 1985-1989

Country 1960-1964 1985-1989
Argentina
Barbados
Belize
Canada
Chile
Colombia
Costa Rica
Cuba
Dominica
Dominican Republic
Ecuador
Grenada
Jamaica
Martinique
Mexico
Nicaragua
Panama
Paraguay
Peru
Puerto Rico
Saint Vincent and the Grenadines
Suriname
Trinidad and Tobago
United States
Uruguay
Venezuela		 20.6
11.9
7.6
17.3
11.5
6.1
12.8
16.0
6.2
3.8
3.6
9.7
10.8
11.0
4.2
3.7
8.5
9.2
5.9
14.9
5.6
9.2
8.7
16.3
22.0
10.7		 18.7
19.5
9.0
26.9
19.9
13.4
21.2
19.5
18.2
8.9
11.2
13.1
17.5
22.9
10.2
7.0
15.3
10.4
12.5
15.9
13.2
11.1
13.2
23.1
24.7
13.8

Source: Adapted from Health Conditions in the Americas, 1994 Edition. Table 46, page 228. Reference 2.

Table 6
Trends in Proportional Mortality from External Causes
(% Based on Deaths from Defined Causes),
Selected Countries, 1960-1964 and 1985-1989

  Period
Country 1960-1964 1985-1989
Argentina
Barbados
Belize
Canada
Chile
Colombia
Costa Rica
Cuba
Dominica
Dominican Republic
Ecuador
Jamaica
Martinique
Mexico
Panama
Paraguay
Puerto Rico
Saint Lucia
Saint Vincent and the Grenadines
Suriname
Trinidad and Tobago
United States
Uruguay
Venezuela		 8.2
3.0
4.2
8.2
7.9
8.7
5.7
7.4
1.8
4.7
6.2
4.5
6.7
7.8
8.4
7.3
8.5
3.2
0.9
8.2
6.1
7.3
6.4
11.1		 6.9
4.8
12.1
7.5
13.3
22.5
11.4
11.9
5.8
9.1
14.2
3.3
9.0
15.5
13.7
8.7
9.2
7.9
7.3
12.6
8.6
7.2
6.4
15.8

Source: Adapted from Health Conditions in the Americas, 1994 Edition. Table 31, page 206, Reference 2.

Much of the mortality, morbidity, and socio-economic impact of these and other non-communicable conditions is preventable through lifestyle modification and specific interventions.

Establishment of a PAHO Program for Non-communicable Diseases

In recognition of the predominance of NCDs among causes of morbidity and mortality throughout the Americas, the Director of PAHO, early in 1995, established a new technical cooperation program. This is in addition to other activities relevant to noncommunicable diseases (e.g. healthy lifestyles, food and nutrition) which remain active elsewhere in the Organization, most notably in the Division of Health Promotion and Protection.

The new Non-Communicable Disease Program (HCN) is located within the Division of Disease Prevention and Control (HCP), and has a staff complement of three professional and two support posts. The program has a mandate to strengthen the capacity of the organization in support of specific prevention and control initiatives in member countries.

During the first few months, much effort was devoted to planning and consultation in order to clarify the role and modus operandi of the program. A limited number of priorities were selected for the coming biennium (1995-97), key internal relationships have been identified, and a method of working defined. A team approach will be emphasized.

Initial priorities include surveillance of disease impact, risk factor intervention (with emphasis on cardiovascular disease), cervical cancer prevention, cancer registry development, diabetes initiatives, and support for injury prevention.

The program will place emphasis on technical capacity building, including support for demonstration projects within countries. It will work in consultation and interprogrammatic collaboration with other technical programs, in the interests of integrating non-communicable disease prevention and control within the context of primary health care.

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Envoi

The following quotation from Murray and Lopez (1994) sums up the situation. "While recognizing the need for continued vigilance over communicable, maternal and perinatal mortality, it is important to realize that globally the non-communicable diseases have already emerged as the leading causes of death in developing regions. Even in poor countries, the epidemiological transition is under way with profound implications on the demand for health care to address the burden of chronic diseases. Moreover, with a number of cost-effective interventions targeted to communicable disease mortality in children, it is reasonable to expect the proportion of mortality due to noncommunicable diseases to increase. At present the risk of death from non-communicable diseases during adulthood (15-60) years is considerably higher in the developing world than in the Established Market Economies, suggesting that the future, in effect, has already arrived.

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Reference

  1. Murray CJL, Lopez AD (eds). Global Comparative assessments in the Health Sector. World Health Organization, Geneva 1994.

  2. Pan American Health Organization. Health Conditions in the Americas, 1994 Edition. Volume I. Washington, DC: PAHO; 1994. (Scientific Publication No. 549).

Source: Non-Communicable Diseases Program, Division of Disease Prevention and Control, HCP/HCN, PAHO.


Health Situation in the Americas
Basic Indicators, 1995

Selected Indicators of Mortality
Country IMR 5MR MMR
Anguila
Antigua y Bermuda
Argentina
Aruba
Bahamas
Barbados

Belize
Bermuda
Bolivia
Brazil
Canada
Cayman Islands

Chile
Colombia
Costa Rica
Cuba
Dominica
Dominican Republic

Ecuador
El Salvador
French Guiana
Grenada
Guadeloupe
Guatemala

Guyana
Haiti
Honduras
Jamaica
Martinique
Mexico

Montserrat
Netherlands Antilles
Nicaragua
Panama
Paraguay
Peru

Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Suriname
Trinidad and Tobago

Turks and Caicos Islands
United States
Uruguay
Venezuela
Virgin Islands (UK)
Virgen Islands (US)

 26
19
26
8
19
16

36
13
74
57
7
8

12
32
12
10
14
48

44
43
20
20
11
51

46
98
44
17
10
30

12
15
53
21
42
59

12
27
19
18
31
17

19
8
19
26
20
13

 34
23
30
10
21
19

46
15
100
67
8
10

17
42
14
12
18
62

62
56
23
25
13
81

62
128
73
23
12
37

15
18
64
27
56
83

14
32
23
23
40
22

22
10
22
31
23
15

 ..
...
52
...
21
20

147
...
247
140
3
8

34
140
40
32
...
90

120
140
...
...
...
220

180
457
220
115
...
45

...
...
150
60
235
261

...
...
...
6
31
49

...
8
38
63
...
...

Note: Data extracted from the brochure "Health Situation in the Americas. BASIC INDICATORS 1995". (PAHO/HDP/sha/95.3).

... Data not available

IMR: Infant mortality rate (1994) (per 1,000 live births)
MR5: Under 5 years mortality rate (1994) (per 1,000 live births)
MM5: Maternal mortality rate (latest year available between 1987-1993 (per 100,00 live births)

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