Why a global strategy on diet, physical activity and health? The growing burden of non-communicable diseases

In January this year, the World Health Organization’s (WHO) Executive Board agreed to forward the WHO Global Strategy on Diet, Physical Activity and Health to its World Health Assembly, after allowing countries an extended period until February 29 for comments. A final draft strategy will be considered by WHO member states this May. The strategy is an important global public health initiative, which was prompted by member states’ concern at the explosion in non-communicable diseases (NCDs), for which unhealthy diet and physical inactivity are, together with tobacco use, among the key risk factors. World health is in transition. Epidemiologically, many lowand middle-income countries all over the world now face a double burden of disease, whereby – in addition to infectious diseases – they are facing a growing toll of death and disability from NCDs. The world’s population is ageing, while increased development has been accompanied by rising disposable incomes, urbanisation, mechanisation and globalisation of food markets, leading to lifestyle and behaviour changes that adversely impact on population health. These lifestyle changes include dietary changes (nutrition transition), reduced physical activity levels and increased tobacco use. The result of these changes is that NCDs are increasing at alarming rates globally. The burden of NCDs in developing countries already outweighs that of communicable diseases, both in highand low-income countries. In 2002, NCDs accounted for 60% of total mortality worldwide and 46% of the global burden of disease. Lowand middle-income countries account for the increased burden of disease from NCDs. One example comes from China. In China’s rural areas – and that’s still more than 800 million people – NCDs account for more than 80% of deaths; communicable diseases, less than 3%. Only in Africa do deaths from communicable diseases outweigh those from NCDs: in WHO’s other five regions, NCDs now dominate. Of the estimated 57 million deaths which occur each year, 33.4 million are attributed to NCDs. Of these, 16.7 million are attributed to cardiovascular diseases (CVDs), especially ischaemic heart disease and cerebrovascular diseases. Twice as many people die from CVDs in developing countries than in developed countries. Obesity is now a global epidemic. Globally, there are more than 1 billion overweight people and at least 300 million of them are clinically obese. Close to 800 million people are suffering from undernutrition, a slow decline over the past decade. The number of people with diabetes is expected to increase threefold by 2020, and most of this growth is projected to occur in Asia. In India alone there are currently close to 33 million diabetics.