When one hears of the term ‘man-made’ disasters, the incidents that instantaneously come to mind are industrial accidents, nuclear disasters, stampedes, fires, and oil spills. No doubt these incidents have caused innumerable loss of lives and environmental damage, however, lifestyle diseases are the leading killers globally. As they are mostly caused by the ‘way we live’, they can be called the biggest man-made disaster. Before we proceed further, let us first understand as to what are lifestyle diseases.
What are lifestyle diseases?
Lifestyle diseases are a new breed of killer diseases that occur as a result of prolonged exposure to a set of similar risk factors. Unlike infectious diseases, they are mostly not caused by any microorganisms, and as such are not contagious. Hence, the World Health Organisation (WHO) has labelled them as noncommunicable diseases (NCD). As most NCDs are chronic – of long duration and slow progression, they are also known as chronic diseases. As the way people live plays an important role in the causation of these diseases, they are also referred to as Lifestyle diseases. Chronic diseases: the silent killers.
Though in the formal text, noncommunicable disease is the preferred term, in practice, the term lifestyle diseases may be preferable. One major advantage of using the term ‘lifestyle diseases’ is that to a layman, the term itself points out the role of ‘lifestyle’ in the causation of these diseases. Since lifestyles are modifiable, its easier to make them understand that these diseases can be prevented by righting lifestyle wrongs. The main types of lifestyle diseases are cardiovascular diseases (disorders of the heart and blood vessels like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease [COPD], and asthma), and diabetes.
Why are lifestyle diseases labelled as man-made disasters?
These diseases are the result of a combination of genetic, physiological, environmental, and behavioural factors. However, behavioural factors play a very major role. Bad lifestyle choices contribute to more than two-thirds of all major lifestyle diseases. The root causes of lifestyle diseases are tobacco use, physical inactivity, unhealthy diet, harmful use of alcohol, and possibly stress. They only require our frenzied, unhealthy way of life, and our exhausted out-of-shape bodies to breed in. Apart from individual behaviours, policies that place economic interests above concerns about the well-being of human lives and the planet that sustains them, are also responsible in equal measure. Thus they aptly qualify to be labelled as ‘man-made’.
What earns them the tag ‘disaster’?
The sheer number of lives they claim and the socioeconomic impact they have has earned them this tag. Lifestyle diseases are the leading killers worldwide. They cause an unacceptable number of people to die prematurely and often after years of needless suffering. According to WHO, lifestyle diseases kill 41 million people each year, equivalent to 71% of all deaths globally. At the turn of the century, lifestyle diseases were not on the public health radar. They were overshadowed by the infectious diseases including HIV, tuberculosis and malaria.
However, with rapidly increasing industrialisation, urbanisation, and globalisation, the transition from infectious to lifestyle diseases took place at a great speed. As per the WHO report, in the year 2005, a total of 35 million people died globally due to lifestyle diseases, the equivalent of 60% of all deaths globally. More worryingly, these diseases are affecting younger people. Each year 15 million people die from lifestyle diseases between the ages of 30 and 69 years; over 85% of these ‘premature’ deaths occur in low- and middle-income countries.
Lifestyle diseases can be labelled as one of the most democratic of all diseases. They affect populations at every income level in every country, but poor suffer the most, the WHO says. Almost three-quarters of all lifestyle disease-related deaths and the majority (85%) of premature deaths (between the ages of 30 and 69 years) occur in low- and middle-income countries, where most of the world’s population lives.
Amongst the major lifestyle diseases, cardiovascular diseases (CVDs) are the number one cause of death globally. As per WHO data, an estimated 17.7 million people died due to CVDs in 2015, representing 31% of all deaths globally. The figure is estimated to go up to almost 23.6 million by 2030. More than 75% of all CVD deaths occur in low- and middle-income countries. Unfortunately, India accounts for almost 60% of all heart disease cases in the world.
The death rate due to CVD has declined significantly in developed countries like the US in the last 15 years. However, it continues to rise in India. The death rate due to CVDs declined by a significant 41% in the US between 1990 and 2016. But in India, it rose by around 34% in the same period. Also, in comparison with the Western population, CVD affects Indians at least a decade earlier and in their most productive midlife years. For example, in the Western population only 23% of CVD deaths occur before the age of 70 years; in India, this number is 52%. Not surprisingly, India has been labelled as the ‘coronary capital’ of the world. While hereditary factors too play a part, 80 to 90% of people dying from heart diseases have one or more risk factors that are influenced by lifestyle and are thus potentially preventable.
As per WHO, Cancer is the second leading cause of death globally. It was responsible for 8.8 million deaths in 2015. Globally, nearly, 1 in 6 deaths is due to cancer. Like CVDs, approximately 70% of deaths from cancer occur in low- and middle-income countries. The number of cases of cancer in India was estimated to be around 14 lakh in 2016. This number is expected to increase to 17.3 lakh by 2020. Cancer deaths in India are also projected to go up from 7.36 lakh to over 8.8 lakh by 2020.
Around one-third of deaths from cancer are due to the 5 leading behavioural and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, and alcohol use. Tobacco use is the most important risk factor for cancer and is responsible for approximately 22% of cancer deaths. Cancer-causing infections, such as hepatitis and human papillomavirus (HPV), are responsible for up to 25% of cancer cases in low- and middle-income countries. All the above causative factors are potentially preventable.
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD), is a progressive life-threatening lung disease that causes breathlessness (initially with exertion) and predisposes to exacerbations and serious illness. According to the Global Burden of Diseases Study, there were approximately 251 million cases of COPD globally in 2016. Globally, it is estimated that 3.17 million deaths were caused by the disease in 2015 (that is 5% of all deaths globally in that year). More than 90% of COPD deaths occur in low- and middle-income countries. The primary cause of COPD is exposure to tobacco smoke (either active smoking or secondhand smoke). Other risk factors include exposure to indoor and outdoor pollution and occupational dust and fumes. Exposure to indoor air pollution can affect the unborn child and represent a risk factor for developing COPD later in life.
The incidence of another major lifestyle disease, diabetes has risen from 108 million in 1980 to 422 million in 2014. In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012. India had an estimated 63 million diabetics in 2013. This number is expected to go up to a whopping 87 million – 8.4% of the country’s adult population, by 2030. No wonder, India has earned the unenviable distinction of being known as the ‘diabetic capital’ of the world.
Socio-Economic impact of lifestyle diseases
The scenario is of great concern. According to a report published by the WHO in the year 2005, lifestyle diseases have a serious socioeconomic impact. These diseases not only cause enormous human suffering, but they also threaten the economy of a country and reduce its development potential. Ironically most of these deaths are occurring early in life, which are the most productive years of life. They cause major adverse effects on the quality of life of affected individuals; cause premature death and create large adverse and underappreciated economic effects on families, communities and societies in general. The costs of ‘diseases of lifestyle’ are diverse: the cost to the individual and to the family of health care and time off work; the cost to the Govt. of health care; and the cost to the country of lost productivity.
According to the WHO report referred to above, countries like China, Russia and India were estimated to forego billions of dollars in national income between 2005-2015 due to heart disease, stroke and diabetes. For China, the estimated accumulated loss during this period was $557.7 billion, for Russia $303.2 billion and for India $236.6 billion. The Harvard School of Public Health carried out a study on economic losses due to lifestyle diseases in India. This study estimated that the economic burden of these ailments for India will be $6.2 trillion for the period 2012-30. This has the potential to threaten India’s march towards being an economically stable nation.
The way forward
With the causes known and highly modifiable, it is really tragic that lifestyle diseases continue to take millions of lives prematurely each year and cause poverty in individuals and families, drawing them into a downward spiral of worsening disease and poverty. There are no specific cures for these lifestyle diseases – they can only be prevented. The best part is that inexpensive and cost-effective means to prevent and treat lifestyle diseases already exist. The major causes of lifestyle diseases are known and if the risk factors are eliminated, at least 80% of all heart diseases, stroke, and type 2 diabetes mellitus would be prevented; over 40% of cancer would be prevented.
Unfortunately, preventive measures are not a major focus of health policy, especially in low- and middle-income countries, which share the maximum burden of these diseases. As highlighted in my earlier post “Holistic Health Approach: Way to Wellness”, we focus only on curative health care interventions. Instead, to deal with this lifestyle disease epidemic, we need to be focusing on prevention and control. Health promotion and behavioural changes – at the level of the individual and the community – are better approaches. In conclusion, following Holistic Health approaches is the way out and one person that can make the most difference is YOU. Rapid commercialisation of the wellness industry.
As I said in my earlier post:
Choose Well to Live Well.