Introduction
80% of global deaths from chronic diseases—mainly cardiovascular disease, cancer, chronic respiratory disease, and diabetes—are in low-income and middle-income countries. Demographic changes in these countries are expected to increase the proportion of deaths attributable to these causes from just over half in 2002 to 61% by 2015.1
The WHO Comparative Risk Assessment project estimated the number of deaths from chronic diseases which could potentially be averted if the distributions of major risk factors were reduced.2 In this and the following paper of the Series, we aimed to assess selected intervention strategies—for which scaled-up coverage can be justified on the basis of sufficient information and evidence3—to see what contribution they could make towards achievement of the goal to reduce rates of mortality from chronic diseases worldwide by an additional 2% per year for the next 10 years.4 We used the WHO's framework for classification of individual and population-based interventions as core, expanded, or optimum (in terms of their effectiveness, cost, acceptability, and feasibility).5 In this paper, we address two population-based strategies: salt reduction and tobacco control. The next paper in this Series assesses interventions for treatment of individuals at high risk of cardiovascular disease.6 Taken together, these population-level and individual-level strategies could be the first elements of a package of chronic disease prevention and control, to which other interventions could be added.
This analysis complements other efforts, including those related to the Millennium Development Goals, to estimate the cumulative financial and health consequences of scaling up coverage for intervention strategies.7, 8 The purpose, methods, and perspective of such analyses are distinct from the economic assessment of the cost-effectiveness of interventions (which aims to identify increased efficiency or best buys across the health sector, and which covers a broader set of potential costs and effects).5, 9 Other research has assessed the cost-effectiveness of salt-reduction and tobacco-control strategies in the context of low-income and middle-income countries, and shown that both are highly efficient uses of societal resources.10, 11, 12, 13
Key messages
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23 countries have 80% of the burden of chronic disease in low-income and middle-income regions of the world
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In these countries, 13·8 million deaths could be averted over 10 years from 2006 to 2015 (8·5 million by a salt-reduction strategy and 5·5 million by implementation of four elements of the WHO Framework Convention on Tobacco Control)
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Most deaths averted would be from cardiovascular diseases (75·6%), followed by deaths from respiratory diseases (15·4%) and cancer (8·7%)
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The cost of implementing these two interventions would be less than US$0·40 per person per year in low-income and lower middle-income countries, and US$0·50–1·00 per person per year in upper middle-income countries (as of 2005)
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Although large absolute numbers of deaths could be averted with these selected interventions, they nevertheless account for only a small fraction of the total burden of chronic disease deaths