The Non-Communicable Disease Paradox

The current debate about the global epidemic of non-communicable diseases (such as heart disease, stroke, diabetes, and cancer) has tended to focus on their growing prevalence. But measures of poor health are, in fact, declining, even as these diseases' prevalence is increasing.

WELLINGTON – Albert Einstein is reputed to have said that “everything should be made as simple as possible, but not simpler.” Yet the current debate about the global epidemic of non-communicable diseases (NCDs) – chronic diseases such as heart disease, stroke, diabetes, and cancer – has ignored this advice. Policymakers have oversimplified the challenge by focusing on the growing prevalence of NCDs – the sheer number of people with these diseases – which, I argue, is not really the problem.

True, almost all regions of the world are currently experiencing an increase in the prevalence of NCDs – in part because, as deaths from acute infectious diseases and injuries decline, people live long enough to develop these diseases. But NCDs are increasing for many other demographic and epidemiological reasons as well – and understanding these has implications for health policy, and even for economic development.

In much of the world, populations are growing and aging simultaneously. Most NCDs increase in prevalence with age – a consequence of the cumulative exposure to risk factors (including unhealthy behaviors such as tobacco use and biological risk factors such as high blood pressure) over a lifetime. All else being equal, larger and older populations mean more people with NCDs.

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