Le paradoxe des maladies non transmissibles

WELLINGTON – Albert Einstein est notamment célèbre pour sa formule « Tout devrait être rendu aussi simple que possible, mais pas plus simple. » Pourtant, les discussions actuelles sur l’épidémie mondiale des maladies non transmissibles (les MNT : également appelées maladies chroniques, telles que les maladies cardiaques, AVC, diabètes et cancers) semblent ignorer ce conseil. Les décideurs politiques ont jusqu’ici excessivement simplifié cette question, en se concentrant sur la prévalence croissante des MNT – le nombre élevé d’individus atteints de ces maladies – qui, je l’affirme, ne constitue pas le réel problème.

Il est vrai que la quasi-totalité des régions du monde connait actuellement une augmentation de la prévalence des MNT – en partie en raison du fait que, le nombre de décès par lésions et maladies infectieuses aiguës étant en déclin, les populations vivent assez longtemps pour développer ces maladies. Toutefois, les MNT sont en augmentation pour de nombreuses autres raisons démographiques et épidémiologiques – dont la compréhension est porteuse d’implications s’agissant des politiques de santé publique, et même du développement économique.

Dans la majeure partie du monde, les populations sont en croissance et connaissent corrélativement un vieillissement. La prévalence de la plupart des MNT augmente avec l’âge – une conséquence de l'exposition cumulée aux facteurs de risque (notamment les comportements à risque comme le tabagisme, et les facteurs de risque biologiques comme la pression artérielle élevée) pendant toute une vie. Toutes choses étant égales, des populations plus nombreuses et plus âgées impliquent davantage d’individus atteints de MNT.

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