Systems and Capacity to Address Noncommunicable Diseases in Low- and Middle-Income Countries
Science Translational Medicine
HEALTH DISPARITIES ACROSS THE WORLD Chronic noncommunicable diseases (NCDs)-such as cardiovascular disease (CVD), diabetes, cancer, and chronic respiratory diseases-threaten the health and economies of individuals and populations worldwide. NCDs account for 65% of deaths globally, and 80% of these occur in low-and middle-income countries (LMICs) (1, 2). T e 25-to 64-year-old age group in LMICsthose in the prime economically productive years of life-bear the greatest morbidity and mortality,
... and mortality, perpetuating productivity losses, poverty, and stif ed development (3). As an example, 26.1% of coronary heart disease deaths in Mexico (4) and 35% of CVD-related deaths in India (5) occur in persons under 65 years of age; this contrasts starkly with the United States, where only 12% of CVDrelated deaths occur in this age range. Cancer transitions of er another example of disparities between country-income groups. Over the period from 1980 to 2010, incidence and mortality related to cervical cancer-a largely preventable malignancy-increased by 24 and 19% in LMICs, respectively, whereas high-income countries (HICs) experienced a 30% decrease for both. Similarly, over the same period, breast cancer incidence and mortality increased in LMICs by 60 and 53%, HEALTH POLICY Noncommunicable diseases (NCDs) are increasingly getting attention from dif erent forums, including media outlets, health agencies, and the public and private sectors. Progress is being made in addressing NCDs, though more slowly in low-and middle-income countries (LMICs) as compared with high-income settings. Here, we of er an analysis of the challenges faced in LMICs. We discuss realistic strategies to understand and develop capacity needs (workforce, f nances, and infrastructure) and systems (institutions and processes) to sustainably optimize NCD prevention and care in LMICs. by guest on July 21, 2018 Systems and capacity to address global chronic diseases in low-and middle-income countries.