News from The Economist

1. 27 February 20121 / 6
Chronic diseases in developing countries
Growing
pains
Poor countries are
developing the diseases
of the rich, with lethal
consequences
Sep 24th 2011 | KAMPALA AND NEW YORK | from the print
edition
THE Uganda Cancer Institute is on a hilltop with a fine view of
the verdant capital, Kampala. But most of its patients are too ill
to stand. They have spent their life’s savings for a chance of a
cure, but most die within weeks of being admitted. “They come
too late,” says Jackson Orem, the clinic’s director.
Of Ugandans who die of cancer, 96% never see a medical
practitioner. The country’s health-care system was designed to
treat infectious diseases: the institute’s neighbour is a big
tuberculosis unit. Non-communicable diseases such as cancer,
diabetes, and heart and respiratory ailments have not been
priorities. Dr Orem’s institute has the only cancer unit for the
country’s 34m people. Kidney failure (a result of diabetes) is a
death warrant. Uganda has only seven dialysis machines. The
cheapest transplant (in India) costs $40,000.

2. 27 February 20122 / 6
Time was when people in poor countries were too hungry and
hardworking to be obese, could not afford cigarettes and mostly
died before the ailments of ripe middle age kicked in.
Non-communicable diseases were a rich-world problem. Not
any more. Affluence and urbanisation mean new kinds of
unhealthy lifestyles. Developing countries already bear more
than 80% of the burden of chronic illnesses. Their share will
grow—at a time when older diseases are still ravaging the poor.
In India over two-fifths of children under five are malnourished,
yet obesity is mushrooming. The leader of the main opposition
party, Nitin Gadkari, is the latest public figure to be fitted with a
gastric band.
Old and new diseases compound each other. Diabetics are
three times as likely to contract tuberculosis. Burkitt’s lymphoma,
a cancer common in equatorial Africa, is linked to malaria. HIV
patients on antiretroviral treatment are at a higher risk of
developing diabetes and cancer. Two-thirds of Mr Orem’s
cancer patients in Uganda also have HIV. “None of the HIV
resources went to cancer—a very big mistake,” he says. Julio
Frenk, dean of the Harvard School of Public Health, highlights
the contradiction between spending thousands of dollars on
each patient with AIDS but not offering “pennies” for those with
diabetes.

3. 27 February 20123 / 6
The World Health Organisation expects deaths from
non-communicable diseases to rise by 15% between 2010 and
2020, with jumps of over 20% in Africa and South-East Asia.
The number of Chinese diabetics is expected to double by 2025.
Even in sub-Saharan Africa, chronic illnesses are likely to
surpass maternal, child and infectious diseases as the biggest
killer by 2030. Most of them stem from sugar, fat, smoke and
sedentary lifestyles. But they also include sickle-cell disease, a
blood disorder that is the biggest non-communicable killer of
Africa’s children. It is easily treatable, but almost always goes
undiagnosed.
The countries concerned are woefully unprepared. Their
health-care systems are designed for acute problems, not least
because that is what foreign donors pay for. Less than 3% of aid
for health goes to chronic illnesses. Many patients without health
insurance delay treatment until it is too late. Many of the drugs
needed are no longer covered by patents, but tariffs, poor
distribution and high mark-ups still make them costly and scarce.
The demands on health authorities are also greater. The right
jab can protect a child for life, but chronic diseases may require
lifelong medication. A big cause of diabetes is unhealthy
diet—but that stems from a complex overlap between brain

4. 27 February 20124 / 6
chemistry and food-industry practice. Even rich countries find
this hard to change.
A feeble response ensures that
non-communicable diseases kill
people earlier in poor countries than
in rich ones. This has a grave impact
not just on health, but on growth.
According to the World Economic Forum, poor and
middle-income countries will lose $7.3 trillion in output from
heart disease, cancer, diabetes and lung disease by 2025 (see
chart)—an annual loss of about 4%.
So far the world’s response has been to have meetings, most
recently a UN summit in New York on September 19th-20th. The
only other summit devoted to health was on HIV in 2001. A
sense of crisis then brought a decade of dramatic progress.
Heart disease does not arouse the same passion. The meeting
passed a “political declaration”, but could not agree on targets
for reducing non-communicable diseases. The declaration’s
wording on drugs was opaque, reflecting stalled negotiations.

5. 27 February 20125 / 6
With no clear global lead, countries muddle along. Mr Orem’s
institute in Kampala spends most of its money on drugs. He
says a budget rise from $2.5m to $8m would help to train nurses
and improve palliative care. But money is scarce and even the
simplest tasks are tricky. It can take a month for a patient
outside Kampala to get results from a biopsy.
Ala Alwan of the World Heath Organisation suggests that even
simple steps can make a difference, such as reducing salt in
foods, offering inexpensive drugs and raising tobacco taxes.
This last is perhaps the single best way of curbing cancer and
diseases of the heart and lungs, as well as raising money for
health care. But James Sekajugo of the Ugandan health ministry
says it is hard to fight the tobacco industry: “a very rich group
here”. His country is trying to stop cancer before it starts. The
ministry is considering spending more on vaccines against
cervical cancer, one of the most deadly cancers for women.
Some hope to build on arrangements in place for treating HIV
(itself now a chronic condition, not a death sentence). A
programme in western Kenya called AMPATH once treated only
HIV patients. Now it offers care for those with such illnesses as
cancer and diabetes. Its door-to-door screening programme for
HIV now tests for blood pressure and blood sugar. America’s

6. 27 February 20126 / 6
PEPFAR (the President’s Emergency Plan for AIDS Relief), is
trying to fight HIV by boosting broader health care.
The most sustainable efforts will be those that provide care and
make money, too. In India Dr Mohan’s Diabetes Centres, a
business, charges middle-class patients to subsidise care for the
poor. Eli Lilly, an American pharmaceutical giant, is testing
models for diabetes treatment in countries such as India, South
Africa and Brazil (it also provides free insulin to AMPATH in
Kenya). Help now, it reckons, and profit later. Novo Nordisk, the
world’s biggest insulin manufacturer, is especially ambitious. In
China it has given training to doctors and education for diabetics.
Last year the firm controlled 63% of China’s insulin market. Now
Lars Rebien Sorensen, its chief executive, wants to replicate the
programme in Indonesia, Malaysia and Vietnam. Chronic
diseases are already a huge market. Sadly, it is also a growing
one.
from the print edition | International