Reducing or curbing just six modifiable risk factors -- tobacco use, harmful alcohol use, salt intake, high blood pressure and blood sugar, and obesity -- to globally-agreed target levels could prevent more than 37 million premature deaths over 15 years, from the four main non-communicable diseases (NCDs): cardiovascular diseases, chronic respiratory disease, cancers, and diabetes, according to new research published in The Lancet.
Worryingly, the findings indicate that not reaching these targets would result in 38.8 million deaths in 2025 from the four main NCDs, 10.5 million deaths more than the 28.3 million who died in 2010.
This is the first study to analyse the impact that reducing globally targeted risk factors will have on the UN's 25x25 target to reduce premature deaths from NCDs by 25% relative to 2010 levels by 2025.
Using country-level data on deaths and risk factors and epidemiological models, Professor Majid Ezzati from Imperial College London, UK, and colleagues estimate the number of deaths that could be prevented between 2010 and 2025 by reducing the burden of each of the six risk factors to globally-agreed target levels -- tobacco use (30% reduction and a more ambitious 50% reduction), alcohol use (10% reduction), salt intake (30% reduction), high blood pressure (25% reduction), and halting the rise in the prevalence of obesity and diabetes.
Overall, the findings suggest that meeting the targets for all six risk factors would reduce the risk of dying prematurely from the four main NCDs by 22% in men and 19% for women in 2025 compared to what they were in 2010. Worldwide, this improvement is equivalent to delaying or preventing at least 16 million deaths in people aged 30-70 years and 21 million in those aged 70 years or older over 15 years.
The authors predict that the largest benefits will come from reducing high blood pressure and tobacco use. They calculate that a more ambitious 50% reduction in prevalence of smoking by 2025, rather than the current target of 30%, would reduce the risk of dying prematurely by more than 24% in men and by 20% in women.
According to Professor Ezzati, "Our findings show that achieving risk factor targets will make an essential contribution to achieving the 25Χ25 mortality target by accelerating the decreasing trends in mortality from cardiovascular diseases and chronic respiratory diseases, lowering mortality from lung and stomach cancers, and reversing the rising trend in diabetes mortality. Most of the benefits will be seen in low-income and middle-income countries where as many as 31 million deaths could be prevented."
Writing in a linked Comment, Professor Rifat Atun from Harvard School of Public Health, Harvard University, Boston, MA, USA says, "With political will and leadership, the 25Χ25 targets are well within reach. But despite robust evidence, well-proven cost-effective interventions, and a compelling case for action made by [this study] to address risk factors for NCDs to save millions of lives, political apathy prevails. Even with much discourse, meaningful and durable action against NCDs is scarce, with little accountability to achieve the promises made and the targets set at the General Assembly in 2011. Such apathy is shown in the unacceptably low levels of overseas assistance for health allocated for NCDs, which in 2011 was a paltry $377 million, out of a total of about $31 billion of development assistance for health in 2011, despite NCDs accounting for 50% of the disease burden in low-income and middle-income countries. None of the innovative financing, which has helped so much to tackle HIV, malaria, tuberculosis, vaccine preventable diseases in children, and more recently maternal health is targeted at NCDs."
He adds, "The challenge of NCDs is less technical than political -- 25Χ25 targets can be reached to achieve grand convergence and pave the way for sustainable development. The HIV response and more recently the maternal and child health movement have shown us what is possible when there is political will, global leadership, and a mobilised civil society. The World Health Assembly and the United Nations have the opportunity to drive for coordinated global action and establish independent global and national accountability mechanisms to tackle NCDs. The moment for decisive action has come."
- Vasilis Kontis, Colin D Mathers, Jόrgen Rehm, Gretchen A Stevens, Kevin D Shield, Ruth Bonita, Leanne M Riley, Vladimir Poznyak, Robert Beaglehole, Majid Ezzati. Contribution of six risk factors to achieving the 25Χ25 non-communicable disease mortality reduction target: a modelling study. The Lancet, 2014; DOI: 10.1016/S0140-6736(14)60616-4
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