The silent epidemic

Hunger and transmissible diseases were the main problems of low-income countries until only a few years ago. Today, chronic diseases are the most common cause of death worldwide. A global rethinking is needed.

Non-communicable and chronic diseases

A worldwide condition

When the World Community adopted the Millennium Development Goals (MDGs) in 2000, the focus was on mitigating poverty and reducing the deaths from HIV and AIDS, malaria and other communicable diseases. Non-transmissible, chronic diseases such as cardiovascular disease, malignant tumors, chronic respiratory disease or diabetes were typical afflictions of people in the industrialized nations. Accordingly, they were not included in the MDGs.

However, in April 2015, the Secretary General of the World Health Organization (WHO), Dr. Margaret Chan, opened an international high-level meeting in Geneva and said: "The challenges in health have changed dramatically since the beginning of this century. Non-communicable diseases can no longer be considered as a problem of rich countries only." Health statistics are alarming: Today, chronic diseases are the most common cause of death worldwide; they entail about 38 million deaths a year. Almost three quarters of these deaths strike people in low and middle income countries. Many of them are under 70 years old. If the World Community does not react to this, an increase of 15% in these fatalities must be expected by 2020 according to the WHO.

If one considers not only the shortening of lifetime, but also the restriction in the quality of life, the range of the non-transmissible diseases expands. Mental diseases, for example, nowadays contribute significantly to the global burden of disease. In addition, accidents and injuries are increasing worldwide.

Complex causes and economic consequences

The causes of the shift in the global disease spectrum are complex. On the one hand, there are natural reasons: if a population grows and becomes older, chronic diseases are automatically increasing. This means, however, that we no longer only have to ensure that children survive the first five years. They must also be allowed to grow up healthy and to live to a healthy old age.

Globalization and urbanization are also causes of the increase in chronic diseases. In Africa, Asia and South America, the better-off people in cities tend to have an unhealthy lifestyle: highly sweetened or industrially processed foods together with a lack of exercise lead to overweight and increase the risk of contracting type 2 diabetes or cardiovascular diseases. In addition, alcohol and tobacco consumption is increasing in many regions of the world, which leads to a large number of chronic secondary diseases.

On the other hand, the „losers“ of the globalization are affected by  chronic diseases as well: People with low income for example cannot afford a well-balanced diet or a healthy lifestyle and have to work and live under unhealthy conditions.

Chronic diseases are also a financial burden to people living in countries with an inappropriate health system. Like for example 45-year-old Faith from Malawi: She is suffering from type 2 diabetes and therefore regularly has to be examined in the hospital which is 10 km from her home. And she has to pay for her bus ticket as well as for the necessary examinations and medicines herself. Additionally, there is the loss of earnings for the time she cannot go to work. She will also have to bear the cost for possible secondary diseases , such as eye or kidney damages. According to a study by the African Union (2013), the treatment costs of chronic diseases bring about 100 million people per year into poverty.

Chronic diseases also have serious consequences for the global economy. The World Economic Forum published a disturbing forecast in 2011: if chronic diseases continue to increase, the global economy could suffer losses of up to 47 trillion US dollars in the next 20 years. On the other hand, according to WHO calculations, only about 11 billion US dollars per year would be needed for an effective prevention and treatment of these diseases in countries with low and middle income.

New strategies required

The increase in non-transmissible diseases is sometimes referred to as a "silent epidemic". The WHO Member States agreed in 2011 on a "Global plan for the prevention and control of non-communicable diseases for the years 2013 to 2020". According to this, for example, alcohol and tobacco consumption should be reduced by prohibiting advertising. Breastfeeding of infants should be promoted and protected by the suppression of advertising for artificial feeding. And the United Nations Sustainable Development Goals, adopted in September 2015, call for "reduction of deaths from non-communicable diseases by one third by 2030 and promotion of mental health."

However, lasting success requires a broad approach. Good medical care is essential. Employees in the health care sector, especially in primary health care, must be trained in the prevention and treatment of chronic diseases, effective drugs should be available, and new ways of financing the health care system should be sought.

Mental health is becoming more and more an integral part of our Institute’s project work; like for example in Liberia and Sierra Leone, where we are promoting the psychosocial care of Ebola survivors, or in India, where DIFÄM supports suicide prophylaxis in the Duncan hospital catchment area. And in Malawi, mental health is a component of our community based health care projects.


Dr. Beate Jakob
Dr. Beate Jakob Theological Studies Mohlstraße 26 72074 Tübingen Tel. 07071 7049023 Fax: 07071 7049039