Chronic diseases: slow-acting, silent killers?

By Marilynn Marchione, The Associated Press
What's killing us? For decades, global health leaders have focused on diseases that can spread - AIDS, tuberculosis, new flu bugs. They pushed for vaccines, better treatments and other ways to control germs that were only a plane ride away from seeding outbreaks anywhere in the world.
Now they are turning to a new set of culprits causing what United Nations Secretary-General Ban Ki- moon calls "a public health emergency in slow motion." This time, germs aren't the target: We are, along with our bad habits like smoking, overeating and too little exercise.
Next week, the U.N. General Assembly will hold its first summit on chronic diseases - cancer, diabetes and heart and lung disease. Those account for nearly two-thirds of deaths worldwide and nearly 9 out of 10 in the United States. They have common risk factors, such as smoking and sedentary lifestyles, and many are preventable.
It's hard to fathom the suffering these maladies are causing in some parts of the world.
Ethiopia, for example, until a few years ago had one cancer specialist, Dr. Bogale Solomon, for more than 80 million people.

"Now three more oncologists have joined," he said, and these four doctors struggle to treat patients in a country where cancer drugs and even painkillers are in short supply.
Wondu Bekele took his 2-year-old son, Mathiwos, to that lone cancer center in Addis Ababa when the boy developed leukemia. The desperate father got advice from St. Jude Children's Research Hospital in the Memphis, Tenn., procured chemotherapy drugs from India, and against all odds, got his son treated. Yet the little boy died because the hospital had no separate ward to protect him from catching disease from other patients. The father founded a cancer society in his son's name and will represent cancer groups at the U.N. meeting.
"Practically all cancer- related medicines are either nonexistent or beyond the reach of ordinary Ethiopians," he said. "We are struggling to make a difference here."
Advocates may be struggling to make a difference at the U.N., too. Key officials have been unable to agree before the meeting on specific goals - reducing certain diseases or risk factors such as smoking by a specific amount and date. With the global economy in turmoil, finding money to meet any goals could be an even bigger hurdle.
"The timing is difficult with the economy the way it is, but it should not prevent us from setting goals," said Dr. Sidney Smith, who heads the World Heart Federation, a group of more than 200 organizations focused on heart disease.
"Many of the things we're proposing cost very little" and some, such as smoking cessation, even save money, said Smith, a cardiologist at the University of North Carolina at Chapel Hill. "We're not talking about trying to find a new magic bullet. We're just talking about behavior and cost-effective medicines" like aspirin and generic blood pressure drugs that lower the risk of multiple diseases, he said.




This is only the second time the U.N. has taken up a health issue. The previous one in 2001 led to creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria, with billions from governments and private groups such as the Bill & Melinda Gates Foundation.
Now even rich nations are cash-strapped, and it's unclear whether private groups will step in.
"Unfortunately, there is a lack of comparable investment in infectious diseases, which disproportionately affect the world's poorest," said a statement from the foundation. "Our priority will continue to be investing in cost-effective treatments that lead to maximum impact and fill in a gap where other resources are not invested."
However, advocates say there are disparities in chronic diseases, too.
"The common belief that cancer is a problem of rich countries is a misconception," said Dr. Eduardo Cazap, president of the Union For International Cancer Control.
Dr. Ala Alwan, assistant director-general of the World Health Organization, agreed.
"Most countries in Africa are currently overwhelmed with their increasing demand" from cancer patients, and the region also has the highest rates of stroke and high blood pressure in the world, Alwan said.
In Ghana, 23 million people are served by two oncology centers; the country has four cancer doctors and no specialist cancer nurses, said Dr. Allen Lichter, CEO of the American Society of Clinical Oncology, an organization of cancer specialists.
Africa also remains the only region in the world where infectious diseases, maternal- infant health problems and poor nutrition still kill more people than noncommunicable diseases do.
Worldwide, stroke and heart-related diseases account for nearly half of all noninfectious disease deaths - 17 million in 2008 alone, the World Health Organization says. Next is cancer, with 7.6 million deaths, followed by respiratory diseases such as emphysema, with 4.2 million deaths. Diabetes caused 1.3 million deaths in 2008, but that's misleading - most diabetics die of cardiovascular causes.