CANCER CONTROL PLANNING
CANCER CONTROL 2014 17
Assembling the evidence for NCD action
The burden from non-communicable diseases (NCDs), also
called chronic conditions, mainly including cancer,
cardiovascular diseases, stroke, diabetes and chronic
obstructive pulmonary disease, is rapidly increasing globally.
The World Health Organization (WHO) has estimated that, of
the total 57 million deaths worldwide in 2008, two-thirds (36
million) were caused by NCDs, with a further 15% rise to 44
million NCD deaths projected by 2020.1 The largest
proportional increases are predicted in Africa, South-East
Asia and the Eastern Mediterranean region.
With the scale of the burden and its rapid spread globally,
WHO has been raising awareness on the need to place a
higher priority on NCDs. This culminated in the World Health
Assembly on 27 May 2013 during which the Ministers of
Health of 194 countries adopted the Global Action Plan for
Prevention and Control of NCDs.2 WHO has, therefore, the
mandate to coordinate Member States, United Nations (UN)
agencies (including the International Agency for Research on
Cancer [IARC]) and other relevant public and private
stakeholders to address the prevention of NCDs. WHO has
engaged in establishing a set of voluntary global targets,
including a 25% relative reduction of premature mortality
from NCDs by 2025 (Figure 1). The target of a 25% reduction
was chosen because many high-income countries achieved
improvements of that size in premature NCD mortality in the
last decade or two. A Global Monitoring Framework including
25 indicators (Figure 2) has been established to assess
progress in the implementation of national strategies and
plans on NCDs.
The causes of the rising NCD burden
The second part of the twentieth century witnessed
enormous progress in improving health and survival around
the world. Average life expectancy at birth rose from 48 years
in 1950-1955 to 68 years in 2005-2010.3 Increasing
longevity and slow declines in fertility has led to a rapid
growth and ageing of the world's populations, particularly in
low- and middle-income countries. The transformation in the
scale of the NCD burden arises from such demographic, as
well as epidemiologic transitions.
4,5 The control of
malnutrition and pandemics of infection (such as TB and
malaria) has brought about a reduction in deaths from
communicable diseases. That NCDs have displaced
communicable diseases as the major cause of death is also
linked to higher average life expectancy and an increasing
adoption of behaviours often associated with "western"
lifestyles, most notably in countries transiting towards higher
levels of human development. They include a rising
prevalence of smoking, overweight and obesity, and physical
CHRONIC CONDITIONS RISING IN
LOW- AND MIDDLE-INCOME
COUNTRIES: THE CASE OF
CANCER CONTROL
SILVIA FRANCESCHI AND FREDDIE BRAY, INTERNATIONAL AGENCY FOR RESEARCH ON
CANCER, LYON, FRANCE
Non-communicable diseases (NCDs) are increasing, especially in low- and middle-income
countries. The number of new cancer cases is predicted to rise to over 20 million worldwide by
2025. These trends represent major challenges for sustainable development and are now being
tackled by the World Health Organization (WHO) and the International Agency for Research on
Cancer (IARC) through the Global Action Plan against NCDs. Reductions in smoking, alcohol
drinking, obesity and physical inactivity are key prevention strategies for NCDs but some cancerspecific preventive tools, e.g.,
vaccination against HBV and HPV and screening, can also be
extremely effective.