Chronic Diseases in Developing Countries

The Economist — 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.

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. (Read Full Article)

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