The Lancet: Chronic Disease Preventable
The current issue of the British medical journal The Lancet has a series of articles on "the neglected epidemic" of chronic disease. One of the central premises of Dr. Fuhrman's work is that many of the most prevelant deadly diseases are preventable with healthy lifestyle choices like stopping smoking, exercising, and eating the healthiest foods. A Lancet article called "Preventing chronic diseases: how many lives can we save?" (by Kathleen Strong, Colin Mathers, Stephen Leeder, and Robert Beaglehole) addresses the entrenched resistance to this approach.
Another more insidious myth about the chronic disease burden is that we can do nothing to prevent these conditions because they are caused by unhealthy behaviours that people choose to have. The reality could hardly be more different. Human behaviour is shaped by many factors, including environment and economic pressures, which with increasingly urbanised populations in low-income and middle-income countries may result in poor diet choices and limited physical activity. Fortunately, many of these diseases are amenable to successful intervention.
The experience of high-income countries clearly shows what can be achieved with sustained interventions. Death rates from heart disease have fallen by up to 70% in the past three decades in Australia, Canada, Japan, the UK, and the USA. Between 1970 and 2000, 14 million deaths due to cardiovascular disease were averted in the USA alone. During the same period, the numbers of deaths averted in Japan and the UK were 8 million and 3 million, respectively. These data correspond to a reduction in chronic disease death rates of 1-3% per year over a 30-year period. Estimates of the joint effects of the leading chronic disease risk factors (tobacco use, raised blood pressure, and poor diet) indicate that more than 30% of the burden of chronic diseases and more than 50% of deaths from chronic disease are attributable to a relatively small number of modifiable risks.