Elsevier

The Lancet

Volume 377, Issue 9781, 4–10 June 2011, Pages 1949-1961
The Lancet

Series
Chronic non-communicable diseases in Brazil: burden and current challenges

https://doi.org/10.1016/S0140-6736(11)60135-9Get rights and content

Summary

Non-communicable diseases (NCDs) have become a major health priority in Brazil—72% of all deaths were attributable to NCDs in 2007. They are also the main source of disease burden, with neuropsychiatric disorders being the single largest contributor. Morbidity and mortality due to NCDs are greatest in the poor population. Although the crude NCD mortality increased 5% between 1996 and 2007, age-standardised mortality declined by 20%. Declines were primarily for cardiovascular and chronic respiratory diseases, in association with the successful implementation of health policies that lead to decreases in smoking and the expansion of access to primary health care. Of note, however, the prevalence of diabetes and hypertension is rising in parallel with that of excess weight; these increases are associated with unfavourable changes of diet and physical activity. Brazil has implemented major policies for the prevention of NCDs, and its age-adjusted NCD mortality is falling by 1·8% per year. However, the unfavourable trends for most major risk factors pose an enormous challenge and call for additional and timely action and policies, especially those of a legislative and regulatory nature and those providing cost-effective chronic care for individuals affected by NCDs.

Introduction

Chronic non-communicable diseases (NCDs) are a global health problem and a threat to human health and development. The burden of these diseases falls mainly on low-income and middle-income countries.1 Leading scientists2 and WHO3 have raised a call to action, as effective interventions are available,4 which define strategies to be taken. The United Nations is convening a high-level meeting of the General Assembly in September, 2011, on the prevention and control of NCDs.5 To contribute to the preparation of this meeting, The Lancet Series of papers was launched in November, 2010,6 in which 23 countries, including Brazil, were assessed with respect to NCD burden and national capacity to respond to the NCD challenge.7 A comprehensive and critical view of the NCD scenario in Brazil, a large middle-income country, is thus timely.

Section snippets

The burden of chronic NCDs

In 2007, about 72% of all deaths in Brazil were attributable to NCDs (cardiovascular diseases, chronic respiratory diseases, diabetes, cancer, and others, including renal diseases), 10% to infectious or parasitic diseases, and 5% to maternal and child health disorders. This distribution contrasts with that of 1930, when infectious diseases accounted for 46% of all deaths in Brazilian state capitals.8 As addressed in greater detail elsewhere in this Series,9 this radical change happened within

Key NCDs and their shared risk factors

The WHO 2008–13 action plan for NCDs3 focuses on four NCDs (cardiovascular diseases, diabetes, cancer, and chronic respiratory disease) and their four shared risk factors (tobacco use, physical inactivity, unhealthy diets, and harmful use of alcohol).4 These four NCDs accounted for 58% of all deaths in Brazil in 2007 and are, along with neuropsychiatric disorders, the main causes of disease burden.21

Rapid population ageing

Brazil has one of the fastest ageing populations in the world.96, 97 Most of today's older Brazilian adults were born in rural areas, but now live in large urban centres; have endured significant socioeconomic adversity throughout their lives; have received little or no formal education; and worked in poorly paid unskilled occupations.98 Moreover, changes such as smaller families and more women in the paid workforce have reduced families' ability to provide support and health care for elderly

Successes and failures of prevention policies

Although various initiatives for the prevention and control of NCDs had been adopted over the past two or three decades, after the resolution of the 53rd World Health Assembly100 Brazil has progressively implemented a comprehensive plan of action and a surveillance system for NCDs and their risk factors (panel 2).

The challenge

The fall in age-adjusted NCD mortality of about 2% per year from 1996 to 2007 is a great achievement, even though rates for diabetes and for certain types of cancer are rising. The goal of reducing NCD mortality by 2% per year over and above existing trends, as has been recommended,1, 123 effectively requires a doubling of Brazil's current rate of decline—an enormous challenge. First, since trends for key diseases and risk factors are not favourable. Second, given the ascending obesity

Conclusions and recommendations

NCDs are quickly becoming the main public health priority in Brazil, and policies for their prevention and control have been implemented. Although formal assessment is often lacking, the SUS has made major strides, among them the implementation of very cost-effective interventions such as tobacco control and the widespread delivery of drugs to those at high risk of cardiovascular diseases. However, much more, can be done.2, 4, 125

The priority and political support for preventing NCDs124 needs

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