SeriesChronic non-communicable diseases in Brazil: burden and current challenges
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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2023, Brazilian Journal of Anesthesiology (English Edition)Citation Excerpt :This hypothesis is supported by the higher frequency of HBP reported by family members. Our sample showed a higher than expected incidence among Brazilians for DM (versus 5.7% of adults and nearly 18% of elderly Brazilians) and cardiac disorder (versus 3.6% of the Brazilian population).10,15 These data, not previously described in our country, may be a fortuitous association resulting from overweight/obesity present in more than half of our sample, while overweight/obesity is present in 18% of the Brazilian population.16