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Percentages of deaths by broad cause and age for high, middle

and low income countries
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Non-communicable diseases:
• Cardiovascular diseases
• Cancers
• Endocrine conditions, such as diabetes
• Neuropsychiatric disorders, which includes
alcohol and drug use disorders

Percentages of deaths by broad cause and age for high, middle

and low income countries
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Almost three quarters occur in

low- and middle-income
countries
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Almost three quarters occur in

low- and middle-income
countries

16 mil occur before the age of 70; 82% (13 mil) of these "premature" deaths
occurred in low- and middle-income countries
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These 4 groups of diseases

account for 82% of all NCD
deaths.
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Probability of dying from the four main non-communicable diseases between
the ages of 30 and 70 years, comparable estimates, 2012
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Probability of dying from the four main non-communicable diseases between
the ages of 30 and 70 years, comparable estimates, 2012
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Top 10 causes of
death (Indonesia)

Stroke was the leading

cause of death, killing
328.5 thousand
people in 2012
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(Indonesia)
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multicausation disease model

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Risk factors
Modifiable behavioral risk factors Metabolic/physiological risk factors

Tobacco use, physical inactivity, unhealthy diet and the

harmful use of alcohol increase the risk of NCDs.
• Tobacco: 6 mil deaths every year (including from the effects of
exposure to second-hand smoke), and is projected to increase
to 8 mil by 2030.
• Insufficient Physical activity: about 3.2 mil deaths annually
• More than half of the 3.3 mil annual deaths from harmful
drinking are from NCDs .
• In 2010, 1.7 mil annual deaths from cardiovascular causes have
been attributed to excess salt/sodium intake.
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Risk factors
Modifiable behavioral risk factors Metabolic/physiological risk factors

These behaviours lead to four key metabolic/physiological

changes that increase the risk of NCDs:
• raised blood pressure
• overweight/obesity
• hyperglycemia (high blood glucose levels)
• hyperlipidemia (high levels of fat in the blood)

In terms of attributable deaths, the leading metabolic risk factor

globally is elevated blood pressure (to which 18% of global
deaths are attributed) followed by overweight and obesity and
raised blood glucose. Low- and middle-income countries are
witnessing the fastest rise in overweight young children.
Voluntary global targets for prevention and control of non-
communicable diseases to be attained by 2025
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Objectives of the Global NCD Action Plan
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WHO “best buys” – (very cost-effective interventions that
are also high-impact and feasible for implementation even in
resource-constrained settings)
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In 2012 it was estimated that 3.3 million deaths, or 5.9% of all deaths
worldwide, were attributable to alcohol consumption.

More than half of these deaths resulted from NCDs –

• chiefly cardiovascular diseases and diabetes (33.4%),
• cancers (12.5%) and
• gastrointestinal diseases, including liver cirrhosis (16.2%).

An estimated 5.1% of the global burden of disease –as measured in disability-

adjusted life-years (DALYs) – is attributed to alcohol consumption.
Cardiovascular diseases, cancers and gastrointestinal diseases (largely due to
liver cirrhosis) are responsible for more than one third (37.7%) of this burden.
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WHO “best buys” – (very cost-effective interventions that are also high-impact
and feasible for implementation even in resource-constrained settings)

Harmful use of alcohol

• Regulate commercial and public availability of alcohol
• Restrict or ban alcohol advertising and promotions
• Use pricing policies such as excise tax increases on
alcoholic beverages
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Insufficient physical activity is one of the 10 leading risk factors

for global mortality, causing some 3.2 million deaths each year.

In 2010, insufficient physical activity caused 69.3 million DALYs –

2.8% of the total – globally.

Adults who are insufficiently physically active have a 20−30%

increased risk of all-cause mortality compared to those who do at
least 150 minutes of moderate-intensity physical activity per
week, or equivalent,
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Walkability is positively associated with physical

activity: Curitiba, Brazil

Partnership and social marketing to promote physical

activity in women: Tonga

Bicycle hire to improve physical activity: Islamic

Republic of Iran

Sustainable transport: Freiburg, Germany

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Excess consumption of dietary sodium is associated with increased

risk of hypertension and cardiovascular disease

estimated that excess sodium intake was responsible for 1.7 million
deaths from cardiovascular causes globally in 2010

A meta-analysis of 36 studies found that decreased sodium intake

resulted in a decrease in resting systolic blood pressure of 3.4
mmHg and a decrease in resting diastolic blood pressure of 1.5
mmHg

Sodium consumption is also associated with cardiovascular disease

events in persons who consume more than 3.5 g/day of sodium
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Salt-smart Americas

National campaign to reduce salt consumption in

Thailand

A regulatory approach to reduce unhealthy food and

beverages in the Pacific islands and Kiribati

Working with the private sector to reduce salt

consumption in Argentina and South Africa

Salt-reduction campaigns in Bahrain, Kuwait and Qatar

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Tobacco use is currently one of the leading causes of preventable

deaths in the world

6 million people are currently estimated to die annually from

tobacco use, with over 600 000 deaths due to exposure to second-
hand smoke (with 170 000 of these deaths among children)

Tobacco use accounts for 7% of all female and 12% of all male
deaths globally

In 2012 there were some 1.1 billion smokers worldwide, with over
8 out of 10 tobacco smokers smoking daily
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Reducing tobacco demand in Turkey

Standardized packaging in Australia

Graphic health warnings in Thailand

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Raised blood pressure is one of the leading risk factors for global
mortality

Estimated to have caused 9.4 million deaths and 7% of disease

burden – as measured in DALYs − in 2010

a reduction in systolic blood pressure of 10 mmHg is associated

with a 22% reduction in coronary heart disease and 41% reduction
in stroke in randomized trials
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In 2014, 39% of adults aged 18 years and older (38% of men and
40% of women) were overweight

In 2014, 11% of men and 15% of women worldwide were obese.

Thus, more than half a billion adults worldwide are classed as
obese

The prevalence of overweight and obesity is highest in the Region

of the Americas (61% overweight or obese in both sexes, and 27%
obese) and lowest in the South-East Asia Region (22% overweight
in both sexes, and 5% obese)

Diabetes was directly responsible for 1.5 million deaths in 2012

and 89 million DALYs
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A zero increase in diabetes incidence rather than prevalence would

be confirmation that modifiable risk factors are being controlled
successfully
• Multisectoral population-based policies to influence production,
marketing and consumption of healthy foods;
• Fiscal policies to increase the availability and consumption of
healthy food and reduce consumption of unhealthy ones;
• Promotion of breast feeding and healthy complementary
feeding according to WHO recommendations
• Policies and interventions to attain the target on reducing
physical inactivity
• Education and social marketing campaigns focused on impacting
dietary and physical activity behaviour in both children and
adults;
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A zero increase in diabetes incidence rather than prevalence would

be confirmation that modifiable risk factors are being controlled
successfully
• Implementation of restrictions on marketing of foods and
beverages that are high in sugar, salt and fat to children;
• Measures to create healthy eating environments in settings
(schools, workplaces, universities, religious settings, villages,
cities) and communities, including disadvantaged communities;
• Research to generate evidence on the effectiveness of individual
and population-wide interventions to prevent and control
obesity and diabetes.
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Of the 17.5 million deaths due to cardiovascular disease in 2012, an estimated

7.4 million were due to heart attacks (ischaemic heart disease) and 6.7 million
were due to strokes

rates of major cardiovascular disease and death are substantially higher in low-
income countries than in high-income countries

Currently, over 80% of cardiovascular deaths occur in low- and middle-income

countries

The target to reduce heart attacks and strokes aims to improve the coverage
of drug treatment and counselling to prevent heart attacks and strokes in people
with raised cardiovascular risk and established disease. It is an aff ordable
intervention that can be delivered through a primary health-care approach, even
in resource-constrained settings
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