Low- and middle-income countries do too little to prevent chronic diseases

Nine years ago, the World Health Organization adopted a global strategy to address risk factors for chronic diseases such as heart disease, cancer and diabetes. Today, only a few low-and middle-income countries have implemented robust national policies to help prevent such non-communicable diseases, according to an international study led by the Institute of Tropical Medicine (ITM) in Antwerp in collaboration with Ghent University, published in this week's PLOS Medicine.

The researchers, led by ITM's Patrick Kolsteren, reviewed relevant policies from all 140 low- and middle-income countries but were only able to find any such policies in 116 countries.

Patrick Kolsteren said: "Unhealthy diets and physical inactivity are no longer the exclusive concern of rich countries. Yet, many low- and middle-income countries are doing too little to prevent chronic diseases. They are not applying evidence-based measures, such as reducing fat and salt intake."

The authors found that less than half of the 116 countries (47% or 54 out of 116) had strategies relating to non-communicable diseases. Only a small proportion of these strategies proposed actions to promote healthier diets and physical activity. Furthermore, only 14 countries (12%) proposed a policy that addressed all main risk factors (reducing salt and fat intake, promoting fruit and vegetable intake and physical activity) and 29 (25%) addressed only one risk factor.

"Low- and middle-income countries need to scale up interventions and develop integrated policies to address risk factors. A quick glance at the worrying rise of heart disease, cancers and diabetes in the world's richest countries should serve as a warning," added Kolsteren.

Poor dietary quality (in particular, high salt intake, high saturated and trans-fatty acid intake, and low fruit and vegetable consumption) and insufficient physical activity are key risk factors for the development of non-communicable diseases worldwide. Physical inactivity is increasingly becoming prevalent in low- and middle-income countries and already constitutes one of the leading causes of mortality. There is also concern about excess intake of saturated and transfatty acids in LMICs, although researchers observe large regional differences.

In 2004, the WHO adopted the Global Strategy on Diet, Physical Activity and Health, envisaging the implementation of national policies to deal with country-specific challenges. The WHO hopes the strategy can counter the global non-communicable disease epidemic.