Diseases of affluence

Diseases of affluence is a term sometimes given to selected diseases and other health conditions which are commonly thought to be a result of increasing wealth in a society.[1] Also referred to as the "Western disease" paradigm, these diseases are in contrast to so-called "diseases of poverty", which largely result from and contribute to human impoverishment. The modern diet and sedentary lifestyle is argued to be the blame for current levels of obesity,[2] cardiovascular disease,[3] high blood pressure,[4] type 2 diabetes,[5] osteoporosis,[6] colorectal cancer,[7] acne,[8] gout,[9] depression, and diseases related to vitamin and mineral deficiencies.[10] These diseases of affluence have vastly increased in prevalence since the end of World War II.

Examples of diseases of affluence include mostly chronic non-communicable diseases (NCDs) and other physical health conditions for which personal lifestyles and societal conditions associated with economic development are believed to be an important risk factor — such as type 2 diabetes, asthma,[11] coronary heart disease, cerebrovascular disease, peripheral vascular disease, obesity, hypertension, cancer, alcoholism, gout, and some types of allergy.[1][12][13] They may also be considered to include depression and other mental health conditions associated with increased social isolation and lower levels of psychological well being observed in many developed countries.[14][15] Many of these conditions are interrelated, for example obesity is thought to be a partial cause of many other illnesses.

In contrast, the diseases of poverty tend to be largely infectious diseases, or the result of poor living conditions. These include tuberculosis, asthma, and intestinal diseases.[16] Increasingly, research is finding that diseases thought to be diseases of affluence also appear in large part in the poor. These diseases include obesity and cardiovascular disease and, coupled with infectious diseases, these further increase global health inequalities.[1]

Diseases of affluence are predicted to become more prevalent in developing countries as diseases of poverty decline, longevity increases, and lifestyles change.[1][12] In 2008, nearly 80% of deaths due to NCDs — including heart disease, strokes, chronic lung diseases, cancers and diabetes — occurred in low- and middle-income countries.[17]

Top ten list

According to World Health Organization (WHO) the top 10 causes of deaths in the high income countries/ affluent countries in 2016 were from

  1. Ischemic heart diseases
  2. Stroke
  3. Alzheimer disease and other dementia
  4. Trachea , bronchus and lung cancer
  5. Chronic obstructive pulmonary disease
  6. Lower respiratory infections
  7. Colon and rectum cancers
  8. Diabetes
  9. Kidney diseases
  10. Breast cancer.

Except for the lower respiratory infections all of them are non-communicable diseases. In 2016 WHO reported 56.9 million deaths worldwide , and more than half (54%) , were due to the top causes of death previously mentioned.[18]

Causes

Factors associated with the increase of these conditions and illnesses appear to be things that are a direct result of technological advances. They include:

  • Less strenuous physical exercise, often through increased use of motor vehicles
  • Irregular exercise as a result of office jobs involving no physical labor.
  • Easy accessibility in society to large amounts of low-cost food (relative to the much-lower caloric food availability in a subsistence economy)
    • More food generally, with much less physical exertion expended to obtain a moderate amount of food
    • More high fat and high sugar foods in the diet are common in the affluent developed economies of the late-twentieth century
    • Higher consumption of meat and dairy products
    • Higher consumption of refined flours and products made of such, like white bread or white noodles
    • More foods which are processed, cooked, and commercially provided (rather than seasonal, fresh foods prepared locally at time of eating)[19]
  • Prolonged periods of little activity
  • Greater use of alcohol and tobacco
  • Longer life-spans
    • Reduced exposure to infectious agents throughout life (this can result in a more idle and inexperienced immune system as compared to an individual who experienced relatively frequent exposure to certain pathogens in their time of life)
  • Increased cleanliness. The hygiene hypothesis postulates that children of affluent families are now exposed to fewer antigens than has been normal in the past, giving rise to autoimmune diseases.[20][21]

Diabetes mellitus

Diabetes is a chronic metabolic disease characterized by increase blood glucose level. Type 2 diabetes is the most common form of diabetes. It is caused by resistance to insulin or the lack of production of insulin. It is seen most commonly in adults. Type 1 diabetes or juvenile diabetes affects mostly children. This condition is due to little or lack of insulin production from the pancreas.[22]

The prevalence of diabetes had increased in the past three decades. According to WHO 422 million adults have diabetes. [23] The global prevalence of diabetes has increased from 4.7% in 1980 to 8.5 % in 2014.[24] Diabetes has been a major cause for blindness, kidney failure, heart attack, stroke and lower limb amputation.[24]

Prevalence in countries of affluence

The Centers of Disease Control and Prevention (CDC) released a report in 2015 indicating that more than 100 million Americans have diabetes or pre-diabetes. Diabetes was the seventh leading cause of death in United States in 2015.[25] In developed countries like the United States, the risk for diabetes is seen in people with low socioeconomic status (SES).[26] Socioeconomic status is defined by the education and the income level of a person. [27] The prevalence of diabetes varies by education level. Of those diagnosed with diabetes:12.6% of adults had less than a high school education, 9.5% had a high school education and 7.2% had more than high school education. [28]

Differences in diabetes prevalence are seen in the population and ethnic groups in USA. Diabetes is more common in non-Hispanic whites, who are less educated and have a lower income. It is also more common in less educated Hispanics.[29] The highest prevalence of diabetes is seen in the southeast, southern and Appalachian portion of the United States.[29] In the United States the prevalence of diabetes is increasing in children and adolescents. In 2015, 25 million people were diagnosed with diabetes, of which 193,000 were children.[29] The total direct and indirect cost of diagnosed diabetes in US in 2012 was $245 billion.[30]

In 2009, the Canadian Diabetes Association (CDA) estimated that diagnosed diabetes will increase from 1.3 million in 2000 to 2.5 million in 2010 and 3.7 million in 2020. [31] Diabetes was the 7th leading cause of death in Canada in 2015. Like United States, diabetes in more prevalent in the low socioeconomic group of people in Canada.[31]

According to the International Diabetes Federation, more than 58 million people are diagnosed with diabetes in the European Union Region (EUR), and this will go up to 66.7 million by 2045. Similar to other affluent countries like America and Canada, diabetes is more prevalent in the poorer parts of Europe like Central and Eastern Europe.[32]

In Australia according to self-reported data, 1 in 7 adults or approximately 1.2 million people had diabetes in 2014-2015. People who were living in remote or socioeconomically disadvantaged areas were 4 times more likely to develop type 2 diabetes as compared to non-indigenous Australians.[33] Australia incurred $20.8 million in direct costs towards hospitalization, medication, and out-patient treatment towards diabetes. In 2015, $1.2 billion were lost in Australia's Gross Domestic Product (GDP) due to diabetes.[34]

In these countries of affluence, diabetes is prevalent in low socioeconomic groups of people as there is abundance of unhealthy food choices, high energy rich food, and decreased physical activity.[35] The rich or more affluent people are typically more educated and have tools to counter unhealthy foods such as the availability of better tasting healthy food, physical trainers or better access to parks or fitness centers. [36]

Risk factors

Obesity and being overweight is one of the main risk factors of type 2 diabetes. Other risk factors include lack of physical activity, genetic predisposition, being over 45 years old, tobacco use, high blood pressure and high cholesterol.[37] [38] In United States, the prevalence of obesity was 39.8 % in adults and 18.5% in children and adolescents in 2015-2016.[39] In Australia in 2014-2015, 2 out 3 adults or 63% were over weight or obese. Also, 2 out of 3 adults did little or no exercise .[40] According to the World Health Organization, Europe had the 2nd highest proportion of overweight or obese people in 2014 behind America. [41]

In developing countries

According to WHO the prevalence of diabetes is rising more in the middle and low income countries. Over the next 25 years, the number of people with diabetes in developing countries will increase by over 150%. Diabetes is typically seen in people above the retirement age in developed countries, but in developing countries people in the age of 35-64 are mostly affected. Although, diabetes is considered a disease of affluence affecting the developed countries, there is more loss of life and premature death among people with diabetes in the developing countries.[42] Asia accounts for 60% of the world's diabetic population. In 1980 less than 1% of Chinese adults were affected by diabetes, but by 2008 the prevalence was 10%.[43] It is predicted that by 2030 diabetes may affect 79.4 million people in India, 42.3 million people in China and 30.3 million in United States. [44]

These changes are the result of developing nations having rapid economic development. This rapid economic development has caused a change in the lifestyle and food habits leading to over-nutrition, increased intake of fast food causing increase in weight, and insulin resistance .[43] Compared to the west, obesity in Asia is low. India has very low prevalence of obesity, but a very high prevalence of diabetes suggesting that diabetes may occur at a lower BMI in Indians as compared to the Europeans. Smoking increases the risk for diabetes by 45%. In developing countries around 50-60 % adult males are regular smokers, increasing their risk for diabetes.[43] In developing countries, diabetes is more commonly seen in the more urbanized areas. The prevalence of diabetes in rural population is 1/4th that of urban population for countries like India, Bangladesh, Nepal, Bhutan and Sri Lanka.[44]

Public health initiatives

In United States, the Centers for Disease Control and Prevention (CDC) works to prevent or delay the onset of type 2 diabetes through a program called the National Diabetes Prevention Program. This program teaches participants to make healthy lifestyle changes and to prevent the development of the disease.[45] The Australian government runs programs like National Health Priority Areas Initiative, which focuses on the care and attention of chronic diseases like diabetes.[46] The National Health Service of United Kingdom has programs for patient education to improve their quality of life.[46] Diabetes Action Now is a initiative by WHO and International Diabetes Federation to increase the surveillance, prevention and control of diabetes in low and middle income countries.[46]

Cardiovascular disease

Cardiovascular disease refers to a disease of the heart and blood vessels. Conditions and diseases associated with heart disease include: stoke, coronary heart disease, congenital heart disease, heart failure, peripheral vascular disease, and cardiomyopathy. [47] Cardiovascular disease is known as the world’s biggest killer. 17.5 million people die from it each year, which equals 31% of all deaths. Heart disease and stroke cause 80% of these deaths. [48]

Prevalence of heart disease in countries of affluence

In the United States, 610,000 people die every year from heart disease which is equal to 1 in 4 deaths. The leading cause of death for both men and women in the United States is heart disease. [49] In Canada, heart disease is the second leading cause of death. In 2014, it was the cause of death for 51,000 people.[50] In Australia, heart disease is also the leading cause of death. 29% of deaths in 2015, had an underlying cause of heart disease.[51] Heart disease causes one in four premature deaths in the United Kingdom and in 2015 heart disease caused 26% of all deaths in that country. [52]

In the United States, 610,000 people die every year from heart disease which is equal to 1 in 4 deaths. The leading cause of death for both men and women in the United States is heart disease. [49] In Canada, heart disease is the second leading cause of death. In 2014, it was the cause of death for 51,000 people.[50] In Australia, heart disease is also the leading cause of death. 29% of deaths in 2015, had an underlying cause of heart disease.[51] Heart disease causes one in four premature deaths in the United Kingdom and in 2015 heart disease caused 26% of all deaths in that country.

Risk factors for cardiovascular disease

High blood pressure if the leading risk factor for cardiovascular disease and has contributed to 12% of the cardiovascular related deaths worldwide.[53] Other significant risk factors for heart disease include high cholesterol and smoking. 47% of all Americans have one of these three risk factors. [54] Lifestyle choices, such as poor diet and physical inactivity, and excessive alcohol use can also contribute to cardiovascular disease. Medical conditions, like Diabetes and obesity can also be risk factors. [54]

In the past few years, there have been several worldwide public awareness campaigns related to cardiovascular disease by the World Health Organization (WHO). In 2013, the World Health Organization’s annual World Health Day’s focus was on monitoring high blood pressure to raise public awareness.[55]Another WHO initiative in 2016, lead to public awareness for reducing salt intake.[55] In recent years, the United Kingdom has made efforts to increase public knowledge on such things as heart health and nutrition through various educational tools.[56]In the United States, the Center for Disease control currently has a national public awareness campaign, entitled Million Hearts®. This campaign's goal focuses on preventing one million heart attack, strokes and events related to cardiovascular disease by 2020 through actions in the public health community and health care systems.[57]

Cardiovascular disease as a disease of affluence

In Canada, a developed country of affluence, people of lower Socio-economic status are more likely to have cardiovascular disease than those who have a higher socio-economic status.[58] This inequality gap has occurred in developed countries because people who have a lower socio-economic status often face many of the risk factors of tobacco and alcohol use, obesity as well as having a sedentary lifestyle. [59] Further social and environmental factors such as poverty, pollution, family history, housing and employment contribute to this inequality gap and to risk of having a health condition caused by cardiovascular disease. [60] The increasing inequality gap between the higher and lower income populations continues in countries such as Canada, despite the availability of health care for everyone. [61]

See also

General:

References

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  41. ↑ "Overweight and obesity - BMI statistics - Statistics Explained". ec.europa.eu. Retrieved 2018-09-30.
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  46. 1 2 3 Kaveeshwar SA, Cornwall J (2014-01-31). "The current state of diabetes mellitus in India". The Australasian Medical Journal. 7 (1): 45–8. doi:10.4066/AMJ.2013.1979. PMC 3920109. PMID 24567766.
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  48. ↑ "WHO | Noncommunicable diseases: the slow motion disaster". WHO. Retrieved 2018-09-29.
  49. 1 2 "Heart Disease Facts & Statistics | cdc.gov". www.cdc.gov. 2017-11-28. Retrieved 2018-09-29.
  50. 1 2 Canada, Public Health Agency of. "Surveillance of heart diseases and conditions - Canada.ca". www.canada.ca. Retrieved 2018-09-29.
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  52. ↑ stats-2015 "British Heart Foundation, Cardiovascular Disease Statistics" Check |url= value (help). British Heart Foundation, Cardiovascular Disease Statistics. 2015.
  53. ↑ "WHO | Noncommunicable diseases: the slow motion disaster". WHO. Retrieved 2018-09-29.
  54. 1 2 "Heart Disease Facts & Statistics | cdc.gov". www.cdc.gov. 2017-11-28. Retrieved 2018-09-29.
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  57. ↑ "Prevent 1 Million Heart Attacks & Strokes". Centers for Disease Control and Prevention. 2018-09-12. Retrieved 2018-10-05.
  58. ↑ Sheth, Tej; Nargundkar, Mukund; Chagani, Karim; Anand, Sonia; Nair, Cyril; Yusuf, Salim (November 1997). "Classifying ethnicity utilizing the Canadian mortality data base". Ethnicity & Health. 2 (4): 287–295. doi:10.1080/13557858.1997.9961837. ISSN 1355-7858.
  59. ↑ Filate WA, Johansen HL, Kennedy CC, Tu JV Can J Cardiol. 2003 Oct; 19(11):1241-8. (October 2013). "Regional variations in cardiovascular mortality in Canada". Cardiology. 19(11): 1241–8.
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  61. ↑ Lee, D. S.; Chiu, M.; Manuel, D. G.; Tu, K.; Wang, X.; Austin, P. C.; Mattern, M. Y.; Mitiku, T. F.; Svenson, L. W. (2009-07-20). "Trends in risk factors for cardiovascular disease in Canada: temporal, socio-demographic and geographic factors". Canadian Medical Association Journal. 181 (3–4): E55–E66. doi:10.1503/cmaj.081629. ISSN 0820-3946.

Further reading

  • Trowell HC, Burkitt DP. Western Diseases: Their Emergence and Prevention. Harvard University Press.
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