Chronic illnesses called epidemic among poor

MAMELODI, South Africa -- Aaron Mathe, 17, took shallow breaths. He had learned four years earlier that he had Hodgkin's lymphoma, and received chemotherapy treatment. But the 10th grader said his doctor recently gave him bad news: His illness appears to be terminal.

''He said he had nothing more he could give me, because the chemotherapy hurts my heart," Mathe said softly.

Here, in the midst of this vast township of 1 million people a few miles east of Pretoria, Mathe's situation is emblematic of what the World Health Organization calls a ''largely invisible epidemic" -- the overwhelming number of chronic disease cases in poor countries.

In a report released today, the WHO estimates that 80 percent of chronic illnesses such as heart disease, stroke, cancer, and diabetes were in low- to middle-income countries, contrary to popular belief that these diseases largely afflict people in wealthy countries.

The report also estimates that 17 million people die prematurely each year from these chronic diseases, and calls for a 2 percent annual reduction in deaths from these diseases. If that goal is reached, according to the report, countries would prevent the deaths of 36 million people in the next decade -- and nearly half the people would be under the age of 70.

Of the projected 58 million total deaths worldwide this year, an estimated 35 million people will die from chronic diseases -- more than double the number of deaths from infectious diseases such as AIDS, malaria, and tuberculosis, according to the WHO.

''We can stop this global epidemic of chronic diseases if we take preventative action now," said Dr. Robert Beaglehole, director of the WHO's Chronic Diseases and Health Promotion, in a telephone interview from Geneva. ''We estimate that 388 million people in the world are expected to die from chronic diseases in the world in the next 10 years, and everywhere the poor are the hardest hit."

Beaglehole said the low-cost prevention measures include changing diets to reduce salt in processed foods and to eat less foods that are high in fat and sugars; improving school meals; and increasing taxes on tobacco products. He and others also recommended that people engage in more physical exercise.

Some of the best examples of prevention came from Poland and Brazil, Beaglehole said. In Poland, death rates for adults under the age of 45 have been reduced by 10 percent a year for several years due to a combination of factors: greater availability of fruit and vegetables, lower consumption of butter, and vigorous control of tobacco products, health officials say. In Brazil, the city of Sao Paulo built walkways, bicycle paths, and parks, as well as encouraged local industries to lower the saturated fat, sugar, and salt in processed food. WHO officials said Sao Paulo's interventions cost a half-cent per person.

While many researchers have studied a growing epidemic of obesity in the United States, that trend is not limited to rich Western countries, the report found. The WHO estimated that 1 billion people around the world, or one of every six persons, is now overweight or obese, and the organization predicts that figure will rise to more than 1.5 billion by 2015 without immediate action.

In South Africa, for instance, 77 percent of women and 51 percent of men are estimated to be overweight or obese. Elsewhere in sub-Saharan Africa, 57 percent of women in Botswana, 56 percent of women in Gabon, and 46 percent of men in Equatorial Guinea are estimated to be overweight or obese, according to the WHO.

This year, the report estimates, 2.6 million people will die as a result of being overweight or obese.

The WHO report also gave new projections for the economic impact of chronic diseases in nine countries -- China, India, Russia, Nigeria, Tanzania, Canada, Brazil, Pakistan, and United Kingdom. The United States was not included in the study.

The accumulated losses to China from chronic diseases, through factors such as impact on labor supply and eroding personal savings, were projected at $558 billion for the next decade; Russia's figure was $303 billion, and India's $236 billion. Canada, partly because of its preventive health measures and its smaller population, came in at $8.5 billion.

It appears the numbers have already had an impact on China. Wang Longde, China's vice minister of health, in a statement released by WHO, said: ''In response to these facts, the Ministry of Health of China, with the support of the WHO, has been developing the first medium- and long-term high-level national plan for chronic disease prevention and control."

The report also estimates that if risk factors for diseases changed people's behavior, 80 percent of heart disease, diabetes, and stroke could be prevented, and 40 percent of cancers could be prevented.

Beaglehole said that even for unpreventable cancers, patients in poor countries could live much longer with better medical care.

In Mamelodi, outside Pretoria, it could not be determined if Mathe's prognosis would change if he had access to Western medical care. Hodgkin's lymphoma can be fatal anywhere, although treatment has greatly improved in high- and middle-income countries in recent years, and patients have a high survival rate, according to health studies.

That gives little comfort to Mathe. ''I've been losing weight, getting tired, feeling low," Mathe, sitting on his bed, told a reporter last week. ''I just pray now."

Hearing those words, Linky Mathabe, 50, a nurse at Mamelodi Hospice who was sitting across from him, slipped outside and pressed a tissue against her eyes, catching her tears.

''I didn't want him to see me cry," Mathabe said later. ''It pained me so."

John Donnelly can be reached at donnelly@globe.com