Pollution and non-communicable disease: time to end the neglect (original) (raw)

2018, The Lancet Planetary Health

Non-communicable diseases (NCDs) account for 72% of all deaths globally and this proportion is growing. 1 Greatest increases in NCD mortality are seen in low-income and middle-income countries (LMICs). Places that only a generation ago knew famine are today experiencing epidemics of obesity, diabetes, cardiovascular disease, and cancer. 1 These epidemics reduce human capital in developing countries and their economic costs are so great that they threaten to slow and even undercut trajectories of economic and social development. 2 International organisations, medical associations, and global philanthropies are mobilising to meet this challenge. In 2011, the United Nations (UN) General Assembly convened a special session on NCDs, followed by a high-level meeting in 2014; 3 a third such gathering is planned for 2018. WHO has developed a global action plan for the prevention and control of NCDs. 4 The World Heart Federation is building a grand coalition to confront the global epidemics of heart disease and stroke. 5 And in September, 2017, with the support of leading global health philanthropies, the global health organisation Vital Strategies launched the Resolve initiative to address the global pandemic of cardiovascular disease. 6 The core strategy of each these efforts is to use evidence-based policy and clinical interventions to tackle the major behavioural and metabolic risk factors for NCDs: tobacco, hypertension, unhealthy diet, physical inactivity, obesity, and the harmful use of alcohol. 7 Pollution is not among the risk factors targeted by any of these campaigns. Nor is pollution an explicit focus of the UN Interagency Task Force on NCDs despite the recommendation of the UN Economic and Social Council that pollution be a Task Force target. Yet air, soil, and water pollution in community, household, and occupational settings and toxic chemical pollution are among the leading NCD risk factors globally and are responsible for an estimated 16% of all NCD mortality. 2 Pollution accounts for 22% of all deaths from cardiovascular disease, 26% of ischaemic heart disease deaths, 25% of stroke deaths, 53% of deaths from chronic obstructive pulmonary disease, and 40% of deaths from lung cancer. 1