The recent WHO update of causes of death for 186 countries in 2016 (www.who.int/evidence/bod) has been used as the basis for an assessment of the importance of non-communicable diseases (NCDs) in tropical countries. The paper “Acting on non-communicable diseases in low- and middle-income tropical countries” was published last week in Nature journal (Ezzati, Pearson-Stuttard, Bennett & Mathers, Nature https://doi.org/10.1038/s41586-018-0306-9). The paper showed that most NCDs cause more deaths at every age in low- and middle-income tropical countries than in high-income Western countries.

The following graph from the paper compares NCD mortality in low- and middle-income tropical countries with that in high-income Western countries. The map (a) shows the share of deaths from NCDs, and map (b) shows the age-standardized death rates from NCDs.  The latter provides a standard measure of the risk of death from NCDs, which removes the effect of different population age structures.  It is clear that NCD mortality risks are higher in most tropical low- and middle-income countries than high income countries.  In contrast, the NCD share of deaths is higher in high income countries, because infectious disease death rates are much lower.

The paper goes on to examine the causes of NCDs in low- and middle-income countries, which  include poor nutrition and living environment, infections, insufficient taxation and regulation of tobacco and alcohol, and under-resourced and inaccessible healthcare. The paper also identifies a comprehensive set of actions across health, social, economic and environmental sectors that could confront NCDs in low- and middle-income tropical countries and reduce global health inequalities.