Tuesday, 25 September 2012

Cancer and Chronic diseases: In the Era of Globalization

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Chronic diseases-such as cancer, heart disease and diabetes are the leading causes of death and disability…..Adopting healthy behaviours such as eating nutritious foods, being physically active, and avoiding tobacco use can prevent or control the devastating effects of these diseases (US Centers for Disease Control and prevention, 2005).

Good health for all has become an international goal and it can be stated that there have been broad gains in life expectancy over the past century. But health inequalities between rich and poor persist, while the future health depends increasingly on the relative new processes of globalization. In the past globalization has often been seen as a more or less economic process. Nowadays it is increasingly perceived as a more comprehensive phenomenon, which is shaped by a multitude of factors and events that are reshaping our society rapidly. This paper has an attempt to explore and understand the most dreaded disease like cancer and the other chronic diseases in the era of globalization.

Chronic illness and cancer have been replaced acute illness as the predominant disease pattern in developed countries over the past 50 years. Greatly improved longevity has meant an increased burden of disease caused by cancer and chronic conditions such as heart disease, stroke, AIDS, back pain, diabetes and dementia. A large proportion of the global burden of disease is caused by toxic environment that encourages health-aversive behaviours and choices. The major risk of underweight (developing counties), overweight and obesity (developed counties), unsafe sex, high blood pressure, alcohol and tobacco (everywhere) account for 30% of global disease burden. All are consequences of the toxic environment, which is creating a significant proportion of ill-health and suffering in the world.

Over 60% of people in developed countries live to at least 70 years of age, compared with only about 30% in developing countries. Of the 45 million deaths among adults worldwide in 2002, 32 million were caused by non-communicable diseases. HIV/AIDS has become the leading cause of mortality among adults aged 15-59 years. Unipolar depressive disorders are the leading cause of disability for females.

Debates about globalization and health focus almost exclusively on communicable diseases. However, chronic diseases— especially cardiovascular diseases, cancer, chronic respiratory diseases and diabetes—now constitute the bulk of the global burden of disease (Yach et al., 2004).

Globalization refers to the increasing interconnectedness of countries and the openness of borders to ideas, people, commerce and financial capital. Globalization drives chronic disease population risks in complex ways, both directly and indirectly. The negative health-related effects of globalization include the trend known as the “nutrition transition”: populations in low and middle income countries are now consuming diets high in total energy, fats, salt and sugar. The increased consumption of these foods in these countries is driven partly by shifts in demand-side factors, such as increased income and reduced time to prepare food. Supply-side determinants include increased production, promotion and marketing of processed foods and those high in fat, salt and sugar, as well as tobacco and other products with adverse effects on population health status. A significant proportion of global marketing is now targeted at children and underlies unhealthy behaviour. The widespread belief that chronic diseases are only “diseases of affluence” is incorrect. Chronic disease risks become widespread much earlier in a country’s economic development than is usually realized.


The proportion of people in Africa, Asia and Latin America living in urban areas rose from 16% to 50%. Globalization creates conditions in which people are exposed to new products, technologies, and marketing of unhealthy goods, and in which they adopt less physically active types of employment. As well as globalization and urbanization, rapid population ageing is occurring worldwide. The total number of people aged 70 years or more worldwide is expected to increase from 269 million in 2000 to 1 billion in 2050. High income countries will see their elderly population (defined as people 70 years of age and older) increase from 93 million to 217 million over this period, while in low and middle income countries the increase will be 174 million to 813 million – more than 466%. (WHO, 2008).

Globalization has affected public health in three ways. First, the shrinking of the world by technology and economic interdependence allows diseases to spread globally at rapid speed. Two factors contributing to the global threat from emerging infections directly from globalization: the increase in international travel and the increasingly global nature of food handling, processing, and sales. HIV/AIDS, tuberculosis, cholera, and malaria represent a few infections that have spread to new regions through global travel and trade. The beneficial economic and political consequences of economic interdependence may have negative ramifications for disease control. Second, the development of the global market has intensified economic competition and increased pressure on governments to reduce expenditures, including the funding of public health programs, leaving states increasingly unprepared to deal with emerging disease problems. Industrialized as well as developing countries confront deteriorating public health infrastructures.

Third, public health programs have also “gone global” through WHO and health-related nongovernmental organizations. Medical advances have spread across the planet, improving health worldwide. The worldwide eradication of smallpox in 1977 is a famous example. The global reach of health care advances has, however, a darker side. The globalization of disease control has contributed to the population crisis because people are living longer. Overpopulation creates fertile conditions for the spread of disease: overcrowding, lack of adequate sanitation, and overstretched public health infrastructures. Further, the widespread use and misuse of antibiotic treatments has contributed to the development of drug-resistant pathogens. Finally, the success of control efforts in previous decades caused interest in infectious diseases to wane in the international medical and scientific communities and is now hampering emerging infectious disease control efforts.

Global human cancer is increasing. Exposures to cancer risk factors are not only becoming more prevalent in the less industrialized countries, but they have also become more complex all over the world. Human societies have always traded and migrated, yet the growth of powerful economic institutions and globalization is accelerating, mixing many cancer risk factors. Critically, new cancer risk factors have also appeared, concurrent with globalization: modern diet, addictive products, pharmaceuticals, and toxic and waste products. Prevention, which still rests on recognition and elimination of exposure to carcinogens, is difficult, with seemingly opposed priorities such as income versus health. The solutions require not only individual behavioural change but also more importantly innovative action of all concerned at the global, collective level (Sasco, 2007).

The global nature of the threat posed by new and reemerging infectious/non-infectious diseases will require international cooperation in identifying, controlling, and preventing these diseases. The general policy environment is another crucial determinant of population health. Policies by central and local government on food, agriculture, trade, media advertising, transport, urban design and the built environment shape opportunities for people to make healthy choices. In an unsupportive policy environment it is difficult for people, especially those in deprived populations, to benefit from existing knowledge on the causes and prevention of the main chronic diseases. Along with that Psychosocial interventions like counseling, psychotherapy, behavioural therapy, pain control techniques, biofeedback, relaxation, yoga/ meditation and self-management of excessive tension also must be promoted globally for the good public health.

Reference
Datt, R. & Sundharam, P. M. (2007). Globalization and its impact on India. Indian Economy. S. Chand & company LTD, Ram Nagar, New Delhi.

David, P. & Fidler, J.D. (1996). Globalization, International Law, and Emerging Infectious Diseases. Emerging Infectious Diseases, Vol. 2 (2).

Huynen, M. M., Martens, P. & Hilderink, H. B. (2005). The health impacts of globalisation: a conceptual framework. Globalization and Health.

Marks, D. F., Murray, M., Evans, B., Willing, C., Woodali, C. & Sykes, C. M. (2006). Cancer and Chronic Diseases. Health Psychology: Theory, Research and Practice (2nd edi.). Sage Publications, London (pp 233-253).

Marks, J.S., & McQueen, D.V. (2001). Chronic disease. Edited by: Koop CE, Pearson CE and Schwartz MR. San Francisco, Jossey-Bass. Critical issues in global health.

Sasco, A. J. (in press). Cancer and Globalization. Dossier : Cancer, Influence of environment. available online at www.sciencedirect.com
US Centers for disease control and prevention (2005) http://www.cdc.gov/nccdphp/(consulted7 January2005).

WHO (2008). Chronic disease and Health promotion. World Health Organization.

Yach, D. & Beaglehole, R. (2004). Globalization of Risks for Chronic Diseases Demands Global Solutions. Perspectives on Global development and technology, Vol. 3 (1-2).