Health transition and emerging cardiovascular disease in developing countries: situation and strategies

1. Health transition and emerging cardiovascular disease in developing countries: situation and strategies for prevention Pascal Bovet, MD, MPH, Senior Lecturer Institute of Social and Preventive Medicine Group for Epidemiologic Transition and Cardiovascular Disease University of Lausanne, Switzerland http://www.hospvd.ch/iumsp http://www.hospvd.ch/iumsp/info/gct/index.htm IUMSP-GCT

2. Definition of the ‘health transition’ • Trends of disease patterns in populations • The 4 stages of the epidemiological transition • The cardiovascular disease transition • Engines of the health transition • Urbanization, demographic, epidemiologic, socioeconomic and health care • Other determinants of NCDs • Predicted trends in disease patterns, ‘Global Burden of Disease’ • The double burden of disease • Impact of NCDs on public health • Evidence for the preventability of CVD • Strategies for the primary prevention of CVD • Public health response to emerging CVD IUMSP-GCT

3. The health transition • Originally described in the 1970s (Omran, later Olshansky, Ault) • As socioeconomic development proceeds, mortality and fertility rates shift from high to low rates, populations get larger and older, and disease pattern shifts from one dominated by infectious diseases, perinatal diseases and nutritional disorders to one dominated by NCDs • conventional classification of 4 stages relating socioeconomic development and disease patterns • Key to understanding current and future health patterns • useful tool to anticipate health needs in developing countries experiencing early stages of health transition • particularly in countries where data on mortality and risk factors are scarce IUMSP-GCT

4. Definition of the ‘health transition’ • Trends of disease patterns in populations • The 4 stages of the epidemiological transition • The cardiovascular disease transition • Engines of the health transition • Urbanization, demographic, epidemiologic, socioeconomic and health care • Other determinants of NCDs • Predicted trends in disease patterns, ‘Global Burden of Disease’ • The double burden of disease • Impact of NCDs on public health • Evidence for the preventability of CVD • Strategies for the primary prevention of CVD • Public health response to emerging CVD IUMSP-GCT

5. Health transition: proportionate mortality over time (US, 1900-1970, Omran) 100% Other causes Violence 80% Diabetes Stroke 60% Heart disease Cancer Percent of all deaths Dis. of early infancy 40% Diarrhea enteritis Pneumonia 20% Other infectious d. Tuberculosis 0% 1900 1910 1920 1930 1940 1950 1960 1970 IUMSP-GCT

6. Health transition: proportionate mortality by broad cause of death (US, 1900-1970) 100% Other 80% Violence 60% Percent of all deaths Cancer 40% CVD 20% Infectious 0% 1900 1910 1920 1930 1940 1950 1960 1970 IUMSP-GCT

7. Health transition: mortality rates (US, 1910-1970) (up to >1000 earlier) IUMSP-GCT

8. The health transition favors the young over the old(Age-specific mortality rates, US, 1890-1970) IUMSP-GCT

9. Definition of the ‘health transition’ • Trends of disease patterns in populations • The 4 stages of the epidemiological transition • The cardiovascular disease transition • Engines of the health transition • Urbanization, demographic, epidemiologic, socioeconomic and health care • Other determinants of NCDs • Predicted trends in disease patterns, ‘Global Burden of Disease’ • The double burden of disease • Impact of NCDs on public health • Evidence for the preventability of CVD • Strategies for the primary prevention of CVD • Public health response to emerging CVD IUMSP-GCT

10. The 4 stages of the health transition IUMSP-GCT

11. Definition of the ‘health transition’ • Trends of disease patterns in populations • The 4 stages of the epidemiological transition • The cardiovascular disease transition • Engines of the health transition • Urbanization, demographic, epidemiologic, socioeconomic and health care • Other determinants of NCDs • Predicted trends in disease patterns, ‘Global Burden of Disease’ • The double burden of disease • Impact of NCDs on public health • Evidence for the preventability of CVD • Strategies for the primary prevention of CVD • Public health response to emerging CVD IUMSP-GCT

12. Transition in cardiovascular disease patterns along the health transition Late stage of health transition High income economies IHD > stroke • Stroke of ischemic origin • Older age • Lower case fatality Early stage of health transition Low & middle income economies • Stroke > IHD • Stroke of hemorrhagic origin • Younger age (stroke, IHD) • Higher case fatality IUMSP-GCT

13. Differences in proportionate CVD mortality across regions at different stages of development, 1990 100% IHD 80% CVA 60% Cardio myopathies 40% Rheumatic 20% 0% India West China East Middle East Europe Latin Sub- America Saharan IUMSP-GCT

14. The high burden of stroke in developing countries: stroke mortality rates in selected countries, age 40-69 IUMSP-GCT

15. High toll of NCD/CVD in middle age in developing countries: mortality by broad cause, Seychelles, 1993-1995

16. Stages of the health transition: focus on the type and regional distribution of cardiovascular disease

17. A model of the health transition accounting for mortality rates of diseases and types of CVD IUMSP-GCT

18. How to interpret the health transition across populations at different stages of development: emergence and decline of CVD IUMSP-GCT