Seven billion people are walking the earth, and for the first time in human history, more than half of us are living in cities. This doesn’t necessarily mean that all of us are living healthier lives, however. The toll of non communicable diseases (NCDs) is rising rapidly, especially among the poor cutting a devastating swath into economic productivity in many nations.
NCDs – primarily cardiovascular disease, cancers, diabetes, chronic lung disease and mental illness – are already responsible for more than two thirds of all deaths globally. No country or region is immune. In Ghana today, for example, forty percent of all deaths are from NCDs. In India, NCDs account for half of all deaths. About 60 percent of all Peruvians die from an NCD. Roughly three quarters of all Moroccan deaths result from NCDs. In Singapore, four out of every five deaths are from NCDs. And in Albania, almost 9 out of every ten deaths result from NCDs. And if present trends continue, these totals are only projected to get worse.
Oddly enough, moving to a city with all of its economic advantages can mean lifestyle changes that are detrimental to health. Individuals who migrate from rural areas to urban ones often leave behind a diet of healthier foods including fresh fruits and vegetables, and substitute instead relatively unhealthy prepared foods that are high in salt, sugar and trans fats. People who are used to daily farm labor now may transition to jobs in cities that are more sedentary. In many cases, rural dwellers are used to traveling relatively long distances by foot or bicycle, whereas city residents habitually skip walking and take buses or cars. Cigarettes are comparatively easier to come by in urban areas than in the countryside. Some individuals living in cramped city apartment units breathe air and drink water that is qualitatively worse than comparable individuals living in villages. The bottom line is that urbanization is probably adding to the global burden of NCDs.
A recent World Economic Forum study by Harvard School of Public Health Economist David Bloom indicates that the cumulative cost of NCDs in low and medium-income countries during the period 2011-2025 will reach $7 trillion, in large measure because of lost productivity from individuals in the peak of their work lives. This staggering total, amounting to approximately $500 billion per year, is true even though the world is projected to add between 867 million and 1.776 billion people during that period. That’s because chronic illnesses including NCDs are taking a large toll especially among working-age people, particularly the poor. The World Health Organization’s 2010 Global Status Report on NCDs notes that in low income countries, nearly 30 percent of NCD-related deaths occur under the age of 60. Even for those who survive, an astonishing number – perhaps 100 million people every year -- are driven into poverty by the costs of medical treatment and care, which they are forced to pay out of pocket.
So seven billion is a dubious milestone, in some ways. There are more of us than ever before, but we are not all healthy. We have made great strides in conquering some of the greatest killers of the 20th century – including many of the causes of childhood mortality. And even some communicable diseases – smallpox and polio, for example – have been eradicated or nearly so. But to beat back the rising tide of NCDs, we may have to re-examine our very notion of what it means to be “modern.” Public health, urban planning, and associated disciples hold some of the answers to this conundrum, since we already know how to build healthier cities. The question is whether we will show the will to do so.