The Lancet, Early Online Publication, 9 May 2011

doi:10.1016/S0140-6736(11)60135-9Cite or Link Using DOI

Chronic non-communicable diseases in Brazil: burden and current challenges

Prof Maria Inês Schmidt MD a , Bruce Bartholow Duncan MD a, Gulnar Azevedo e Silva MD b, Ana Maria Menezes MD c, Carlos Augusto Monteiro MD d, Sandhi Maria Barreto MD e, Dora Chor MD f, Paulo Rossi Menezes MD g

Summary

Non-communicable diseases (NCDs) have become a major health priority in Brazil—72% of all deaths were attributable to NCDs in 2007. They are also the main source of disease burden, with neuropsychiatric disorders being the single largest contributor. Morbidity and mortality due to NCDs are greatest in the poor population. Although the crude NCD mortality increased 5% between 1996 and 2007, age-standardised mortality declined by 20%. Declines were primarily for cardiovascular and chronic respiratory diseases, in association with the successful implementation of health policies that lead to decreases in smoking and the expansion of access to primary health care. Of note, however, the prevalence of diabetes and hypertension is rising in parallel with that of excess weight; these increases are associated with unfavourable changes of diet and physical activity. Brazil has implemented major policies for the prevention of NCDs, and its age-adjusted NCD mortality is falling by 1·8% per year. However, the unfavourable trends for most major risk factors pose an enormous challenge and call for additional and timely action and policies, especially those of a legislative and regulatory nature and those providing cost-effective chronic care for individuals affected by NCDs.

This is the fourth in a Series of six papers on Health in Brazil

Introduction

Chronic non-communicable diseases (NCDs) are a global health problem and a threat to human health and development. The burden of these diseases falls mainly on low-income and middle-income countries.1 Leading scientists2 and WHO3 have raised a call to action, as effective interventions are available,4 which define strategies to be taken. The United Nations is convening a high-level meeting of the General Assembly in September, 2011, on the prevention and control of NCDs.5 To contribute to the preparation of this meeting, The Lancet Series of papers was launched in November, 2010,6 in which 23 countries, including Brazil, were assessed with respect to NCD burden and national capacity to respond to the NCD challenge.7 A comprehensive and critical view of the NCD scenario in Brazil, a large middle-income country, is thus timely.

The burden of chronic NCDs

In 2007, about 72% of all deaths in Brazil were attributable to NCDs (cardiovascular diseases, chronic respiratory diseases, diabetes, cancer, and others, including renal diseases), 10% to infectious or parasitic diseases, and 5% to maternal and child health disorders. This distribution contrasts with that of 1930, when infectious diseases accounted for 46% of all deaths in Brazilian state capitals.8 As addressed in greater detail elsewhere in this Series,9 this radical change happened within the context of economic and social development, in which major advances toward the resolution of the then reigning public health concerns were made. In parallel with this change in disease burden was a rapid demo-graphic transition in Brazil that produced an age pyramid weighted more towards adults and elderly people.10 Greater income, more mechanisation and industrialisation, improved access to food, urbanisation, and globalisation of unhealthy habits have produced a rapid nutritional transition11 and have increasingly exposed the population to a greater risk of chronic disease. Within this context, less privileged ethnic and racial groups bear a disproportionately large share of the resultant burden (panel 1)./.../