『一系列的研究表明，肥胖及烟酒导致的癌症、糖尿病、心脏病等慢性疾病已不再是富人的专利，这些疾病正以前所未有的速度席卷中低收入国家。』

Fat is a global killer - not just the rich man's burden

肥胖—全球性的杀手而非只是富人的负担

November 2010 | from The Guardian

"What will it take to get chronic diseases on the international health agenda?", the Lancet medical journal asks today. Globalisation is taking our bad habits to every corner of the world able to afford a chocolate bar or a packet of chips. As populations become just a bit wealthier, cheap junk food and less physical work ensure that they get unhealthier. Obesity looms large in every sense. The old foes - tobacco and alcohol - are out there, too. And the result is the rapid spread of diabetes, heart disease, cancers and respiratory diseases.

These chronic diseases have already become the big killers of our time in the affluent parts of the planet and are now taking an ever-bigger toll of the low- and middle-income populations. Out of every 10 deaths globally, six are the result of these chronic diseases.

A Lancet series of five papers published today is another attempt to make the world sit up and take notice. The same experts, led by Professor Robert Beaglehole from the University of Auckland in New Zealand, have tried it before. This is the third series on chronic diseases that the Lancet has published. But maybe it"s like giving up smoking - each time you make the effort, you are a bit closer to succeeding even if you fail (or so they say).

While the rich countries are hardly doing brilliantly, the big worry for the Lancet authors is the failure of global health and development experts to pay attention to what is happening in the low- and middle-income countries. Less than 15% of the World Health Organisation's budget and less than 2% of the World Bank and Gates Foundation total health budgets are spent on efforts to prevent and control chronic diseases, they say.

Yet there are cheap and effective things that can be done. The 2007 series proposed salt reduction, tobacco control and the use of cheap generic drugs for those at risk of heart problems. This time, a paper from the Organisation for Economic Co-operation and Development (OECD) points to the cost-effectiveness of governments taking a grip on the food industry. Taxing unhealthy food (or reducing taxes on healthy fruit and vegetables, which is politically more acceptable), restricting junk food advertising and better food labelling are value for money, the authors say. They would add nearly 7 million "life years in good health" over the next two decades in the seven countries they analysed - Brazil, China, India, Mexico, Russia, South Africa and (for comparison, they say) England. It would cost less than $1 per head per year.

Another interesting paper points out that there is a downside to the economies of some low- and middle-income countries from a drive to better health. A big move to eat less saturated fat across Europe would have a massive impact on major meat exporters such as Brazil and China - damaging their economies and causing widespread job losses, says the paper from Professor Richard Smith of the London School of Hygiene and Tropical Medicine.

But, he said at the press conference, you need to know your enemy as well as your ally. And one assumes nothing will happen in a hurry - it certainly hasn't yet. Economies evolve as markets change to suit the needs and desires of consumers.

Doing nothing, as the burden of disease spreads across the poorer parts of the globe, should surely not be an option.