ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Monday, September 16, 1996 TAG: 9609160107
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
DATELINE: UNITED NATIONS
SOURCE: The New York Times
NOTE: Above
In a comprehensive survey of the health of the world's population, an international team of experts says in a book to be published on Monday that non-communicable diseases and accidents are quickly replacing infectious diseases and malnutrition as leading causes of premature death and disability worldwide.
The changing pattern, caused among other factors by the aging of populations almost everywhere and more deaths related to accidents and the growing use of tobacco, creates new challenges for policy-makers, especially in poorer countries where public health has often focused almost entirely on vaccination drives and other campaigns aimed at children, rather than on preventive medicine for adults.
Even new epidemics, such as the spread of HIV-AIDS and the resurgence of tuberculosis, are being counterbalanced by advances against other infectious diseases, according to the five-year study by the Harvard School of Public Health, the World Health Organization, the World Bank, and health officials in a number of countries.
While accidents and non-communicable illnesses like heart disease or cancer have been leading causes of death in industrial countries, in the developing world, these ailments have traditionally lagged behind infections, often in the intestines or respiratory tract, and diseases like measles or malaria.
The study, which completes a 10-volume survey called the Global Burden of Disease and Injury Series, published by Harvard, provides new statistics on ``hidden'' diseases whose incidence is often unacknowledged in developing countries. The findings in mental illness surprised even the study's authors.
``I did start out being very skeptical about claims that there is a huge hidden problem around neuropsychiatric conditions,'' said Christopher J.L. Murray, associate professor of international health economics at Harvard and the author, with Alan Lopez of the World Health Organization, of the new study.
``But through this megaexercise, this overview exercise, I became quite convinced that there is a much larger burden of disease due to neuropsychiatric conditions than I or my colleagues in health policy thought,'' he said.
Looking at the diseases that shorten life or cause disabilities in the developing world, Murray said that the top three are still infectious. But fourth on the list is now clinical depression - ``and that's going to get bigger, based on demographic shifts,'' he said.
He added that when disability, not just death, is factored into surveys - a process this report uses throughout - the effects of depression can be ``a huge issue.''
Murray said the survey does not publicize new information on neuropsychiatric diseases in order to promote particular health policies but simply to lay out as fully as possible the situations many countries face as they weigh how to invest their limited resources.
Another surprising finding, Murray said, was the impact of injuries on national health.
``There are 50 million deaths in the world a year,'' he said. ``Five million of those deaths are from injuries, both the unintentional injuries like road accidents and the intentional injuries like homicide or suicide.''
``Injuries tend to affect young people and they tend to cause quite a bit of disability,'' he said. ``For every road accident that kills somebody, there are 10 or more - in the West, 20 - that occur with consequences severe enough to send someone to the hospital but don't kill people. When you take that into account, injuries account for 15 percent of the disease burden.''
Examples of how the burden of mental disorders and injuries in the poorest countries falls on families are vivid for William Drayton, president of Ashoka, a private, nonprofit organization in Virginia that provides grants to public-service innovators in the developing world, some of whom are working to ease the pressure on families and communities of long-term disabilities in societies where these ailments receive little public attention.
``For every disabled person, there is a family of maybe four or five other people who are profoundly affected, economically and socially,'' Drayton said. ``In these families, there is anger, guilt, fear.''
Drayton said there are 600,000 paraplegics in Mexico alone, many of whom receive inadequate care.
``If they were living in the U.S., they would have rehabilitation and computers to talk to,'' he said. ``In Mexico, they may go into a back room where they cannot be seen socially. It becomes a horrible psychological weight on the family.''
LENGTH: Medium: 85 linesby CNB