Disease control priorities in developing countries

Every developing region is facing a transition in its epidemiological profile from an environment with high fertility rates and high mortality from preventable causes to one in which a combination of lower fertility rates and changing lifestyles has led to aging populations and epidemics of tobacco addiction, obesity, cardiovascular disease, cancers, diabetes, and other chronic ailments. The 20th century will be remembered for, among other things, witnessing the largest universal increase in life expectancy in history. While life expectancy is highest in the richest countries, the upward trend is apparent in almost every society. Moreover, in the past 50 years, variations in this health indicator across and within countries have decreased. This convergence of improved life expectancy and reduced variations, which has occurred even in the presence of widening income gaps in many regions, can be explained solely by the impact of knowledge expansion and direct public health interventions. The increase in life expectancy worldwide will, however, soon reach a plateau, and a retraction has occurred in many countries. HIV/AIDS and civil unrest in Africa, vaccinepreventable diseases and alcoholism in Eastern Europe, and obesity in the United States have reduced—or will soon do so—the years of life their populations can expect. [authors abstract]

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