Noncommunicable disease risk factors and socioeconomic inequalities - what are the links? A multicountry analysis of noncommunicable disease surveillance data
The growing burden of noncommunicable diseases (NCDs) - especially cardiovascular disease, cancer, chronic respiratory disease and diabetes - affects all levels of society in rich and poor countries and is contributing to increasing proportions of the total burden of disease, especially among adults. In 2005, NCDs accounted for at least 50% of all deaths worldwide and projections indicate that, by 2015, at least 60% of deaths will be attributable to NCDs. Socioeconomic factors have been recognized as playing a major role in the distribution of NCDs in both wealthy and poor countries.In developed countries, evidence shows that NCDs and their risk factors initially occur in groups with the highest socioeconomic status and those living in urban areas, before the burden of disease shifts to all social groups. Also, that those from groups with higher socioeconomic status are usually the first to respond to NCD prevention campaigns, while those with groups with lower socioeconomic status continue to experience increasing rates of NCDs. It has been argued that these patterns are likely to be replicated in developing countries, with the NCD burden shifting gradually to those with lower educational attainment or economic status. The double burden of disease that currently challenges many developing countries will place increased stress on already stretched clinical and prevention resources, with those from households with lower socioeconomic status possibly receiving inadequate care for both noncommunicable and communicable diseases.This report presents the results of analysis of population-level surveillance data on NCD risk factors from selected countries in the Region, namely, China, Fiji, Malaysia, Nauru and Philippines. Specifically, the aim was to conduct comparable cross-country analyses to examine the relationships between NCD (behavioural) risk factors and indicators of social disadvantage and socioeconomic status. The central research question was whether the distribution of risk factors within countries is similar across socieconomic groups between different countries, cultures and economies, or different, and in what way the differences are manifest. Although this question has been explored in developed countries to a large extent, cross-national data from deveoping countries are sparse. The policy and programme implications of these results are also briefly discussed.