Rethinking the “diseases of affluence” paradigm in global health: patterns of obesity and cardiovascular risk factors in relation to economic development

Majid Ezzati, Harvard University
Stephen Vander Hoorn, University of Auckland
Carlene Lawes, University of Auckland
Rachel Leach, International Obesity Task Force (IOTF)
W Philip T James, International Obesity Task Force (IOTF)
Alan D Lopez, University of Queensland
Anthony Rodgers, University of Auckland
Christopher J.L. Murray, Harvard University

Cardiovascular diseases and their risk factors – including overweight and obesity, elevated blood pressure and cholesterol – are among the leading causes of global mortality and morbidity, and have been predicted to rise globally with economic development. When considered in relation to national income, overweight and obesity currently rise rapidly, then flatten, and eventually decline. A similar, but lagged, pattern is observed for cholesterol but average population blood pressure is not correlated or weakly correlated with national economic variable. When considered together with evidence on shifts in income-risk relationships within developed countries, these results indicate that cardiovascular disease risks are expected to systematically shift to low-mid-income countries and further increase global health inequalities. Utilizing cost-effective interventions for blood pressure and cholesterol in mid-income countries can partly counter this. Preventing and reducing obesity should be a priority from early stages of economic development.