2. Demographic Changes in Size and Age of Populations
The first driver of increase in the burden of NCDs is aging of the population mainly due to global successes in improved life expectancy combined with a declining fertility rate (11-131212, 13). Importantly, persons over the age of 65 years are several times more likely to develop NCDs compared with individuals less than 65 years (2, 14, 15).
3. Increasing Tobacco Use
Tobacco is the most important established modifiable risk factor for CVDs. Currently, about 80% of the 1.2 billion smokers live in low and middle income countries (LMIC), particularly in Asia, while smoking is falling in most developed countries (1) (16) 171, 16, 17). Therefore, there will be another 30 years before the full impact of smoking will become apparent because of the substantial time-lag between exposure to cigarette smoking and disease onset (1, 16, 17).
4. Changing Lifestyle Behaviors
Over the past two decades, the percentage of urbanization has increased dramatically: among the total world population by 4%, and even more so in East Asia and the Pacific, by 8% (18). Increased urbanization is often liked with the adoption of habits and lifestyles that tend to be hazardous to health including high fat and energy diets and sedentary lifestyles at the expense of traditional social and cultural habits (3, 19, 203, 19, 20). In comparison, physical activity appears to be declining due to modernization, and changes in occupational behaviors (3, 19, 20). Accordingly, there will be a considerable increase in overweight and obesity. Today, more than a billion adults are overweight, of which 300 million are clinically obese (21). Given that obesity and dietary habits represents potential risk factors for CVDs, type -2 diabetes and some types of cancer in absence of physical activity, it is non-surprising that the epidemic of overweight and obesity will be paralleled by the global epidemic of type-2 diabetes and consequently CVDs and cancer particularly in developing countries.
5. Prevention and Control of NCDs in LMIC
In conclusion, the primary prevention efforts focused on healthy diet, physical activity and the avoidance of tobacco smoking seems to be the three main pillars of NCDs prevention. The available data from the WHO and community-based intervention trials have come mainly from developed regions indicate that 80% of all the cases of CVDs and type-2 diabetes as well as 40% of all cancer cases could be prevented through abovementioned primary preventions (6). These experiences could be highly applicable in NCDs prevention and lifestyle modification in developing nations as well.
