290 Diet and Health
countries). Other leading causes of death include diarrhoeal disease (almost totally
occurring in developing countries), chronic obstructive pulmonary disease, tuber-
culosis, measles, low birthweight, road-traffic accidents and lung cancer, with only
diarrhoea and low birthweight having a diet-related aetiology. They also calculated
that cancers caused about 6 million deaths in 1990. About 2.4 million cancer
deaths occurred in established market economies and former socialist economies
of Europe. By 1990, therefore, there were already 50 per cent more cancer deaths
in less developed countries than in developed countries.
For their analysis, Murray and Lopez created a new index they called the DALY,
standing for the ‘disability adjusted life year’. A DALY is the sum of life years lost
owing to premature death, and years lived with disability (adjusted for severity). It
is thus a measure of both death and disability (both mortality and morbidity). The
top ten DALYs in all developing regions combined already included ischaemic
heart disease and cerebovascular disease. Murray and Lopez’s report concluded:
‘Clearly, the focus of research and debate about health policy in developing regions
should address the current challenges presented by the epidemiological transition
now, rather than several decades hence.’ Table 13.6 gives their original breakdown
for the world of the DALYs by main disease, present and anticipated.
The authors anticipated that the greatest increase in cardiovascular disease-re-
lated DALYs would occur in developing countries, up from 8.3 per cent in 1990 to
13.8 per cent in 2020 – a rising burden of disease for those countries which could
least afford it. The corresponding increase in developed countries’ DALYs associated
with non-communicable diseases was calculated to be only relatively slight, rising
from 20.4 per cent to 22.0 per cent. (The developed world already had a high base
rate of DALYs from diet-related disease.) (Interestingly, there is hardly any movement
Table 13.6 DALYs lost by cause for the developed and developing countries, 1990 and
2020Cause Developed Developing
1990 (%) 2020 (%) 1990 (%) 2020 (%)
Infectious diseases 7.8 4.3 48.7 22.2
Cardiovascular disease 20.4 22.0 8.3 13.8
Coronary heart disease 9.9 11.2 2.5 5.2
Stroke 5.9 6.2 2.4 4.2
Diabetes 1.9 1.5 0.7 0.7
Cancer 13.7 16.8 4.0 9.0
Neuropsychiatric disorders 22.0 21.8 9.0 13.7
Injuries 14.5 13.0 15.2 21.1Source: Murray, C. J. L and Lopez, A. D. (1996) The Global Burden of Disease: A
Comprehensive Assessment of Mortality and Disability from Diseases. Injuries and Risk Factors
in 1990 and Projected to 2020. Harvard University Press on behalf of the World Bank and
WHO, Cambridge, MA