ANN ARBOR—Major health care problems associated with noncommunicable diseases like heart disease, cancer, diabetes and chronic respiratory conditions are not unique to the United States. In fact, NCDs are a concern across the globe, and are growing at an alarming rate in some developing regions like Latin America.

The unprecedented increase can be attributed in part to rapid urbanization and the influence of western lifestyles, say University of Michigan School of Public Health researchers, who have received funding to develop a program for Latin America aimed at prevention of these diseases.

Ana Diez-Roux, professor and chair of epidemiology and director of the Center for Integrative Approaches to Health Disparities and of the Center for Social Epidemiology and Population Health, and Eduardo Villamor, associate professor of epidemiology, are co-principal investigators on a $1.4 million National Institutes of Health five-year grant that will provide several levels of training to health professionals aimed at reversing the growth of NCDs.

The program is based at the Center for Social Epidemiology and Population Health and establishes partnerships with two research sites in Latin America, the Comprehensive Center for the Prevention of Chronic Diseases from the Institute of Nutrition for Central America and Panama in Guatemala, and the National University of Lanus in Buenos Aires.

“Latin America is an exciting and important region to work and establish these bridges,” Villamor says.

Diez-Roux says that noncommunicable diseases are a major cause of morbidity and mortality in Latin America.

“In addition, social and economic changes occurring throughout the region are increasing the prevalence of cardiovascular risks factors,” she says. “It is, therefore, imperative to support training in the area in order to better understand the determinants of noncommunicable diseases in these countries and develop the most effective policies and interventions to reduce the population burden of these conditions.”

The education will involve training junior-level health care professionals at U-M’s School of Public Health and in Latin America, Villamor says. The program will provide scholarships for U-M public health graduate and postdoctoral students from Latin America. The onsite training will take the form of workshops, online journal clubs and webinars. Research will be promoted through the training experiences of the Latin American scholars.

“Rapid environmental changes—including changes in diet and physical activity patterns—are occurring in Latin America, and it is important to document how they are occurring and how they are affecting people’s health,” Villamor says.

These changes involve diets that are high in refined sugars, saturated fat and salt, and marked declines in physical activity, all of which are contributing to an obesity epidemic, he says.

Diez-Roux says lessons learned from combating these illnesses in other regions have influenced their approach to this project.

“Two important things that we have learned—and that are, in fact, the focus of our project—are that social and economic conditions have a profound impact on the overall incidence and distribution of NCDs, and that conditions early in life, indeed over the full life course, are crucial to understanding the risk of chronic diseases later in life.

“This is why interventions and policies that address the multilevel determinants—from social and economic policies to risk factor screening and control—at all stages of life will be necessary to reduce NCDs.

“At the end of the program, we hope to see a cadre of rigorously trained investigators leading independent research on NCDs in Latin America, focusing on understanding the determinants and policies that are most relevant in the Latin American context.”

Facts about noncommunicable diseases cited in the proposal:

• Globally, NCDs account for 63 percent of deaths, and between 37 percent and 86 percent of disability-adjusted life years, which are calculations of the number of years lost due to illness, disability or death.
• Low- and middle-income countries currently experience 80 percent of the world’s deaths due to NCDs, and the absolute number in these nations is expected to rise by more than 50 percent by 2030.
• In 1990, NCDs and injuries accounted for 69 percent of deaths and 65 percent of disability-adjusted life years in Latin America. By 2000, the diseases accounted for 73 percent of deaths and 76 percent of disability-adjusted life years.
• About 60 percent of the population of Latin America is overweight or obese.
• Demographic changes, including increases in both life expectancy (from 65.4 years in 1975-80 to 72.2 in 2000-05) and in the proportion of the population 65 or older (projected to increase from 5.5 percent in 2000 to 9.8 percent in 2025), are leading to a greater number of chronic diseases.
• Cardiovascular disease tops the list as the most critical NCD issue in Latin America. Between 1990 and 2020, mortality associated with ischemic heart disease and cerebrovascular disease is projected to increase by more than 140 percent and 138 percent, respectively.

For more information, see: http://projectreporter.nih.gov/project_info_description.cfm?aid=8335689&icde=13742778