In the past 30 years, there has been appropriate, effective emphasis in research and action on tropical diseases, the health of children, the communicable diseases of childhood, and maternal health. Surviving childhood is not the only hurdle, however: 27 percent of all deaths in developing countries occur among adults ages 15 to 59; 72 percent of those deaths are avoidable.
The nature, distribution, and trends of adult mortality in developing countries challenge preconceptions: noncommunicable diseases and injuries are the leading causes of death among adults in most developing countries. Deaths from noncommunicable diseases among adults are increasing both in absolute numbers and in relative importance. These high mortality rates are accompanied by substantial (and costly) levels of morbidity.
The noncommunicable diseases, commonly thought of as diseases of the rich, actually cause higher death rates among individuals in poorer populations. Poor adults suffer more often from severe ill health, are more likely to depend on regular physical work, and have fewer resources with which to cope. Consequently, they are more heavily penalized by ill health, which also has major impacts on children, family, and society, so that the health risks that they take may have direct or indirect deleterious effects on the health of individuals in other age groups. Since adults make up the majority of the labor force, their ill health or death also tends to have negative effects on productivity and may be related to the slow pace of development in some countries.
Sick adults consume substantial proportions (often more than half) of health sector resources in developing countries. Yet, because adult ill health involves more noncommunicable disease, more long-term morbidity and disability, and more lifestyle risk factors, policy makers cannot reduce the numbers of adults with ill health simply by expanding policies that have been successful in improving child health.
There are large gaps in knowledge about the levels, causes, distribution, and determinants of sickness and death among adultscancer, cardiovascular disease, chronic obstructive lung disease, diabetes, injuries, sexually transmitted diseases (including human immunodeficiency virus infection and AIDS), and tuberculosis. Because morbidity is poorly understood and hard to measure, policy in both the curative and preventive subsectors is rudimentary, and there is imbalance between current resource allocations and reality. Absent better data, understanding, and policies, expenditures on sick adults will grow rapidly and sometimes inappropriately, as in the developed