The world’s biggest killer that you never considered

Some of the world’s big challenges get a lot of attention. Climate change, war and immigration are constantly in the news and receive large funding from states and private philanthropies. Other significant problems like tuberculosis and nutrition receive less airtime and awareness, but count among major global priorities, with funding allocated.

Even the aptly named Neglected Tropical Diseases like rabies, river blindness and leprosy, which kill 200,000 people each year in poorer countries, have their own programmes and attention in the World Health Organisation.

But there is a challenge which we hear little to nothing about that affects more than a billion people and could be addressed very efficiently. We could reasonably call it the Neglected Enormous Disease.

The world has made large inroads tackling infectious diseases. Two centuries ago, it routinely caused almost half of all death, but today it kills less than 15 per cent. Instead, half of all death is caused by the two biggest killers, cardiovascular disease and cancer. Cancer causes about 18 per cent of all deaths, but it is hard and costly to tackle with only modest success rates, which is why most treatment happens in rich countries.

The biggest killer of all, which is technically called cardiovascular disease but mostly consists of heart attacks and strokes, kills more than 18 million people each year, making up a third of all global deaths. A big part of the problem is unhealthy diets, physical inactivity, tobacco and alcohol use, which causes obesity and high blood pressure.

While doctors will tell you to stop smoking, cut down on alcohol and salt, exercise more, and eat fewer calories but more fruit and vegetables, this advice is evidently fairly difficult to follow. Tobacco and alcohol regulation can make this easier, along with reducing the levels of salt in ready-made meals.

But focusing on high blood pressure is key to turning around this Neglected Enormous Disease. Incredibly, the indicator of high blood pressure is the single biggest global death risk, leading to almost 11 million deaths annually, causing 19 per cent of all fatalities in the world.

As the world’s population is aging, ever-more people are affected. The number of people living with blood pressure doubled in the past 30 years, to about 1.3 billion people. Because there are no obvious symptoms, almost half do not even know it, and four out of five people are not adequately treated.

This combination makes high blood pressure both enormously impactful and surprisingly neglected.

The good news is that treating high blood pressure is incredibly cheap and effective with one or more pills that are off-patent and cost next-to-nothing. This is done fairly well in rich countries, but we should be doing this across the whole world.

Community screenings for high blood pressure cost as little as $1 per person, and the prescription of blood pressure medications often cost only $3–11 per year.

Peer-reviewed research shows that controlling high blood pressure in the poorer half of the world would cost about $3.5 billion annually. But it would save almost a million lives each and every year. Put into economic terms, each dollar spent would achieve $16 in returns to society, making it one of the world’s most efficient policies.

Despite becoming a bigger killer than infectious diseases, even in the developing world, chronic diseases like cardiovascular disease receive very little funding. External funding accounts for almost 30 per cent of health spending in low-income countries, but only 5 per cent of all this funding goes toward chronic diseases. In Nigeria, where heart disease is now responsible for one in ten deaths, the Federal Ministry of Health’s Non-communicable Disease Division has launched a new programme to control high blood pressure. This is an excellent start — but it is vital that donors step up their support for programmes that increase access to affordable, comprehensive high-quality prevention and treatment services for high blood pressure not only across Africa but in all developing nations.

High blood pressure is the world’s leading global killer risk, yet it receives little attention and even less funding. For just $3.5 billion annually, we can implement one of the best solutions for the world, saving millions of lives. We just need to know.

Bjorn Lomborg is president of the Copenhagen Consensus and visiting fellow at Stanford University’s Hoover Institution. His new book is “Best Things First”, which The Economist named one of the best books of Project Syndicate 2023.