"Bold and creative policies" are needed to address harmful alcohol consumption, improve diet and increase physical activity, say Imperial researchers.

In a review published in the New England Journal of Medicine, Professors Majid Ezzati and Elio Riboli note that some high-income countries have succeeded in reducing smoking and to a lesser extent cutting salt consumption through taxes and sales restrictions, contributing to declines in deaths from lung cancer and heart disease.

Obesity and diabetes have proved harder to tackle and will require more imaginative solutions, they argue.

Smoking among men declined by more than half in English-speaking countries and northern Europe during the second half of the 20^th century, followed by more than two decades of decline in lung cancer. The majority of the one billion or more smokers in the world are now in low- and middle-income countries, including more than 60 per cent of men in some countries in eastern Europe and east Asia.

Harmful alcohol consumption has been curbed in some western countries but remains a major public health burden or is worsening in others, especially in eastern Europe and Latin America.

Body mass index, the researchers say, is the “wild card” of risk factors, having increased almost everywhere in recent decades - a rise that threatens past gains in life expectancy in many countries .

Although trends in dietary components are harder to elucidate, the researchers noted that salt consumption decreased in countries like Japan and Finland in parallel with a decline in rates of stomach cancer and haemorrhagic stroke. They also highlighted the rapid rise in consumption of animal fats in Asian countries such as China, which appears to be linked to a rising trend in cholesterol.

Professor Ezzati, from the School of Public Health at Imperial College London, said: “Many countries have succeeded in reducing the disease burden of smoking and alcohol through taxes and sales restrictions, but they still account for a major proportion of non-communicable diseases worldwide. Governments should take note of the success stories and replicate the policies that have been effective.

Professor Riboli noted: “Excessive body weight and lack of physical activity are growing problems across the globe, and they account for a huge burden of cancers and diabetes. Currently there are few policies that have proven effective for tackling them at the population level. The success of cutting lung cancer by reducing smoking should inspire us to come up with bold and creative solutions to deal with other risk factors.”

Reference

M Ezzati, E Riboli ‘Behavioral and Dietary Risk Factors for Noncommunicable Diseases.’ N Engl J Med 2013; 369:954-964 September 5 2013 DOI: 10.1056/NEJMra1203528