and we’re still not talking about why.
Heart disease, cancer, diabetes and chronic respiratory disease are killing millions. But the real story isn’t just disease. It’s the food we eat, the air we breathe, the systems we live in, and the industries shaping our choices.
What if some of the world’s biggest killers aren’t just medical problems, but failures of prevention, public policy and collective responsibility
Every two seconds, someone, somewhere in the world, under the age of 70 dies from a noncommunicable disease (NCD).
How shocking is that?
These are not rare conditions. They are not confined to one country, one culture or one income group. They are among the greatest threats to global health and many of the deaths they cause could be prevented or delayed.
According to the World Health Organization (WHO), NCDs accounted for approximately 43 million deaths in 2021, equivalent to 75% of all deaths not caused by the COVID-19 pandemic.
Around 18 million people died from an NCD before reaching the age of 70. The vast majority of which occurred in low and middle-income countries.
- Heart disease is the single biggest cause of death in the world. Yet 86% of heart disease deaths could be prevented.
- 8M deaths are caused by unhealthy diets annually.
- Cancer is responsible for 1 in 6 deaths globally: 9.3M deaths. The same number of visitors to the Paris Louvre in 2019.
- Whilst you can’t prevent Type 1 diabetes. Type 2 can be.
- Diabetes causes 2M deaths annually.
These are not simply statistics. They represent lives cut short, families changed forever, communities placed under strain, and years of health and well-being lost.
And yet, the scale of this crisis rarely seems to generate the urgency it deserves.
The WHO calls them Silent Killers.
Perhaps the most uncomfortable question is this: if we know so much about what drives these diseases, why are we still failing to prevent so many of them?
Source: WHO — Noncommunicable diseases.
The Killers and Their Accomplices
NCDs often develop quietly. High blood pressure may go unnoticed for years. Type 2 diabetes can progress before symptoms become obvious. Some cancers remain undetected until they are advanced. Chronic respiratory disease may gradually limit a person’s ability to breathe, work and live fully.
The consequences can be devastating.
The major NCDs share a number of important, modifiable risk factors:
- Tobacco use
- Unhealthy diets
- Physical inactivity
- Alcohol consumption
- Air pollution
Other important risk factors include raised blood pressure, obesity and elevated blood glucose.
These factors can be reduced through prevention, healthier environments and effective public health policies.
Genetics also matters. Not every disease can be prevented, and not every risk can be controlled. Type 1 diabetes, for example, is not currently preventable, whereas many cases of type 2 diabetes can be prevented or delayed.
But knowing the risk factors is not the same as creating the conditions in which people can avoid them.
That is where the story becomes bigger than medicine.
The silent killers have accomplices. And some of those accomplices are embedded in the systems we have built.
Follow the Money. Follow the Environment.
The WHO’s The #SilentKillers campaign makes an essential point: Health is shaped not only by individual behaviour, but also by commercial interests, social conditions, environmental exposures and public policy.
Nutritious food may be unaffordable or difficult to access. Ultra-processed products can be aggressively marketed. Alcohol and tobacco industries have powerful commercial incentives to maintain consumption. Air pollution may be a consequence of transport systems, industrial activity and inadequate environmental regulation.
There may be no safe place to exercise. Preventive healthcare may be inaccessible. Essential medicines may be too expensive. Screening and early diagnosis may be limited by geography, cost or a lack of healthcare infrastructure.
Then we tell people to make better choices…
A person cannot simply choose clean air when the air around them is polluted. A family cannot consistently choose affordable, nutritious food if it is unavailable or beyond their budget. And a patient cannot manage a chronic condition effectively without access to diagnosis, treatment and ongoing care.
This isn’t just about personal choices. It’s about questioning the systems and industries that shape them.
This is the territory of the phrase commercial determinants of health: the ways commercial activities, products and business practices influence health, both positively and negatively.
When commercial success depends on selling products that increase disease risk, public health must ask difficult questions. When the costs of illness are borne by individuals, families and healthcare systems while profits accrue elsewhere, we must ask who benefits and who pays.
This is not an argument against commerce. It is an argument for accountability.
Prevention cannot rest entirely on the shoulders of individuals while the environments around them continue to undermine their health.
A Crisis of Inequality
Whilst the burden of NCDs is global, it is not shared equally.
According to the WHO 27% of the world’s burden takes place in high-income countries. This is not a poverty issue. We cannot use lack of money/options as an excuse – this is wilful ignorance. ‘NCDs thrive in environments shaped by the commercial determinants of health – where profit is placed before well-being.’
When prevention is underfunded and diagnosis comes too late, manageable conditions can become life-threatening. When treatment is unaffordable, people may be forced to choose between their health and other basic needs. No-one should have to make that choice.
NCDs are not simply a healthcare challenge. They are also a development challenge, an economic challenge and a question of social justice.
We should be careful not to confuse unequal resources with a lack of concern or knowledge. Lower-income countries face genuine constraints, including limited funding and healthcare capacity. The answer is not to blame the people carrying the greatest burden, but to invest in prevention, accessible treatment and stronger health systems.
Nor should wealthier countries assume they are protected. NCDs affect every region and income group.
Wherever we live, the question is whether our systems are designed to protect health or whether they allow preventable risks to become normal.
Explore the data: WHO Noncommunicable Disease Data Portal.
- In 2021 23% of deaths from NCD’s in the UK and France were under 70 years old.
- The same year 35% of deaths from NCD’s were in under 70 year olds in the States.
- In 2019 the comparable stats were 61% in Africa.Share
Prevention Is Not a Slogan
Prevention is often discussed as if it were a simple matter of telling people what to do: eat better, exercise more, stop smoking, drink less and attend health checks.
These are important measures. But effective prevention must go further.
It requires access to nutritious food, safe places to be physically active, clean air, effective tobacco and alcohol policies, affordable medicines and healthcare systems that support people throughout their lives.
It also means recognising that prevention and treatment are complementary, not competing, priorities.
We need to reduce exposure to risk factors. We also need to detect disease early, treat it effectively and support people already living with chronic conditions.
High blood pressure, elevated cholesterol and raised blood glucose can often be identified through appropriate screening and managed with lifestyle support and medical treatment. Early intervention can reduce complications and save lives.
The same principle applies to the broader environment: healthier public spaces, better food policies and stronger environmental protections can reduce risks before people become patients.
Let’s recognise that many risks are modifiable, many deaths are avoidable or delay-able, and many opportunities for intervention are being missed.
Prevention is not simply a matter of personal discipline. It is a commitment to building societies in which people have a fairer chance of staying healthy.
Where Traditional, Complementary and Integrative Medicine Fits In
If the NCD crisis demands a more comprehensive approach to health, we must also consider how healthcare itself can evolve.
This brings us to traditional, complementary and integrative medicine.
These terms are related, but they are not interchangeable:
Traditional medicine encompasses knowledge and practices rooted in different cultural and historical contexts.
Complementary medicine refers to approaches used alongside conventional medical care.
Integrative medicine seeks to coordinate evidence-informed approaches to support health and well-being.
The WHO describes integrative medicine as:
An interdisciplinary and evidence-based approach to health and well-being that combines biomedical and traditional and/or complementary medical knowledge, skills and practices.”
The key words are interdisciplinary and evidence-based.
An integrative approach does not mean accepting every traditional remedy or complementary therapy without scrutiny. Nor does it mean replacing effective medical treatment with an alternative.
It means asking what the evidence supports, what is safe, what meets the needs of the individual, and how different approaches can work together responsibly.
Depending on the person and the clinical context, this might include conventional medical treatment alongside support for physical activity, nutrition, stress management, sleep or practices such as prayer. Other complementary approaches may have a role where evidence supports their use.
The priority must remain the same: patient safety, informed choice, effective treatment and meaningful improvements in health and quality of life.
A thoughtful, evidence-based integrative approach can contribute to a broader vision of healthcare: one that values prevention, considers the whole person, encourages collaboration and recognises that well-being involves more than treating disease after it develops.
It offers an opportunity to ask a different question.
Instead of asking only how we treat illness, how do we create the conditions that help people remain healthy and how do we support those whose health has already been compromised?
The Bigger Picture: Health Is Everyone’s Business
The Silent Killers thrive when risks go unnoticed, prevention is neglected and responsibility is fragmented.
Healthcare professionals can diagnose and treat. Researchers can strengthen the evidence base. Communities can advocate for healthier environments. Governments can invest in prevention, regulate harmful products and improve access to care. Businesses can be held accountable for the health consequences of their practices.
Individuals deserve the knowledge, resources and support to make informed decisions about their own health.
No single intervention will solve the NCD crisis. No one discipline has all the answers.
We need effective biomedical care, better prevention, equitable health systems, responsible commercial practices, healthier environments and a willingness to learn from different medical traditions without abandoning scientific standards.
Above all, we need to stop treating the consequences of unhealthy systems as though they were solely the fault of unhealthy individuals.
The evidence is clear: NCDs account for an enormous share of global deaths, and many of their risk factors are preventable or manageable. The challenge is turning that knowledge into action.
The silent killers count on remaining invisible.
Our task is to make the risks visible, challenge the forces that perpetuate them and build a more comprehensive, equitable and evidence-informed approach to health.
The real measure of a healthcare system is not just how well it treats disease. It is also how effectively it prevents avoidable suffering.
Further reading:
- WHO: The #SilentKillers
- WHO: Noncommunicable diseases — facts and figures
- WHO: Invisible numbers — the true extent of NCDs and what to do about them
- NCD Data PortalNoncommunicable diseases (NCDs)
- NCD Quiz from Kahoot
‘Til next time, Denise
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