Healthy Cities: Old and New Solutions - Theme Cities: Solutions for Urban Problems - page 482

of a total mortality of 57 million, which has led to calls for urgent world attention
to be paid to these problems (WHO 2010 ). Yet despite the major advances that have
taken place in the treatment of such diseases, especially if the problem is diagnosed
early, Table 13.1 shows they are still predicted to be the highest ranking sources of
mortality in the foreseeable future. Moreover, these chronic diseases are no longer
restricted to the developed world, for 80 % of the deaths from such causes now take
place in low or medium income countries, places that are the least equipped to deal
with such problems. Clearly there is need for more research into the cures for these
problems, some of which come from long exposures to unhealthy environments or
poor life-styles over many years, which means better health education and moni-
toring. Also more treatments for such diseases in the developing world is needed.
Indeed it has been estimated that less than 3 % of the international development
assistance going to developing countries is spent on non-communicative diseases
(WHO 2010 ), showing the continued fixation with diseases spread by infections.
A related issue here is the increased costs of providing care for patients with such
chronic conditions, which require longer periods of care and greater expense.

13﻽4﻽2﻽2 Aging

These changes in the causes of mortality are also related to the general problem
of coping with aging, for it is estimated that the global population of those over
65 years will almost double from the current 600 million to 1.1 billion by 2035,
resulting in a change from 8 to 13 % of the population. Some of these people will be
healthy and active but many will have ill-health and there is predicted to be major
increases in the numbers of people suffering from various forms of dementia, such
as Alzheimer's, for which there is no known cure at present, except for interventions
that help to delay or reduce its impacts. Recent estimates show that 35.6 million
people in the world are already suffering from this disease of cognitive impairment
and loss, conditions that already leads to health care costs of $ 604 billion (WHO-
ADI 2012 ). The numbers with dementia are predicted to almost double by 2030
and will more than triple to 115.4 million sufferers by 2050. This will require much
larger numbers of senior centres and homes to cope with, and treat, the growing
number of patients, as well as finding enough qualified staff. It has been known that
many life-style factors are correlated with those who have the disease; for example,
people who are active and socially integrated and those with higher educational
attainments less likely to be at risk. In 2014 a major new study focused on the
impact of a series of modifiable life-style factors on the incidence of Alzheimer's,
a major type of dementia (Norton et al. 2014 ). It revealed that seven factors—physi-
cal inactivity, smoking, mid-life hypertension, midlife obesity, diabetes, depression
and low educational attainment—were all significantly correlated with the disease
and that one-third of cases could be avoided by changes in life-style. For example,
those who did not engage in at least three 20 min bursts of rigorous exercise a week
were 82 % more likely to develop the disease. The importance of the study is that
the estimated huge increase in numbers could be drastically reduced by these life-