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According to World Health Organization (WHO) the top 10 causes of deaths in the high income countries/ affluent countries in 2016 were from

 * 1) Ischemic heart diseases
 * 2) Stroke
 * 3) Alzheimer disease and other dementia
 * 4) Trachea, bronchus and lung cancer
 * 5) Chronic obstructive pulmonary disease
 * 6) Lower respiratory infections
 * 7) Colon and rectum cancers
 * 8) Diabetes mellitus
 * 9) Kidney diseases
 * 10) Breast cancer.

Except for the lower respiratory infections all of them are Non communicable diseases. In 2016 WHO reported 56.9 million deaths worldwide and more than half (54%) were due to the top causes of death previously mentioned. .

Diabetes Mellitus
Diabetes is a chronic metabolic disease characterized by increase blood glucose level. Type 2 diabetes is the most common form of diabetes. It is caused by resistance to insulin or the lack of production of insulin. It is seen most commonly in adults. Type 1 diabetes or juvenile diabetes affects mostly children. This condition is due to little or lack of insulin production from the pancreas.

 Prevalence of diabetes 

The prevalence of diabetes had increased in the past three decades. According to WHO 422 million adults have diabetes. The global prevalence of diabetes has increased from 4.7% in 1980 to 8.5 % in 2014. Diabetes has been a major cause for blindness, kidney failure, heart attack, stroke and lower limb amputation.

 Prevalence of diabetes in countries of affluence 

The Centers of Disease Control and Prevention (CDC) released a report in 2015 indicating that more than 100 million Americans have diabetes or pre-diabetes. Diabetes was the seventh leading cause of death in United States in 2015. In developed countries like the United States, the risk for diabetes is seen in people with low socioeconomic status (SES). Socioeconomic status is defined by the education and the income level of a person. The prevalence of diabetes varies by education level. Of those diagnosed with diabetes:12.6% of adults had less than a high school education, 9.5% had a high school education and 7.2% had more than high school education.

Differences in diabetes prevalence are seen in the population and ethnic groups in USA. Diabetes is more common in non-Hispanic whites, who are less educated and have a lower income. It is also more common in less educated Hispanics. The highest prevalence of diabetes is seen in the southeast, southern and Appalachian portion of the United States. In the United States the prevalence of diabetes is increasing in children and adolescents. In 2015, 25 million people were diagnosed with diabetes, of which 193,000 were children. The total direct and indirect cost of diagnosed diabetes in US in 2012 was $245 billion.

In 2009, the Canadian Diabetes Association (CDA) estimated that diagnosed diabetes will increase from 1.3 million in 2000 to 2.5 million in 2010 and 3.7 million in 2020. Diabetes was the 7th leading cause of death in Canada in 2015. Like United States, diabetes in more prevalent in the low socioeconomic group of people in Canada.

According to the International Diabetes Federation, more than 58 million people are diagnosed with diabetes in the European Union Region (EUR), and this will go up to 66.7 million by 2045. Similar to other affluent countries like America and Canada, diabetes is more prevalent in the poorer parts of Europe like Central and Eastern Europe.

In Australia according to self-reported data, 1 in 7 adults or approximately 1.2 million people had diabetes in 2014-2015. People who were living in remote or socioeconomically disadvantaged areas were 4 times more likely to develop type 2 diabetes as compared to non-indigenous Australians. Australia incurred $20.8 million in direct costs towards hospitalization, medication, and out-patient treatment towards diabetes. In 2015, $1.2 billion were lost in Australia's Gross Domestic Product (GDP) due to diabetes.

In these countries of affluence, diabetes is prevalent in low socioeconomic groups of people as there is abundance of unhealthy food choices, high energy rich food, and decreased physical activity. The rich or more affluent people are typically more educated and have tools to counter unhealthy foods such as the availability of better tasting healthy food, physical trainers or better access to parks or fitness centers.

 Risk factors for diabetes 

Obesity and being overweight is one of the main risk factors of type 2 diabetes. Other risk factors include lack of physical activity, genetic predisposition, being over 45 years old, tobacco use, high blood pressure and high cholesterol. In United States, the prevalence of obesity was 39.8 % in adults and 18.5% in children and adolescents in 2015-2016. In Australia in 2014-2015, 2 out 3 adults or 63% were over weight or obese. Also, 2 out of 3 adults did little or no exercise. According to the World Health Organization, Europe had the 2nd highest proportion of overweight or obese people in 2014 behind America.

 Diabetes and developing countries 

According to WHO the prevalence of diabetes is rising more in the middle and low income countries. Over the next 25 years, the number of people with diabetes in developing countries will increase by over 150%. Diabetes is typically seen in people above the retirement age in developed countries, but in developing countries people in the age of 35-64 are mostly affected. Although, diabetes is considered a disease of affluence affecting the developed countries, there is more loss of life and premature death among people with diabetes in the developing countries. Asia accounts for 60% of the world's diabetic population. In 1980 less than 1% of Chinese adults were affected by diabetes, but by 2008 the prevalence was 10%. It is predicted that by 2030 diabetes may affect 79.4 million people in India, 42.3 million people in China and 30.3 million in United States.

These changes are the result of developing nations having rapid economic development. This rapid economic development has caused a change in the lifestyle and food habits leading to over-nutrition, increased intake of fast food causing increase in weight, and insulin resistance. Compared to the west, obesity in Asia is low. India has very low prevalence of obesity, but a very high prevalence of diabetes suggesting that diabetes may occur at a lower BMI in Indians as compared to the Europeans. Smoking increases the risk for diabetes by 45%. In developing countries around 50-60 % adult males are regular smokers, increasing their risk for diabetes. In developing countries, diabetes is more commonly seen in the more urbanized areas. The prevalence of diabetes in rural population is 1/4th that of urban population for countries like India, Bangladesh, Nepal, Bhutan and Sri Lanka.

Public health initiatives
In United States, the Centers for Disease Control and Prevention (CDC) works to prevent or delay the onset of type 2 diabetes through a program called the National Diabetes Prevention Program. This program teaches participants to make healthy lifestyle changes and to prevent the development of the disease. The Australian government runs programs like National Health Priority Areas Initiative, which focuses on the care and attention of chronic diseases like diabetes. The National Health Service of United Kingdom has programs for patient education to improve their quality of life. Diabetes Action Now is a initiative by WHO and International Diabetes Federation to increase the surveillance, prevention and control of diabetes in low and middle income countries.

Alzheimer and other dementia
Dementia is a chronic syndrome which is characterized by deterioration in the thought process beyond what is expected from normal aging. It affects the persons memory, thinking, orientation, comprehension, behavior and ability to perform everyday activity. There are many different forms of dementia. Alzheimer is the most common form which contributes to 60-70 % of the dementia cases. Different forms of dementia can co-exist.Young onset dementia which occurs in individuals before the age of 65 contributes to 9% of the total cases. It is the major cause of disability and dependency among old people.

Worldwide, there are 50 million people who are suffering from dementia and every year 10 million new cases are being reported. The total number of people with dementia is projected to reach 82 million by 2030 and 152 million in 2050.

Prevalence in countries of affluence
According to CDC, Alzheimer is the 6th leading cause of death in U.S adults and 5th leading cause of death in adults over the age of 65. In 2014, 5 million Americans above the age of 65 were diagnosed with Alzheimer. This number is predicted to triple by the year 2060 and reach up to 14 million. Dementia and Alzheimer has been shown to go unreported on death certificates, leading to under representation of the actual mortality caused by these diseases. Between 2000 and 2015, mortality due to cardiovascular diseases has decreased by 11%, where as death from Alzheimer has increased by 123%. 1 in 3 people over the age of 65 die from Alzheimer or other forms of dementia. Furthermore, 200,000 individuals have been affected by young onset dementia. In United States, Alzheimer affects more women than men. It is twice more common in African-Americans and Hispanics than in whites. As the number of older Americans increases rapidly, the number of new cases of Alzheimer will rise too.

East Asia has the most people living with dementia (9.8 million) followed by Western Europe (7.5 million ), South Asia (5.1 million) and North America (4.8 million). In 2016, the prevalence of Alzheimer was 5.05 % in Europe. Like in United States, it is more prevalent in women than in men. In the European Union, Finland has the highest mortality among both men and women due to dementia. In Canada, over half a million people are living with dementia. It is projected that by 2031 the number will go up by 66 % to 937,000. Every year 25,000 new cases of dementia are diagnosed.

Dementia is the second leading cause of death in Australia. In 2016, it was the leading cause of deaths in females. In Australia 436,366 people are living with dementia in 2018. 3 in 10 people over the age of 85 and 1 in 10 people over the age of 65 have dementia. It is the single greatest cause of disability in older Australians. Rates of dementia are higher for indigenous people. In people from the northern territory and western Australia the prevalence of dementia is 26 times higher in the 45-69 year old group and about 20 times greater in 60-69 year old group.

Risk factors in countries of affluence
The risk factors for developing dementia or Alzheimer's include age, family history, genetic factors, environmental factors, brain injury, viral infections,neurotoxic chemicals, and various immunological and hormonal disorders.

A new research study has found an association between the affluence of a country, hygiene conditions and the prevalence of Alzheimer in their population. According to the Hygiene Hypothesis, affluent countries with more urbanized and industrialized areas have better hygiene, better sanitation ,clean water and improved access to antibiotics. This reduces the exposure to the friendly bacteria, virus and other microorganisms that help stimulate our immune system. Decreased microbial exposure leads to immune system that is poorly developed, which exposes the brain to inflammation as is seen in Alzheimer's disease.

Countries like the UK and France that have access to clean drinking water, improved sanitation facilities and have a high GDP show a 9% increase in Alzheimer's disease as opposed to countries like Kenya and Cambodia. Also countries like UK and Australia, where three quarters of their population lives in urban areas, have a 10% higher Alzheimer's rate than in countries like Bangladesh and Nepal where less than one tenth of their population live in urban areas.

Alzheimer's risk changes with the environment. Individuals from the same ethnic background living in an area of low sanitation will have a lower risk as compared to the same individuals living in an area of high sanitation who will be exposed to a higher risk of developing Alzheimer's. An African-American in U.S. has a higher risk of developing Alzheimer's as compared to one living in Nigeria. Immigrant populations exhibit Alzheimer disease rates intermediate between their home country and adopted country. Moving from a country of high sanitation to a country of low sanitation reduces the risk associated with the disease.

Public health initiatives
In 2015, the global societal cost of dementia the U.S. was estimated to be $818 billion. The total cost as a proportion of GDP varied from 0.2% in low income countries to 1.4% in high income countries. The WHO recognizes dementia as a public health priority. In May 2017, WHO endorsed a global action plan on the public health response to dementia.The goal of this plan is to increase awareness, establish more dementia friendly initiatives, reduce the risk of dementia and increase early diagnosis and treatment. WHO has also developed an e-health solution called i support. This e-health solution provides information and skills training for caregivers of dementia patients. The first study of this solution is taking place in India to evaluate its usability and effectiveness.

The CDC has developed an initiative called the Healthy Brain Initiative (HBI). Their focus is to promote brain health, offer better care for people with cognitive impairment and increased attention to caregivers.The four main actions of the HBI are to educate and empower, develop policies and mobilize partnerships, assure a competent workforce and monitor and evaluate.

The Australian government, in addition to the Medicare and pharmaceutical benefit scheme, established the National Dementia Support Program in 2005 .The program aims to improve awareness and understanding about dementia, provide information about the services available to the people with dementia, their caregivers, family and service providers.

In 2014, the government of Canada started the National Dementia Research and Prevention Plan with a goal of finding a cure or disease modifying treatment for dementia by 2025. In 2015, the Federal government of Canada and the Alzheimer's Association started the Dementia Friends of Canada. This program is a digital program created to increase awareness, reduce the stigma, and increase access to information about dementia. Another initiative called Minds in Motion offers physical activity, intellectual stimulation and social engagement for people with early and mid-stage dementia.

Kidney Diseases
In our body the kidneys function to remove toxins, waste and excess fluid from our body. They also help to regulate our blood pressure, stimulate the production of red blood cells and also regulate blood chemicals that are essential for a healthy body. Chronic kidney disease is a condition in which the kidneys are damaged and do not function which causes the wastes, toxins and excess fluid to remain in the body. This may lead to other health conditions like heart diseases, stroke, anemia, low calcium level, increased risk of infections and a low quality of life.

World-wide,10% of the population suffers from Chronic Kidney Disease. According to the Global Burden of Disease study of 2010, chronic kidney disease rose from the 27th place in 1990 to the 18th place in 2010 in the list of causes for total number of deaths worldwide. Although over 2 million people receive treatment in the form of dialysis or kidney transplant, they represent only 10% of the people who actually require treatment. More than 80% of all patients who receive treatment for kidney failure are from affluent countries with a universal health care system and a large aging population. High-income countries spend 2-3% of their annual healthcare budget on the treatment of end-stage kidney diseases.

Prevalence in countries of affluence
According to the Centers for Disease Control and Prevention, 30 million people or 15% of U.S. adults are estimated to have chronic kidney disease. It is the 9th leading cause of death. African-Americans are thrice more likely to develop end-stage renal disorder as compared to Caucasians. Also, the risk of developing end-stage renal disorder is 35% higher in Hispanics as compared with non-Hispanics.

One in Ten Canadians has kidney disease. Since 2007, the number of people living with kidney disease has increased by 36%. In 2014, kidney disease was the 11th leading cause of death in Canada. In Australia, chronic kidney disease effects one in ten adults, which is approximately 1.7 million people.

About 10% of the European population is affected by chronic kidney disease. About 70 million people have lost some of their renal function and are at risk for dialysis or transplantation. The reasons for this can be attributed to the large aging population of Europe, as loss of renal function is a symptom of old. The prevalence of chronic kidney disease varies greatly between different European countries. In 2016, the prevalence in Norway was 3.31 % and 17.3% in Northeastern Germany.

In affluent countries like USA, Canada, and Australia, chronic kidney disease is more prevalent in the low socioeconomic status population due to behavioral, metabolic risk factors, and reduced access to care.

Risk factors
Diabetes, hypertension and cardiovascular diseases are all a major cause of chronic kidney disease. Smoking and obesity, which are important risk factors for diabetes, hypertension and cardiovascular diseases, also cause and exacerbate chronic kidney disease.The burden of chronic kidney disease is growing greatly in developing nations due to the epidemic of diseases like diabetes, hypertension and cardiovascular diseases.

Public health initiatives
In 2006, the CDC established Chronic Kidney Disease Initiative to provide public health strategies to promote kidney health. These strategies include preventing and controlling risk factors for chronic kidney diseases, early diagnosis, creating awareness and improving quality of life for people with chronic kidney disease.

Kidney Health for Life (KH4L) is an international multi-stake holder initiative with support from the International Society of Nephrology.Their emphasis is on early detection, management and to reduce gaps and inequalities in care They also help to guide national strategic initiatives for the care of chronic kidney disease patients.The initial phase of KH4L focused on Canada, Israel and countries in Europe.

In Australia, chronic kidney disease is addressed at national level through a range of programs and initiatives to support treatment and management of renal problems. Funding is provided for clinical research and to support organ donation.

Cancer
Cancer is a generic term for a large group of disease which is characterized by rapid creation of abnormal cells that grow beyond their usual boundaries. These cells can invade adjoining parts of the body and spread to other organs causing metastases, which is a major cause of death.

According to WHO, Cancer is the second leading cause of death globally. One in six deaths worldwide are caused due to cancer, accounting to a total of 9.6 million deaths in 2018.Tracheal, bronchus, and lung cancer is the leading form of cancer deaths across most high and middle-income countries.

Prevalence in countries of affluence
In United States, 1,735,350 new cases of cancer will be diagnosed in 2018. Most common forms of cancer are cancer of the breast, lung, bronchus, prostrate, colorectal cancer, melanoma of skin, Non-Hodgkin's lymphoma, renal cancer, thyroid cancer and liver cancer. Cancer mortality is higher among men than in women. African-Americans have the highest risk of mortality due to cancer. The national expenditure on cancer care in United States was $147.3 billion in 2017 and it is estimated to rise further due to the aging population.

Cancer is the leading cause of death in Australia. One in two men and women will be diagnosed with cancer by the age of 85. The most common cancers in Australia are prostrate, breast, colorectal, melanoma and lung cancer. They account for 60% of the cancer cases diagnosed in Australia.

Europe comprises of only 1/8 of the total world population, but has around one quarter of the global total cancer cases with 3.7 million new cases each year. Lung, breast, stomach, liver, colon are the most common cancers in Europe. The overall incidences among different cancers vary across countries.

About one in two Canadians will develop cancer in their lifetime, and one in four will die of the disease. In 2017, 206,200 new cases of cancer were diagnosed. Lung, colorectal, breast, and prostate cancer accounted for about half of all cancer diagnoses and deaths.

Risk factors
High prevalence of cancer in high-income countries is attributed to lifestyle factors like obesity, smoking, physical inactivity, diet and alcohol intake. Around 40% of the cancers can be prevented by modifying these factors.

Public health initiatives
The CDC has taken numerous initiatives for control and prevention of cancer. The programs like Colorectal Cancer Control Program, the National Breast and Cervical Cancer Early Detection Program focus on early detection, screenings, promoting healthy lifestyle among low socioeconomic group of people. The National Comprehensive Cancer Control Program assesses the burden of cancer and implements comprehensive cancer control programs. The CDC also has different educational programs which educate the people about symptoms of cancer and about reducing their risk for cancer.

In Australia, the Department of Health funds research, prevention and detection through population screening programs. Cancer Australia is an agency that works towards reducing the health outcome disparities among different groups of people who have poorer than average cancer survival rates.

Canada fights cancer through Canadian Strategy for Cancer Control (CSCC).The goals of CSCC are to reduce the incidence, mortality and morbidity of cancer and improve the quality of life for those living with cancer. The CSCC also focuses on improving integrated healthcare, supportive care, palliative care, and the harmonization with provincial, territorial and federal health plans.