Changing lifestyles and health Background paper for Technical Discussions at 43rd Session of Regional Committee, September, 1991, World Health Organization, Regional Office for the Western Pacific, Manila, Philippines.

By early next century a majority of deaths in the countries classed as 'developing' will be due to chronic non-communicable diseases (NCDs). Such countries must now seek to counter the rise of NCDs while continuing the fight against traditional killers. 'Lifestyles'--socially sustained styles of living viewed in their material aspect--are major determinants of most diseases that vary markedly across cultures and through time, not just of those NCDs that typically increase with socio-economic modernization. Earlier phases of socio-economic development also brought with them adverse as well as beneficial effects on health. Living in cities greatly increased the transmissibility of infection but has since been made compatible with good health. The 'lifestyle diseases' associated with socio-economic modernization pose difficult public health challenges: they often arise from the otherwise welcome 'first fruits of affluence' and there is typically a long delay between the behaviours involved and their health effects. Major efforts may be required, over several decades, to first contain adverse trends and then to encourage favourable trends. The first task may be to help build constituencies for action by documenting and publicizing the likely health impact of the elements of lifestyle involved. In most industrialized countries, earlier adverse trends in the NCDs have been either reversed (heart attack, traffic injuries) or contained (lung cancer) in the last 2 decades, showing that such health costs are not a price that must inevitably be paid for by the other benefits of modernization.