The Asian and Pacific region is undergoing a "health transition" characterized by a rise in the prevalence of non-communicable or chronic diseases.

Infectious and parasitic diseases have historically been the main causes of death in Asia and the Pacific. The contribution of cancer, cardiovascular diseases, chronic obstructive pulmonary diseases and others to mortality has increased considerably in the last few years. In 2005, chronic diseases accounted for 64 per cent of all deaths in the Asian and Pacific region, and they are now the leading causes of mortality in almost all subregions.

Chronic diseases account for 81 per cent of deaths in high-income economies, compared with 76 per cent in middle-income economies and half of all deaths in low-income economies. Cancer and cardiovascular diseases, accounting for 31 per cent each, are the leading causes of death in high-income economies (table 8.1).

In Central Asia, 80 per cent of deaths are caused by chronic diseases - the highest percentage among all subregions. Cardiovascular diseases are the main single cause, accounting for 55 per cent of all deaths. In Georgia, three quarters of all deaths are caused by cardiovascular diseases, while in the Russian Federation three in five deaths are due to such diseases.

An increasing prevalence of risk factors, such as tobacco and alcohol consumption, unhealthy diets and physical inactivity, contribute to the surge in chronic diseases, particularly in high-income economies.

Several Asian countries have some of the highest proportions of the population smoking in the world. In Indonesia, the Lao People's Democratic Republic and Armenia, the prevalence of smoking among male adults exceeds 65 per cent. In others, such as Malaysia, the Philippines, Bangladesh, China and the Russian Federation, more than half of the male population smokes. Although the prevalence of smoking among women is lower than among men everywhere, there are still countries where a considerable part of the female population smokes, as in Bangladesh, Nepal and Turkey.

Figure 8.1 Prevalence of smoking among women compared with men in selected Asian countries, latest year between 2001 and 2005

This high prevalence of smoking in the region does not appear to be likely to fade in the near future, since smoking among youths aged 13-15 is also widespread. In the Russian Federation and Georgia, more than a quarter of all adolescents smoke, while in Bhutan and India, the number is close to one in five. In the Pacific, the Cook Islands and Palau are noteworthy in that the prevalence of smoking among youngsters reaches levels of 45 and 33 per cent, respectively (table 8.2).

Alcohol consumption is also a risk factor in the Asia and the Pacific region although, at 3.5 litres per adult annually, it is still lower than in Europe, North America and Latin America and the Caribbean. Asia and the Pacific, along with Africa, on the other hand, are the only regions where per capita alcohol consumption increased between 1990 and 2003.

Across subregions, per capita alcohol consumption in Central Asia declined from the levels in 1990. Small island developing States, on the other hand, registered the largest increase in alcohol consumption in Asia and the Pacific. Among country income groupings, only middle-income economies recorded an increase in alcohol consumption between 1990 and 2003.

While several countries registered an increase in their alcohol consumption levels, the highest increase took place in the Russian Federation, where consumption increased from 7.1 litres per person in 1990 to 10.3 litres in 2003. In China, alcohol consumption increased from 3.4 to 5.2 litres per person during the same period.

Figure 8.2 Alcohol consumption per capita among adults aged 15 years and over in Asia and the Pacific, 1990 and 2003