The surprising cause of most deaths worldwide and how we can stop it

Some of our world’s greatest challenges attract a lot of attention. Climate change, war and immigration are constantly in the news and are widely promoted by states and private charities.

Other serious problems, such as tuberculosis and nutrition, receive less airtime and attention, but are among the most important global priorities and receive financial support.

The World Health Organization even devotes its own programs and attention to so-called neglected tropical diseases such as rabies, river blindness and leprosy, which kill 200,000 people every year in poorer countries.

But there is a challenge that we rarely hear about, but which affects more than a billion people and which could be addressed very effectively. You could call it the neglected enormous disease.

The world has made great strides in controlling infectious diseases. Two centuries ago they accounted for almost half of all deaths; today they account for less than 15 percent. Half of all deaths are due to the two leading causes of death: cardiovascular disease and cancer. Cancer causes about 18 percent of all deaths, but it is difficult and expensive to treat and has modest success rates, so most treatment takes place in rich countries.

The most common cause of death of all, which is technically cardiovascular disease but usually consists of heart attacks and strokes, kills over 18 million people each year, a third of all deaths worldwide.

A large part of the problem is unhealthy diet, physical inactivity, and tobacco and alcohol consumption, which cause obesity and high blood pressure.

Doctors may advise you to stop smoking, drink less alcohol and salt, exercise more and eat fewer calories and more fruit and vegetables. However, this advice seems to be quite difficult to follow. Limiting tobacco and alcohol consumption and reducing the salt content in ready meals can make this easier.

But to reverse this neglected, enormous disease, we must focus on high blood pressure.

It’s hard to believe, but high blood pressure is the world’s leading cause of death. It causes nearly 11 million deaths each year and is responsible for 19% of all deaths worldwide.

As the world’s population ages, more and more people are affected. The number of people suffering from high blood pressure has doubled in the last 30 years – to around 1.3 billion people. Because there are no obvious symptoms, almost half of those affected are not even aware of it and four out of five people do not receive appropriate treatment.

This combination means that high blood pressure has enormous consequences and yet is surprisingly neglected.

The good news is that treating high blood pressure is incredibly cheap and effective – with one or more pills that are off patent and cost next to nothing. This works pretty well in rich countries, but we should do this all over the world.

Community screenings for high blood pressure cost as little as $1 per person, and prescriptions for blood pressure medications often cost only $3 to $11 per year.

Peer-reviewed research shows that tackling high blood pressure in the poorer half of the world would cost about $3.5 billion annually, but it could save nearly a million lives each year.

In economic terms, every dollar spent would generate $16 in return for society, making this policy one of the most efficient in the world.

Although chronic diseases such as cardiovascular disease now claim more lives than infectious diseases – even in developing countries – they receive very little support. In low-income countries, almost 30 percent of health expenditure is financed from external sources, but only five percent of these funds go towards treating chronic diseases.

In Nigeria, where heart disease now accounts for one in ten deaths, the Federal Ministry of Health’s Noncommunicable Diseases Division has launched a new programme to tackle hypertension. This is an excellent start – but it is critical that donors increase their support for programmes that improve access to affordable, comprehensive and high-quality hypertension prevention and treatment services not only in Africa but in all developing countries.

Hypertension is the world’s leading killer, yet it receives little attention and even less financial support. For just $3.5 billion a year, we can implement one of the world’s best solutions and save millions of lives. We just need to know about it.

Bjorn Lomborg is president of the Copenhagen Consensus and a visiting professor at the Hoover Institution at Stanford University. His new book is Best Things First, which The Economist named one of the best books of 2023.