In a twist to the usual commentary on disease in developing countries, the latest issue of the Economist features an analysis on the rise of chronic diseases in the developing world. The authors argue that “chronic disease has become the poor world’s greatest health problem” and “that developing countries suffer more from ‘rich world maladies’ than the rich world itself . . . By 2015, says the World Bank, these ailments will be the leading cause of death in low-income countries. They already account for almost half of all illnesses there and impose substantial economic costs.”

Unfortunately despite the growing importance of these numbers, the developing world is still focused on fighting infectious diseases for both practical and political reasons that the article is at pains to point out.

This shift in the constellation of health challenges for poor countries, however, requires an accompanying shift in the strategies for global health care. In most ways, the prevention and management of chronic disease is a vastly more difficult proposition than the more straight forward interventions of infectious disease control.

Chronic disease management programs — those with a modicum of success — utilize complex cultural outreach, behavioral, educational and medical strategies to secure the focused attention of both the system and the patient in controlling the course of disease factors. Mounting these kinds of efforts will require a more substantial engagement with local communities and a meaningful change in public attitudes and behaviors. But the world health community has to take the shift seriously and not enable the denial that still seems to have a hold on our thinking.