PUBLIC HEALTH

countries and the openness of borders to ideas, people, commerce, and financial capital—has beneficial and harmful effects on the health of populations.1,2 The effect of the current phase of globalisation, or more properly reglobalisation,3 on health has been debated worldwide.1,2,4 Most attention has been directed towards control of infectious diseases and national security threats, provision of affordable medicines, and changes required in international trade and finance agreements to improve access to treatment. Broader policy concerns include the relation between globalisation and equity and the changing role of the state and governance for health.5 By contrast, the growing burden of non-communicable diseases—mainly heart disease, stroke, cancer, diabetes, and obesity—has been neglected. In this article, we assess the relation between globalisation and non-communicable disease epidemics, summarise the evidence in support of preventing such disease, and outline the required global and national responses. The global burden of non-communicable disease This year there will be an estimated 56 million deaths globally, of which 60 % will be due to non-communicable diseases:6 16 million deaths will result from cardiovascular disease (CVD), especially coronary heart disease (CHD) and stroke; 7 million from cancer; 3·5 million from chronic respiratory disease; and almost 1 million from diabetes. Mental health problems are leading contributors to the burden of disease in many countries and contribute substantially to the incidence and severity of many non-communicable diseases including CVD and cancer.7 Table 1 shows that non-communicable diseases are leading causes of death in developing and developed countries. Only in Africa do communicable diseases cause more deaths than non-communicable diseases; this yea