(p. 48) Development of public health in economic transition: the middle-income countries 

While communicable diseases are declining in middle income countries, there are threats of new and re-emerging infectious diseases with rapid socio-economic developments linked to environmental and climate change. All middle income countries are witnessing a rise of non-communicable diseases and associated risk factors such as diet, tobacco and alcohol use, obesity, and sedentary and harmful lifestyles, as populations become richer and older.

Many governments have embarked on healthcare reform efforts to improve equity and efficiency in their provision, financing and regulation of health systems. Building upon a growing capacity to deliver basic health services, the new priorities in middle income countries are to achieve greater social protection with universal health coverage. The rising costs of healthcare due to chronic diseases and ageing populations have created an unprecedented challenge and a strong case for investment in the public health systems of middle income countries, especially in disease prevention and health promotion.