Building a healthy public policy and reorienting health services towards control of chronic diseases

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More than 14 million people between the ages of 30 and 70 die each year from noncommunicable diseases (NCDs), 85% of which live in developing country [1]. Most people with NCD die from cardiovascular disease (CVD), which includes coronary heart disease, stroke, and peripheral artery disease [2]. Evidence from developed countries have indicated that cardiovascular disease (CVD) mortality has declined significantly since 1975 among men and particularly among women [3]. Capewell et al. estimate that nearly half of the decline in Auckland, New Zealand is because of earlier diagnosis and more aggressive treatment, particularly with adjunctive drug therapies of life saving benefit [4]. WHO attribute the remaining half of the decline in CVD mortality to favorable changes in modifiable risk factors and the aggressive management of hypertension, diabetes mellitus, and lipids [5]. The modifiable risk factors for CVD include diet, smoking, hypertension control, dyslipidemia control, physical activity, weight control, glycemic control, and harmful use of alcohol [6, 7].

Implementing simple interventions that reduce NCD risk factors will decrease premature deaths by half to two-thirds. In addition, health systems that respond to the needs of people with NCDs can reduce mortality by another third to half [8]. The World Health Organization has proposed nine targets and six global objectives to prevent and control NCD—the world’s most common diseases, which will lead to a 25% reduction by 2025 in premature deaths from NCDs [8]. Empowering local administrative bodies in adopting measures to cope with modifiable risk factors and early diagnosis and treatment of chronic diseases similar to the effort of the Thai Health Security Funds as reported in this issue is a way forward [9]. The key components include building healthy public policy, creating supportive environment, strengthening community action, developing personal skills, and reorienting health services for early diagnosis and clinical preventive services. Added components can include encouraging research, and tracking or monitoring trends and progress of action plans. Most critical is the commitment to establishing healthy public policy by health leaders and the use of financial and other incentives to prompt local governments to actions towards modifiable risk factors. Strengthening and reorienting health system towards early screening and clinical preventive services relevant to prevention of NCDs as advocated by the U.S. Task Force for Preventive Services is another critical action to be undertaken [10]. Together we can meet the challenges by adopting and implementing the actions now, since “a journey of a thousand miles begins with a single step”—a step that can make a world of difference to the people we serve.

References

  • 1

    Preventing chronic diseases: a vital investment. World Health Organization Global Report. 2005.

  • 2

    Lopez AD Mathers CD Ezzati M Jamison DT Murray CJ. Global and regional burden of disease and risk factors 2001: systematic analysis of population health data. Lancet. 2006; 367:1747.

  • 3

    Capewell S Morrison CE McMurray JJ. Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994. Heart. 1999; 81:380.

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  • 4

    Capewell S Beaglehole R Seddon M McMurray J. Explanation for the decline in coronary heart disease mortality rates in Auckland New Zealand between 1982 and 1993. Circulation. 2000; 102:1511.

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  • 5

    World Health Organization. The Ottawa Charter for Health Promotion Adopted on 21 November. 1986.

  • 6

    Yusuf S Hawken S Ounpuu S Dans T Avezum A Lanas F et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364:937.

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  • 7

    Knoops KT de Groot LC Kromhout D Perrin AE Moreiras-Varela O Menotti A van Staveren WA. Mediterranean diet lifestyle factors and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004; 292:1433.

    • Crossref
    • Export Citation
  • 8

    World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: WHO; 2013.

  • 9

    Lijutipoom S Lertmaharit S Hanvoravongchai P. Engaging local governments in health promotion and chronic disease prevention activities: the case of Local Health Security Funds in Thailand Asian Biomed. 2015; 9:761-70.

  • 10

    Agency for Healthcare Research on Quality [AHRQ]. The guide to clinical preventive services 2014. Recommendations of the U.S. Preventive Services Task Force.

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  • 1

    Preventing chronic diseases: a vital investment. World Health Organization Global Report. 2005.

  • 2

    Lopez AD Mathers CD Ezzati M Jamison DT Murray CJ. Global and regional burden of disease and risk factors 2001: systematic analysis of population health data. Lancet. 2006; 367:1747.

  • 3

    Capewell S Morrison CE McMurray JJ. Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994. Heart. 1999; 81:380.

    • Crossref
    • Export Citation
  • 4

    Capewell S Beaglehole R Seddon M McMurray J. Explanation for the decline in coronary heart disease mortality rates in Auckland New Zealand between 1982 and 1993. Circulation. 2000; 102:1511.

    • Crossref
    • Export Citation
  • 5

    World Health Organization. The Ottawa Charter for Health Promotion Adopted on 21 November. 1986.

  • 6

    Yusuf S Hawken S Ounpuu S Dans T Avezum A Lanas F et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364:937.

    • Crossref
    • Export Citation
  • 7

    Knoops KT de Groot LC Kromhout D Perrin AE Moreiras-Varela O Menotti A van Staveren WA. Mediterranean diet lifestyle factors and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004; 292:1433.

    • Crossref
    • Export Citation
  • 8

    World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: WHO; 2013.

  • 9

    Lijutipoom S Lertmaharit S Hanvoravongchai P. Engaging local governments in health promotion and chronic disease prevention activities: the case of Local Health Security Funds in Thailand Asian Biomed. 2015; 9:761-70.

  • 10

    Agency for Healthcare Research on Quality [AHRQ]. The guide to clinical preventive services 2014. Recommendations of the U.S. Preventive Services Task Force.

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