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12.5 Disease prevention and control of non-communicable diseases Oxford Textbook of Public Health 12.5 Disease prevention and control of non-communicable diseases Jørn Olsen Introduction Types of prevention Screening Causation Health promotion Prevention and care Reducing risk factors Social determinants of health Environmental risk factors Social support A life-course approach to disease prevention Non-communicable diseases in developing countries Changes during the course of life Burden of chronic diseases Health futures The economy of prevention Conclusions Chapter References Introduction In the year 2000 the Executive Board of the World Health Organization (WHO) recommended the 55th World Health Assembly: (1) to formulate a global strategy for the prevention and control of non-communicable diseases. However, they all share a recognition that in health, as in many other fields, societal averages typically disguise as much as they reveal.(2) to recognize the enormous human suffering caused by cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases, and the threats they pose to the economics of member states. Thus their interest is not in the health conditions that prevail in society as a whole, but in the condition of different socio-economic groups within society—especially the lowest or most disadvantaged groups.

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Non-communicable diseases include arteriosclerosis, psychosocial diseases, low back pain, infertility, congenital malformations, poor visual acuity, hypertension, psoriasis, diabetes, etc. Marine n-3 fatty acids ingested in pregnancy as a possible determinant of birth weight: a review of the current epidemiologic evidence. In the same vein, the 1984 targets of the WHO Regional Office for Europe (EURO) were expressed in terms of reducing poor–rich disparities.

Some of these diseases may be caused by infection, but most are probably not. ‘By the year 2000’, said the WHO document in which these targets were presented, ‘the actual differences in health status between countries and between groups within countries should be reduced by at least 25 per cent, by improving the health of disadvantaged nations and groups’ (Whitehead 1990).

On the other hand, epidemiologists have a message that is of interest to the public and therefore to the media. ‘Concentrate first on overall growth’, was the prevailing view.

Thus they have much more influence than their sparse financial resources would suggest. The result might be a rise in inequality over the short term, but eventually the benefits would trickle down to the poor and, in the long run, they would end up better off than under a development strategy oriented towards their immediate needs.

There is no magic treatment that will make arteriosclerosis go away and it is unlikely that any cancer treatment will ever be able to eliminate the excess cancer mortality associated with smoking. However, others feel that relative poverty and deprivation are just as important, if not more so.

Cancer treatment may in time be able to cure a growing number of cancer diseases, but many opportunities for prevention have been lost because we have waited in vain for this to happen. Inequality in health While a concern for improving the health of the poor is widespread, it is by no means universally preferred.The ability to set up a preventive programme that is evidence based is limited, as the more distal determinants of lifestyle factors are not known, except that they are related to education, social conditions, peer pressure, role models, etc. These similarities and differences can most easily be understood by considering each of the three indicators and concepts in turn, and then reviewing the practical implications of thinking in terms of one or the other.Lifestyle factors are closely related to our roles as consumers and we must realize that many actors are involved. The health of the poor A concern for poor population groups has occupied a central role in established thinking about overall socio-economic development for over two decades.The shift from communicable to non-communicable diseases in many developing countries is an achievement that cannot and should not be prevented as it is largely driven by forces that prevent premature death. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. The second approach is simply to define the national poverty line as some proportion—often arbitrarily determined—of a society’s average per capita income or expenditure.The challenges lie in reducing the avoidable deaths and disabilities related to non-communicable diseases as much as possible with the available resources. B., Williams, P., Fosher, K., Criqui, M., and Stampfer, M. In the United Kingdom, a statistic frequently cited to document the prevalence of poverty refers to the proportion of the population (currently just under a quarter) with less than half the country’s average per capita income (Anonymous 1999).Non-communicable diseases increase when clean drinking water is provided, poverty has been reduced, and malnutrition is gradually eliminated. Relative poverty The second approach, which is more country-specific, deals with what is frequently referred to as ‘relative poverty’.

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