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| Current Issues | No.62 October 2011 |

WHO Report on No Communicable Diseases
Victor Matsudo
World Health Organization (WHO) just considered sedentariness as a cardio-vascular risk factor in 1992. However, after that WHO has tried to face this epidemic. Recently, WHO released an important report on No communicable diseases that is summarised here.
Of the 57 million global deaths in 2008, 36 million, or 63%, were due to NCDs, principally cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. As the impact of NCDs increases, and as population`s age, annual NCD deaths are projected to continue to rise worldwide, and the greatest increase is expected to be seen in low- and middle-income regions. Over 80% of cardiovascular and diabetes deaths, and almost 90% of deaths from chronic obstructive pulmonary disease, occur in low- and middle-income countries. More than two thirds of all cancer deaths occur in low- and middle-income countries.
Insufficient Physical Activity
Approximately 3.2 million people die each year due to physical inactivity. People who are insufficiently active have a 20% to 30% increased risk of all-cause mortality. Regular physical activity reduces the risk of cardiovascular disease including high blood pressure, diabetes, breast and colon cancer, and depression. Insufficient physical activity is highest in high-income countries, but very high levels are now also seen in some middle-income countries especially among women.
Interventions to prevent NCDs on a population-wide basis are not only achievable but also cost-effective. And the income level of a country or population is not a barrier to success. Low-cost solutions can work anywhere to reduce the major risk factors for NCDs. While many interventions may be cost-effective, some are considered `best buys` - actions that should be undertaken immediately to produce accelerated results in terms of lives saved, diseases prevented and heavy costs avoided.
Best Buys Include

- Protecting people from tobacco smoke and banning smoking in public places;
- Warning about the dangers of tobacco use;
- Enforcing bans on tobacco advertising, promotion and sponsorship;
- Raising taxes on tobacco;
- Restricting access to retailed alcohol;
- Enforcing bans on alcohol advertising; • Raising taxes on alcohol;
- Reduce salt intake and salt content of food;
- Replacing trans-fat in food with polyunsaturated fat;
- Promoting public awareness about diet and physical activity, including through mass media.

In addition to best buys, there are many other cost-effective and low-cost population-wide interventions that can reduce risk factors for NCDs. These include:

- Nicotine dependence treatment;
- Promoting adequate breastfeeding and complementary feeding;
- Enforcing drink-driving laws;
- Restrictions on marketing of foods and beverages high in salt, fats and sugar, especially to children;
- Food taxes and subsidies to promote healthy diets.

Also, there is strong evidence, though currently a shortage of cost-effectiveness research, for the following interventions:

- Healthy nutrition environments in schools;
- Nutrition information and counselling in health care;
- National physical activity guidelines;
- School-based physical activity programmes for children;
- Workplace programmes for physical activity and healthy diets;
- Community programmes for physical activity and healthy diets;
- Designing the built environment to promote physical activity.

Individual Health-Care Interventions
In addition to population-wide interventions for NCDs, country health-care systems should undertake interventions for individuals who either already have NCDs or who are at high risk of developing them. Evidence from high-income countries shows that such interventions can be very effective and are also usually cost-effective or low in cost. When combined, population-wide and individual interventions may save millions of lives and considerably reduce human suffering from NCDs.
Priorities for action
While the magnitude of the NCD epidemic has been rising in recent years, so has the knowledge and understanding of its control and prevention. Evidence shows that NCDs are to a great extent preventable. Countries can reverse the advance of these diseases and achieve quick gains if appropriate actions are taken in the three components of national NCD programmes: surveillance, prevention, and health care. Those actions include:
A comprehensive approach
Risk factors for NCDs are spread throughout society, and they often begin early in life and continue throughout adulthood. Evidence from countries where there have been major declines in certain NCDs indicates that both prevention and treatment interventions are necessary. Therefore, reversing the NCD epidemic requires a comprehensive approach that targets a population as a whole and includes both prevention and treatment interventions.
Multisectoral action
Action to prevent and control NCDs requires support and collaboration from government, civil society and the private sector.
Therefore, multiple sectors must be brought together for successful action against the NCD epidemic. In this respect, policy-makers must follow successful approaches to engage non-health sectors based on international experience and lessons learnt. Guidelines on promoting intersectoral action are included in Chapter 7 of this report.
Surveillance and monitoring
Measuring key areas of the NCD epidemic is crucial to reversing it. Specific measurable indicators must be adopted and used worldwide. NCD surveillance must be integrated into national health information systems. This is achievable even in the lowest-resourced countries by considering the actions recommended above under "lack of monitoring".
Health systems
Strengthening of country health-care systems to address NCDs must be undertaken through reorienting existing organisational and financial arrangements and through conventional and innovative means of financing. Reforms, based on strengthening the capacity of primary health care, and improvements in health-system performance must be implemented to improve NCD control outcomes.
Best buys
As highlighted above, prevention and control measures with clear evidence of effectiveness and high cost-effectiveness should be adopted and implemented. Population-wide interventions must be complemented by individual health-care interventions.
Sustainable development
The NCD epidemic has a substantial negative impact on human and social development. NCD prevention should therefore be included as a priority in national development initiatives and related investment decisions. Depending on the national situation, strengthening the prevention and control of NCDs should also be considered an integral part of poverty reduction and other development assistance programmes.
Civil society and the private sector: Civil society institutions and groups are uniquely placed to mobilise political and public awareness and support for NCD prevention and control efforts, and to play a key role in supporting NCD programmes. Strong, united advocacy is still required for NCDs to be fully recognised as a key priority of the global development agenda.
Businesses can make a decisively important contribution to addressing NCD prevention challenges. Responsible marketing to prevent the promotion of unhealthy diets and other harmful behaviours, and product reformulation to promote access to healthy food options, are examples of approaches and actions that should be implemented by the corporate sector. Governments are responsible for monitoring the required actions.
The NCD epidemic exacts an enormous toll in terms of human suffering and inflicts serious damage to human development in both the social and economic realms. The epidemic already extends far beyond the current capacity of lower-income countries to cope with it, which is why death and disability are rising disproportionately in these countries. This state of affairs cannot continue. There is a pressing need to intervene. Unless serious action is taken, the burden of NCDs will reach levels that are beyond the capacity of all stakeholders to manage.
Contact
Prof. Dr. Victor Matsudo
Physical Fitness Research Laboratory of Sao Caetano do Sul – CELAFISCS
Sao Caetano do Sul, Brazil
Email: matsudo@celafiscs.org.br

http://www.icsspe.org/