Towards a better and longer life / by Evgueni N. Chigan

NON-COMMUNICABLE DISEASES: Towards a better and a longer life by Evgueni N. Chigan Since health condi~ions depe~d upon many socio-economic, demographic, behavioural, environmental and other factors , it follows that changes in these fac- tors lead to changes in the health status of populations. In spite of dif- ferences existing between devel- oped and developing countries, it is possible to select certain common trends which have an influence on public health strategy, on the set- ting of priority health problems and on the allocation of resources. The gradual decline of the birth rate in many countries has resulted step by step in an increased propor- tion of old persons in any given population. The process of urbani- sation, boosted by the migration of able-bodied youngsters from the countryside to the cities, has also led to an increase in the proportion of old people left behind in village communities. All too often, what for generations have been large self-contained and self-supporting families have disintegrated. More and more we find old and some- times ailing persons living alone in their own homes. Meanwhile, progress in preven- tive and curative medicine in the national health care systems, as well as international activity in health promotion and disease pre- vention, have led to a decrease in mortality among younger age groups and to an increase in longevity. Left: More and more we find old and sometimes ailing persons living alone in their own homes. Right: Non-communicable diseases can be disabling. Arthritic fingers of a young Indian woman. Photos: WHO/Zafar and WHO/A. S. Kochar WORLD HEALTH, October 1988 All these processes have led to substantial changes in the structure of causes of death and illness in all countries. In a predictable pattern, the mortality and morbidity rates caused by infectious diseases have declined while the rates related to non-infectious pathology have increased. / Dr Evgueni N. Chigan is Di- rector ' of. WHO's Division ..... of Non-communicable Diseases. ' At present, non-communicable diseases are the cause of 70 to 80 per cent of deaths in developed countries and of 40 to 50 per cent of deaths in developing countries. There is no doubt that, if the trend remains the same, non-communi- cable diseases will play a much more important role in both societ- ies. Cardiovascular diseases, cancer and chronic respiratory diseases take a leading role among causes of death. Cardiovascular diseases, chronic respiratory diseases, endo- crinological and gastro-intestinal complaints, osteoporosis and others are important causes of disability and invalidity. Many countries are therefore de- veloping a system of activities aimed at checking this negative process; by creating and applying national disease prevention and control programmes they are achieving positive results in cutting back the mortality and morbidity caused by non-communicable dis- eases. They are helped in this by many international but non- governmental organizations, such as the International Diabetes Fed- eration, the International League Against Rheumatism, the Inter- national Union Against Cancer, the International Union Against Tuber- culosis and Lung Diseases, the World Hypertension League and so forth. The International Epidemio- logical Association promotes the exchange of information about risk factors and their influence on death and sickness caused by non- communicable diseases. How to change unhealthy lifestyles presents a longstanding challenge to the health services. Photo WHO/Zafar. Cartoon by Regula Hartmann WHO itself plays a methodological, catalytic and coordinative role in uniting the activities of national and international bodies and direct- ing them towards disease preven- tion and control. Its credo is that " each health programme should have its specific objectives and tar- gets, whenever possible quantified, that are consistent with those of the national health strategy. The pro- gramme should set out clearly the requirements in health workers, physical facilities, technology, equipment and supplies, informa- tion and intercommunication, the methods of monitoring and evalua- tion, the timetable of activities, and ways of ensuring correlation be- tween its various elements and re- lated programmes". For the present the methodologi- cal tool of health programme devel- opment consists of epidemiological, economic, mathematical, expert and other methods which are used at different stages of the program- ming procedure. Meanwhile epidemiological, so- 4 cial, psychological and other stud- ies have uncovered the complex nature of many non-communicable diseases, their trends, distribution and frequency in different regions, countries, social and other groups of population. In spite of differ- ences among them, all these dis- eases have a multifactorial struc- ture, and it is apparent that, in order to decrease the harm they do, the influence of the main socio- economic, behavioural, environ- mental and medica-biological risk factors should be eliminated or at least decreased. Some factors, such as age, sex, genetics and climate, cannot be controlled, but there are control- lable factors too which depend on individual, family and community lifestyles, health care and other fields of activity. So any general programme aimed at solving the problem should have a three-fold aim: changes in behaviour and life- style, health care activity per se, and the reorientation or reorgan- ization of related sectors of activi- ty. The role of these three inter- vention programmes will differ according to the socio-economic sit- uation, the cultural level and the basic principles of health care in each country. But under changes in lifestyle will fall smoking, alcohol consumption, dietary habits, physi- cal inactivity and psychosocial be- haviour. Under reorganization and reorientation of health care come development of primary health care, community and district ser- vices; creating new types of medi- cal services for target groups or risk groups; team work and training. And reorganization or reorienta- tion of other health-related sectors will involve creating a social envi- ronment; integrating new sectors, groups and movements into health problem solving; and dealing with air and water pollution. There are many studies proving that, in about 70 per cent of cases, the appearance of such non-com- municable diseases as heart dis- eases, hypertension, diabetes, chronic bronchitis, and lung cancer W o RLD HEALTH, October 1988 depends upon individual behaviour and lifestyle. That is why WHO pays special attention to what we call factor-oriented programmes such as those directed against smoking and alcohol or in favour of better nutri- tion, which are already proving highly effective. Disease-oriented programmes in- clude those against cancer (includ- ing cancer pain relief), hyperten- sion, ischaemic heart disease and diabetes. They include preventive and curative measures, recommen- dations about rehabilitation and so on. Several years ago WHO started a new programme, the Integrated Programme for Community Health in Non-communicable diseases. This combines resources and ap- proaches currently being devoted to preventing and controlling se- lected diseases and related condi- tions ; and it puts a set of preven- tive and other control activities under unified management in order to promote better health in whole communities. Its prime aims are: to reduce common risk factors in the field of smoking, alcohol con- sumption, bad nutritional habits, physical inactivity, high blood pressure and so on ; to involve the entire com- munity; to integrate various health pro- motion strategies-those aimed at high-risk groups (the elderly, children, workers, pregnant women) or at screening for early detection, for instance ; to integrate different types of in- tervention-change of lifestyle, or improved health care or inter- sectoral action ; and to carry out prevention and control activities through exist- ing primary health care systems and other health and community structures. The methodology of the Integrat- ed Programme is flexible and can be adapted to suit any environ- ment, lifestyle or culture. It is being tested on demonstration projects within 15 countries, and eventually could be extended to entire countries. This issue of World Health maga- zine examines some of the progress being made in tackling non- communicable diseases throughout the world. • WoRLD HEALTH, October 1988 Who will persuade this woman in the Soloman Islands that smoking is harmful? Or these women in an Eastern Mediterranean city slum that the water they drink must first be boiled? Photos W. Stone © and Earthscan/S. Sprague ©