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Volume 4: No. 2, April 2007
EDITORIAL
Continuing Efforts in Global Chronic Disease Prevention
David V. McQueen, ScD
Suggested citation for this article: McQueen DV. Continuing efforts in
global chronic disease prevention. Prev Chronic Dis [serial online] 2007 Apr [date
cited]. Available from:
http://www.cdc.gov/pcd/issues/2007/
apr/07_0024.htm.
This issue of Preventing Chronic Disease (PCD) illustrates some of the
breadth of work in chronic disease prevention being undertaken throughout the
world. The wide range of activity includes health promotion, descriptive
epidemiology, behavioral risk-factor surveillance, and purely exploratory and
descriptive research. The emphasis of this issue is on efforts being made in
economically less-developed parts of the world as well as on efforts being
made to address the needs of subgroups within more economically advanced
countries.
Chronic diseases (usually termed noncommunicable diseases in the
international health literature) are generally characterized by a long latency
period, a mixture of causal factors including some well-known risk factors, a
prolonged course of illness, a noncontagious origin, functional impairment or
disability, and incurability. In addition, many globally important
communicable diseases (e.g., AIDS, polio) have chronic characteristics. The
global cost of these conditions, in human as well as in financial terms, is
enormous, and the burden that they impose is especially critical in countries
that are economically less well off.
By the last decade of the 20th century, chronic diseases had
superseded communicable diseases as the leading cause of death in all areas of
the world except sub-Saharan Africa and the Middle East, and within the next 15 years, chronic diseases
are projected to account for nearly
three quarters of all deaths in low-income regions of the world (1).
Two
points about the impact of chronic diseases are important to keep in
mind. First, because around 80% of the world’s population lives in
industrializing or nonindustrialized countries, these countries will
experience most of the cases of death and disability associated with major
chronic diseases, and such widespread disability and death may have
catastrophic effects on the health care infrastructure and the further
economic development of many of them. Second, the relatively poor quality of
health care services available to lower-income populations, in both developing
and highly developed countries, continues to exacerbate the increased risk for
chronic health problems associated with such key factors as urbanization and
an aging population. In addition, the worldwide increase in average lifespan
has also contributed to the increased global threat posed by chronic diseases.
For low-income countries, lower birth rates coupled with greater life
expectancy and an increased risk for chronic diseases portend dramatic
increases in both the relative and absolute importance of chronic conditions
such as ischemic heart disease, stroke, diabetes, and depression.
Most chronic diseases are associated with or caused by a combination of
social, cultural, environmental, and behavioral factors. Their causality is
thus both complex and multilevel. Many of the sociocultural factors
influencing the development, spread, and persistence of chronic diseases are
tied to macro-level factors that may include socioeconomic variables
such as economic status, race, social status, education, and income. The wide
variation in these factors adds to the complexity of public health efforts to
address chronic disease globally. The articles published in this issue of PCD
demonstrate the numerous contexts in which public health specialists
throughout the world address chronic diseases and their causes and
illustrate the wide variety of methods that they are using to do so.
The articles in this issue are like appetizers on the menu of a restaurant
offering a plethora of choices. They represent just some of the possibilities.
Strategic approaches to chronic disease prevention and health
promotion generally fall into one of four categories: a community-based
approach, a disease-based approach, a population-based approach, and a
settings-based approach. Ideally, we would like to combine these approaches in
order to address chronic disease in a more comprehensive fashion; however, in
the real world of public health practice, which usually involves limited
resources, this is not always possible. The articles in this issue also
reflect the diverse methodologies that have become accepted practice in
chronic disease prevention and health promotion efforts throughout the world. Thus we see
articles that describe qualitative studies, descriptive studies, and case
studies, as well as the use of focus groups, surveys, and surveillance. For
example, the article by Mier et al on type 2 diabetes illustrates how chronic
disease problems cut across international borders and how the particular
context of an at-risk population needs to be taken into account if interventions
are to be effective (2); the article by Minh et al shows the importance
of a point-in-time survey to reveal the burden of chronic diseases in a
rapidly developing country (3); O’Hegarty et al use focus group results
to argue for policy change in cigarette labeling requirements by comparing the
responses of adolescents to cigarette labels from two
neighboring countries with quite different policies (4); Robinson et al use nearly two decades of
efforts to address cardiovascular diseases in Canada as background to
highlight the need for prevention programs
to be more comprehensive and partnership oriented (5); and Ebrahim et al
stress the need to more widely distribute information and interventions that
address the behavioral risk factors related to chronic diseases; in doing so,
they clearly show the need for systematic and timely surveillance of risk
factors across the globe, a goal whose achievement unfortunately appears to be
well into the future (6).
In all likelihood, chronic diseases will be the predominant global source
of morbidity, death, and disease during the 21st century. Although
much of the global community is benefiting from the accomplishments of
medicine and public health, these benefits remain unevenly distributed.
Studies and interventions such as those reported in this issue may hold part
of the key to translating the successes of industrialized countries to
countries that are less economically developed. Nevertheless, the science of public health is still underdeveloped in much of
the world: chronic disease surveillance systems are spotty, behavioral risk
surveillance is uncommon, and health promotion infrastructure is often
lacking. To address the great burden of chronic disease globally, we will need
significantly more studies and interventions of the type described here.
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Author Information
David V. McQueen, Associate Director for Global Health, National Center for
Chronic Disease Prevention and Health Promotion, Centers for Disease Control
and Prevention, 4770 Buford Hwy, NE, Mailstop K40, Atlanta, GA 30341.
Telephone: 770-488-5403. E-mail: dvm0@cdc.gov.
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References
- Murray CJL, Lopez AD, editors. The global burden of disease: a
comprehensive assessment of mortality and disability from diseases,
injuries, and risk factors in 1990 and projected to 2020. Cambridge (MA):
Harvard School of Public Health; 1996.
- Mier N, Medina AA, Ory MG.
Mexican Americans with type 2 diabetes:
perspectives on definitions, motivators, and programs of physical
activity. Prev Chronic Dis [serial online] 2007 Apr.
- Minh HV, Byass P, Huong DL, Chuc NTK, Wall S.
Risk
factors for chronic disease among Vietnamese adults and the association of
these factors with sociodemographic variables: findings from the WHO STEPS
survey in rural Vietnam, 2005. Prev Chronic Dis [serial online] 2007 Apr.
- O’Hegarty M, Pederson LL, Yenokyan G, Nelson D, Wortley P.
Young
adults’ perceptions of cigarette warning labels in the United States and
Canada. Prev Chronic Dis [serial online] 2007 Apr.
- Robinson K, Farmer T, Elliott SJ, Eyles J.
From heart health promotion
to chronic disease prevention: contributions of the Canadian Heart Health
Initiative. Prev Chronic Dis [serial online] 2007 Apr.
- Ebrahim S, Garcia J, Sujudi A, Atrash H. Globalization of
behavioral risks needs faster diffusion of interventions. Prev Chronic Dis
[serial online] 2007 Apr.
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