prevention and control of non-communicable diseases - icrier

More documents

Recommendations

Info

ecent years (Chadha et al. 1997; Reddy 1993; King et al. 1998; Anand 2000; Gupta et al. 1996). These too portend a major rise in future NCD burdens in India. Strategies follows. Principle 1: The principles of prevention which underline the strategies for NCD control are as Risk operates in a continuum—not across arbitrary thresholds; Risk reduction benefits across the range. Principle 2: Principle 3: Principle 4: Majority of NCD events arise in a population from the middle of the distribution (of a risk factor) than from its high end. Co-existence of risk factors leads to interactive risk which is multiplicative. The absolute risk of a major NCD event (e.g. CHD/stroke) is dependent on the overall risk profile contributed by co-existent risk factors operating in a continuum. Traditionally, public health approaches to NCD control have been (a) a high risk strategy, targeting persons with high levels of risk factors and employing interventions to reduce them, usually with drugs and (b) a population strategy which attempts to reduce risk factor levels in the whole community, usually through lifestyle related measures (Rose 1985; Rose and Day 1990). The former provides higher benefits to individuals at maximum risk. However, since such individuals are a small segment of the society, there is no major impact on national morbidity or mortality on the country. The population approach aims at relatively modest reductions in the risk for each individual, but the cumulative benefits to the community are large since there are many more persons in the mild or moderate range of risk factor elevation than there are in the highest range. The two strategies are not mutually exclusive but are synergistically complementary. However, population-based and lifestyle linked strategies are likely to prevent the acquisition or augmentation of NCD risk factors in transitional societies like India, while avoiding the economic and biological costs of pharmacological risk reduction strategies practised in the developed countries. 9
Simultaneously effective low-cost case-management strategies are required for persons who manifest disease. Such technologies are available but await widespread dissemination and application. For example, oral aspirin administration in cases of suspected heart attack saves as many lives as the intravenously administered clot dissolving drug streptokinase (Antiplatelet Trialists Collaboration 1994). The community needs to be empowered, through information, to avail of such technologies, which are both feasible for wide application and are cost-effective (Table VI). Table VI Effect of Treatment of 1000 Patients with AMI Premature deaths avoided Cerebral haemorrages caused Aspirin 23 0 Rs. 152 Cost per life saved Streptokinase 25 2–3 Rs. 123,560 Source: Murray and Lopez (1996). At the population level, programmes for promotion of (a) a health promoting diet (calories appropriate to the level of physical activity; moderation in the intake of saturated fat, salt, and refined sugar; high intake of fresh fruit and vegetables; fish in preference to red meat in non-vegetarian diets) and (b) adequate physical activity and regular exercise are required. These are likely to have benefits for a wide range of NCDs, especially CVD, diabetes, hypertension, and some cancers which are related to saturated fat intake. Tobacco control is a major public health imperative which will provide the largest benefit, for NCD prevention. Tobacco-related cancers, CVD, and chronic obstructive airway disease are amongst the diseases which can be effectively prevented if abstinence from tobacco and cessation of the tobacco habit are encouraged in the population. It has been estimated that of all the teenagers who are currently smoking, half will eventually die of tobacco related diseases (a quarter in the middle age and a quarter at an older age). 10
Page 1 and 2: WORKING PAPER NO. 104 PREVENTION AN
Page 3 and 4: Foreword This paper formed part of
Page 5 and 6: care. Surveillance of NCDs and thei
Page 7 and 8: These post-transitional diseases al
Page 9 and 10: Table II Contribution of NCDs and I
Page 11: While these estimates (present and
Page 15 and 16: (primary, secondary, and tertiary).
Page 17 and 18: (Table VII Contd.) Management Healt
Page 19 and 20: The health care systems of most sat
Page 21 and 22: up of such patients at primary/seco
Page 23 and 24: anticipated growth in ‘capacity
Page 25 and 26: chronic care interventions and the
Page 27 and 28: Broadening the Base of Care Provide
Page 29 and 30: Delivery of chronic care in primary
Page 31 and 32: chronic diseases. High blood pressu
Page 33: Rose G. Sick individuals and sick p

prevention and control of non-communicable diseases - icrier

Create successful ePaper yourself

Delete template?

Save as template?