Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 2
trade. There are provisions that allow public health
concerns to “ override ” the desire for more free trade
in the WTO but the drawbacks of relying upon WTO
exemptions include economic disincentives associated
with violation of WTO rules that may prevent States
from giving priority to public health when conflicts
arise, and may also impede the negotiation, ratification
and implementation of international public
health instruments.
Optimize e ffectiveness (in t erms
of q uality and c overage) of
e xisting e fficacious i nterventions
e specially in h ealth s ector
There are a number of efficacious and effective interventions
that can prevent or reduce the morbidity
and mortality associated with non - communicable
diseases. However, too often, the inverse care law
applies in terms of the coverage of these interventions:
those who need the interventions the most are
the least likely to receive them. Within countries, there
are differences in coverage between the rich and
poor and between urban and rural areas. There are
also large differences in access to care between
countries.
Unfortunately, the evidence for what works in
terms of scaling up interventions for non - communicable
diseases is limited. Reviews of relatively successful
non - communicable disease programmes have
highlighted some common features including: routine
patient monitoring; shared decision making between
health professionals and patients; self - management
support that allow patients to successfully manage
their symptoms, treatments and preventive health
behaviors on a day - to - day basis; and community
linkages that allow interventions such as population -
based health promotion and disease prevention,
integration of people with NCDs into community life,
and provision of complementary and home - based
health services. 13 However, nearly all these lessons are
based on non - communicable care models in the USA
or UK with very little evidence of what works at scale
in resource - poor settings. The approach of WHO with
regards to the non - communicable care and treatment
of people living with HIV/Aids is interesting in that
it focuses on a slightly different set of principles
(Box 2.2 ).
Box 2.2 Scaling up HIV t reatment
The huge burden of unmet care and treatment for HIV
has led to a plethora of treatment options for those
infected, especially in Southern Africa where the epidemic
is at its worst. Difficulty in accessing efficacious
drug treatments has led many HIV patients to spend
significant amounts of resources in accessing sub -
standard care and treatment. Governments and agencies
are now responding by scaling up the introduction
of long - term treatment of HIV with the provision of
anti - retroviral treatment ( ART ). The challenges of providing
non - communicable care in the context of weak
health systems have led WHO to adopt what they
termed a “ public - health approach to ART treatment ” .
A number of innovations marked a shift from previous
attempts to provide ART:
1) standardization of first - line and second - line treatment
along with a prescriptive approach, facilitating
the development of fixed - dose first line combinations,
and driving down the price of these drugs;
2) simplification of clinical decision making with an
attempt to manage without necessarily having any
immunological monitoring;
3) decentralization of treatment to the district level
through the development and training in adapted
integrated management of adult illness (IMAI)
guidelines;
4) task shifting of essential activities such as initiation
and monitoring of treatment from physicians to
nurses;
5) procurement and supply management strengthening,
with a focus on reducing the number of commodities
and drugs and being more specific of
exact requirements. Such an approach has allowed
a significant scaling up of the provision of ART and
early results suggest that while early mortality is
high the medium - term outcomes for those on the
programmes is good. 14
Decentralized c are f ocused at the
p rimary h ealth c are l evel
The example of the scale - up of treatment for HIV/
Aids emphasizes the shift in the care of patients from
specialists and hospitals to nurse - led care at a primary
health care center. There is now good evidence from
well resourced settings that primary - care - led patient
models can lead to similar and often better outcomes
than specialist, tertiary level care. There is also some
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