Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Lessons from the control of other epidemics
evidence that such an approach is also effective in low
income settings.
Essential to the success of a primary health care
approach is the identification of core competencies
required by the primary health care team and then
building the capacity of such a team. WHO has highlighted
five basic competencies, which apply to
all members of the workforce caring for patients
with non-communicable diseases: patient-centeredcare;
partnering; quality improvement; information
and communication technology; and public health
perspective.
Achieving these results across a wide range of settings
has also required some innovation in order to
overcome the increasing shortages of highly specialized
and skilled health workers, especially in more
disadvantaged areas. Examples of such innovation
include task shifting where different cadres of workers
take on tasks traditionally assigned to a more specialized
level. For example, a number of rigorous studies
have shown that capable nurses can manage clinical
challenges at primary level just as competently as
general practitioners. 15 In the United States a large
number of non - physician clinicians and nurse practitioners
have been developed and been shown to be
just as competent as physicians. 16 However, the success
of such approaches does require a multi - disciplinary
teamwork approach so that carers can be provided
with support and there are good referral mechanisms
for more complex cases.
Increasing attention is also being paid to the potential
of non - professionals, including community
members and “ expert patients ” in the prevention and
management of many non - communicable diseases.
Interventions to increase the capacity of either individual
or groups of individuals in the self - management
of the disease has led to improvements in
outcomes such as pain control, reductions in disability
and depression as well as self - efficacy (confidence
about managing their own condition).
More s ophisticated
a dvocacy r esponses
Moving from policy to implementation remains a challenge.
Analysis of attempts to address global and
regional determinants of poor social outcomes has
highlighted three major deficits that need to be overcome.
These are: first, “democracy ” deficits as power
is concentrated in the hands of a few governments
(e.g., G8) often heavily influenced by big industrial
interests in these matters; second, “ coherence ” deficits
between different Ministries within governments and
sometimes between different international agencies
work to inhibit the necessary intersectoral action;
third, the shortcomings of democratic participa tion,
accountability and coherence contribute to “ compliance
” deficits as international institutions and national
governments fail to implement decisions they make.
Regardless of the exact deficiency, it is clear from
the experience of other non - communicable diseases
that strong political will and leadership is required
to achieve the necessary coordination of the planning
and implementation of priority policies and
prgrammes. Unlike other communicable epidemics
in the past, there are now far more stakeholders
including the private sector, non - governmental organizations
and civil society, operating at many different
levels and settings, who need to be brought together.
In particular, most of these epidemics are occurring
in the context of urbanized settings where achieving
changes to physical and environ mental structures
requires high levels of policy and advocacy skills
(along with plenty of patience). Building coalitions,
especially with non-governmental organizations and
other parts of civil society, has been important in the
fight against tobacco and HIV/Aids.
Developing a ppropriate
m onitoring s ystems
The lack of timely, reliable and comparable data on
prevalence, risk factors and trends has traditionally
hampered attempts to raise awareness of the problem
of non - communicable disease. Proper planning and
implementation of prevention and control strategies
depend on the availability of reliable and comparable
information for monitoring the burden of non -
communicable diseases and their risk factors; information
needs are greatest in the poorest countries. The
generation of simple but valid data concerning the
contribution of non - communicable diseases to premature
mortality and disability, together with the high
health care costs – and ensuing high economic costs
– have been important in raising awareness of the
problem for even poor and middle income countries.
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