An introduction to population-level prevention of non-communicable diseases

279 Pages·2017·3.284 MB·English

by  Mike Rayner, Kremlin Wickramasinghe, Julianne Williams, Karen McColl, Shanthi Mendis

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An Introduction to
Population- Level Prevention of
Non- Communicable Diseases
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An Introduction
to Population- Level
Prevention of 
Non- Communicable
Diseases
Edited by
Mike Rayner
British Heart Foundation Centre on Population Approaches for
Non- Communicable Diseases Prevention, Nuffield Department
of Population Health, University of Oxford, UK
Kremlin Wickramasinghe
British Heart Foundation Centre on Population Approaches
for Non- Communicable Diseases Prevention, Nuffield Department
of Population Health, University of Oxford, UK
Julianne Williams
British Heart Foundation Centre on Population Approaches
for Non- Communicable Diseases Prevention, Nuffield Department
of Population Health, University of Oxford, UK
Karen McColl
Freelance consultant/ writer
Shanthi Mendis
Geneva Learning Foundation, Geneva, Switzerland
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Foreword
Non- communicable diseases (NCDs), including heart disease, stroke, cancer, diabetes,
and chronic lung disease, are collectively responsible for more than two- thirds of all deaths
worldwide. Primarily four risk factors are responsible for the burden of NCDs: tobacco
use, physical inactivity, the harmful use of alcohol, and unhealthy diets.
Almost three- quarters of all deaths from NCDs before the age of 70 occur in low- and
middle- income countries. For a long time there was a strong belief that NCDs are asso-
ciated with affluent lifestyles. But current statistics clearly show that not just developed
countries, but low- and middle- income countries face a growing burden of NCDs and
that it is in some of the poorest populations around the world where NCDs have the
greatest impact.
In 2011 a high- level meeting of the United Nations recognized the growing burden
of NCDs as a threat to global development and called for actions from heads of state to
tackle the issue. The inclusion of a goal to reduce premature mortality from NCDs by
one- third in the Sustainable Development Goals agreed in 2015 was a turning point in
scaling up the global response. The World Health Organization (WHO) recommends a
series of actions to tackle NCDs and they can be categorized as the following: improved
governance, tackling risk factors more effectively, strengthening health systems, and bet-
ter monitoring and evaluation. Health systems in all but a few countries are more focused
on treatment of individuals with disease than prevention. Population-l evel prevention
approaches such as national- level policies to raise taxes on tobacco or restrict the market-
ing of unhealthy food and drinks to children are likely to be extremely cost-e ffective, but
many countries lack the capacity to implement such actions.
Since 2012 the WHO Collaborating Centre on Population Approaches for Non-
Communicable Disease Prevention at the Nuffield Department for Population Health,
University of Oxford has organized a regular short course on population approaches
to NCD prevention. With the participation of other experts, including representatives
of WHO, the course aims to build capacity for population- level action to tackle NCDs.
However, given the large number of trained professionals needed to tackle this global
issue, a face-t o- face training programme is not able to reach everyone who requires the
knowledge and skills necessary for effective action.
An Introduction to Population- Level Prevention of Non- Communicable Diseases is
mainly based on material presented at the course, and it provides an exciting opportu-
nity for this to be shared with a greater global audience. This book brings together evi-
dence about different aspects of the problem of NCDs and their solution for academics,
policy- makers, and other practitioners. It is structured around the key steps of the policy
cycle and encourages evidence- based policy- making and evaluation at a population level.
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vi FOREWORD
While providing the general principles and scientific basis to population-l evel prevention
for NCDs, it also provides case studies from countries around the world seeking to imple-
ment such prevention in practice.
I hope this book will play a significant role in our global response to the prevention of
NCDs in coming years and decades. I congratulate the authors on this publication and
wish every success for the dissemination and future updates.
Dr Oleg Chestnov
Assistant Director- General— Noncommunicable Diseases
and Mental Health World Health Organization
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Acknowledgements
We would like to thank all the participants and resource persons who have presented at
the short course on Prevention Strategies for Non- Communicable Diseases run by the
University of Oxford. This book is based on presentations made during short courses held
between 2012 and 2015. Presenters during these courses included the following: Steve
Allender, Virginia Arnold, Prachi Bhatnagar, Francesco Branca, Adam Briggs, Simon
Capewell, Sudeep Chand, Michel Coleman, Gill Cowburn, Aiden Doherty, Kaia Engesveen,
Charlie Foster, Gauden Galea, Simon Gillespie, Celina Gorre, Corinna Hawkes, Shabbar
Jaffar, Prasad Katulanda, Mike Kelly, Paul Kelly, Mike Knapton, Alexandra Krettek, David
Matthews, Karina McHardy, Klim McPherson, Shanthi Mendis, Bente Mikkelsen, Colin
Mitchell, Modi Mwatsama, Oliver Mytton, Melanie Nichols, Brian Oldenburg, Richard
Peto, Emma Plugge, Johanna Ralston, Mike Rayner, Srinath Reddy, Aaron Reeves, Justin
Richards, Harry Rutter, Peter Scarborough, David Stuckler, William Summerskill, Nick
Townsend, Temo Waqanivalu, Kremlin Wickramasinghe, Denis Xavier, and Xuefeng
Zhong.
This book contains a number of case studies. The following individuals contributed to
these cases studies or provided other additional material for the book: Luke Allen, Simone
Bösch, Hannah Brinsden, Linda Cobiac, Dylan Collins, Alessandro de Maio, Randa
Hamadeh, Erin Hoare, Nousin Hussain, Kiran Jobanputra, Sandeep Kishore, Alexandra
Krettek, Tim Lang, Nijole Gostautaite Midttun, Modi Mwatsama, Jessica Pullar, Nabil
Sulaiman, Anne- Marie Thow, Daniel Vujcich, Temo Waqanivalu, and Rouham Yamout.
We also appreciate the help of Sahar Bhatti, Oluwatosin Ogunmoyero, Anja Mizdrak,
and Lizzie Wilkins, who documented presentations and discussions from the short
course. We would also like to thank all our colleagues at the British Heart Foundation
Centre on Population Approaches for Non- Communicable Disease Prevention, Nuffield
Department of Population Health, University of Oxford and the Department for
Continuing Education, University of Oxford for their support throughout this publica-
tion. Finally, we are so grateful for the team at the Oxford University Press, who worked
very hard to publish this book on a tight timeline. Thank you to James Cox, Geraldine
Jeffers, Catherine Barnes, and Nicola Wilson for their tireless help as we prepared the
manuscript for publication.
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Contents
Foreword v
Acknowledgements vii
Abbreviations xi
Part I Introduction
1 Introduction 3
Part II Problem definition
2 Understanding NCDs 13
3 NCDs: Risk factors and determinants 31
4 The sociopolitical landscape of NCDs, Part I 47
5 The sociopolitical landscape of NCDs, Part II 63
6 Public health advocacy for the prevention of NCDs 81
7 Screening and surveillance 107
Part III Solution generation
8 Evidence for population- level approaches to the prevention
of NCDs: Evaluating effectiveness and modelling 129
9 Evidence for population- level approaches to the prevention
of NCDs: Economic evaluation 147
10 Developing a prevention strategy 167
Part IV Resource mobilization and implementation
11 Capacity building 181
12 Implementation of an NCD prevention strategy 191
13 Implementation: Beyond the health sector 207
Part V Monitoring progress
14 Evaluation and monitoring 227
15 Revisiting the stages of the policy cycle 249
Index 257