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Although many non-communicable diseases are preventable, a large proportion are not, even under optimal circumstances. A well-known practitioner of this approach is the World Bank, which has devoted a great deal of time and effort to defining a suitable international poverty line and estimating the number of people living below it.

12.5 Disease prevention and control of non-communicable diseases Oxford Textbook of Public Health 12.5 Disease prevention and control of non-communicable diseases Jørn Olsen Introduction Types of prevention Screening Causation Health promotion Prevention and care Reducing risk factors Social determinants of health Environmental risk factors Social support A life-course approach to disease prevention Non-communicable diseases in developing countries Changes during the course of life Burden of chronic diseases Health futures The economy of prevention Conclusions Chapter References Introduction In the year 2000 the Executive Board of the World Health Organization (WHO) recommended the 55th World Health Assembly: (1) to formulate a global strategy for the prevention and control of non-communicable diseases. However, they all share a recognition that in health, as in many other fields, societal averages typically disguise as much as they reveal.

(2) to recognize the enormous human suffering caused by cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases, and the threats they pose to the economics of member states. Thus their interest is not in the health conditions that prevail in society as a whole, but in the condition of different socio-economic groups within society—especially the lowest or most disadvantaged groups.

One could envisage a taxation system where taxes are partly paid according to how much one’s behaviour has negative consequences for the environment and to what extent one expects to need the health-care system to cure self-inflicted health problems. For example, at the same time as the Alma-Ata Declaration professed its concern for the unacceptable health conditions found among the hundreds of millions among the world’s poor, it also advocated primary health care because of its potential ‘to close the gap between the “haves” and the “have-nots” ‘, i.e. The previously cited World Health Report 1995 (WHO 1995), which had a great deal to say about the health of the poor, was subtitled Bridging the Gaps, referring to the inequalities between poor and rich.

Non-communicable diseases have only one common property —the diseases are non-transmittable directly from one person to another via a single external agent. A recent major WHO publication in this area emphasizes the importance of being concerned with poor–rich health inequalities, rather than simply focusing on the health of the poor alone (WHO 1996).

Accepting non-smokers’ right to avoid passive smoke will reduce smoking habits as role models will have less influence when smoking is not performed in public places. To say that the focus has been exclusively on inequality would be to overstate the case, for it is possible to cite expressions of concern for poverty in prominent international health documents from at least the time of the Alma-Ata Declaration (1978) onwards.

Subsidizing healthy food or taxation on alcohol, tobacco, fat, and sugar may also facilitate a change towards a more prudent diet. However, it is rare for a prominent international health statement not to give at least equal, if not more, weight to inequality reduction.

An enormous amount of money is spent on influencing consumer behaviour on the market through advertising. It emerged in the late 1960s and early 1970s in reaction to the then dominant emphasis on overall per capita income growth rates.

Many people want to influence our lifestyle, yet there are few epidemiologists or public health workers and their financial resources are comparatively sparse. At the time, a concern for distribution was thought likely to detract from the overall economic growth that was considered a necessary condition for the long-term alleviation of poverty.

(3) to notice that these diseases are linked to common risk factors, namely, tobacco use, unhealthy diet, and physical inactivity, and being aware that these risk factors have economic, social, gender, political, behavioural, and environmental determinants. Perinatal correlates of specific histological types of testicular cancer in patients below 35 years of age: a case-cohort study based on midwives’ records in Denmark. But within this shared concern lie a number of distinctions.

Although, in principle the WHO knows how to prevent many of the most important non-communicable diseases in industrialized countries, in general it does not know how to implement this knowledge. Insertion/deletion polymorphism of the angiotensin-converting enzyme gene is strongly associated with coronary heart disease in non-insulin-dependent diabetes mellitus. Those interested with the health of the poor are typically concerned primarily with improving the health of that group alone, rather than with reducing differences between poor and rich.

The ability to set up a preventive programme that is evidence based is limited, as the more distal determinants of lifestyle factors are not known, except that they are related to education, social conditions, peer pressure, role models, etc. These similarities and differences can most easily be understood by considering each of the three indicators and concepts in turn, and then reviewing the practical implications of thinking in terms of one or the other.