An “epidemic” of health problems, including heart disease, stroke and diabetes may “kill about 388 million people worldwide over the next decade unless governments take concerted action”, reported The Guardian today. A report from experts in 55 countries calculates that “preventable disease now account for about 60% of deaths worldwide and 44% of premature deaths”, the newspaper said.
The news report is based on a feature article in a scientific journal that reports a process of consensus building used to collect the views from a diverse group of 155 public health experts. The aim was to agree a list of 20 challenges on the subject of preventable diseases. The hope was that having these challenges explicitly stated, would inspire “debate, support and funding” in this area, along with research and policy changes to reduce disease burden. The report’s authors conclude that, “with concerted action, 36 million premature deaths can be averted by 2015.” This is about one tenth of 388 million expected to die from preventable diseases. It is not possible to confirm the numbers referred to in this research; however, the methods used to provide direction and focus attention on this problem seem robust.
Drs Abdallah Daar and Deepa Leah Persad from the McLaughlin-Rotman Centre for Global Health (University Health Network/University of Toronto) carried out the study, with help from colleagues sitting on an international executive committee. The study was funded by the Oxford Health Alliance with contributions from the UK Medical Research Council and the McLaughlin-Rotman Centre. It was published in the peer-reviewed scientific journal: Nature .
This was a qualitative research project that used a structured consensus building method (the Delphi Method) to engage professionals in a structured discussion about preventable diseases known together as chronic non-communicable disease (CNCDs).
The researchers recruited a panel of 155 geographically diverse, public health experts from 50 countries. They asked the experts a structured series of questions and fed back the answers in a number of rounds. They first asked, “What do you think are the grand challenges in chronic non-communicable diseases?” They received 1,854 ideas, many of which overlapped. These were summarised and the panel then selected, ranked and commented on the top 30. The final step was to filter the list to 20 “grand challenges” that were grouped into six goals. The executive committee and scientific board matched a list of research needs to the goals and the results were published.
The challenges were related to the six goals of:
For example, the challenges listed in the “modifying risk factors” goal included deploying measures proven to reduce tobacco use and boost resources to implement the WHO Framework Convention on Tobacco Control, increasing the availability and consumption of healthy food, promoting lifelong physical activity, and better understanding environmental and cultural factors that change behaviour. The authors also list some suggested research areas needed to reach each goal.
The researchers aim to “galvanise the health, science and public-policy communities into action on the chronic (long-term) non-communicable disease epidemic”. They list measures to discourage smoking, alcohol consumption and unhealthy foods, to limit the negative impacts of poverty and urbanisation on health and to move health systems towards prevention rather than cure.
The study has drawn on the expertise of a range of public health professionals in order to outline the challenges in preventing diseases. The steps needed to meet these challenges are familiar public health messages and this study has reinforced the call for concerted action to tackle a range of preventable disease.
The authors suggest further research aimed at developing a better understanding of health at the population level and investigating public health approaches to manage risk factors. The authors considered the use of new and combined medications to prevent cardiovascular disease and diabetes were considered, and contrasted the researching of new drug treatments for the diseases themselves with a public health approach. It remains to be seen whether resources directed to such public health endeavours, which aim to prevent disease, provide better value than investing in the development of new drugs to treat them.
The future is here, it is just not evenly distributed. What we can see around us in the UK will become a worldwide phenomenon, with developing countries like India suffering from both under and over nutrition. The key responsibility rests not with ‘government’ but with individual citizens.