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Overcoming Impediments to Prevention and Control

Derek Yach, MBChB, MPH; Corinna Hawkes, PhD; C. Linn Gould, MS, MPH; Karen J. Hofman, MD

JAMA. 2004;291:2616-2622.

Chronic diseases are the largest cause of death in the world. In 2002, the leading chronic diseases—cardiovascular disease, cancer, chronic respiratory disease, and diabetes—caused 29 million deaths worldwide. Despite growing evidence of epidemiological and economic impact, the global response to the problem remains inadequate. Stakeholders include governments, the World Health Organization and other United Nations bodies, academic and research groups, nongovernmental organizations, and the private sector. Lack of financial support retards capacity development for prevention, treatment, and research in most developing countries. Reasons for this include that up-to-date evidence related to the nature of the burden of chronic diseases is not in the hands of decision makers and strong beliefs persist that chronic diseases afflict only the affluent and the elderly, that they arise solely from freely acquired risks, and that their control is ineffective and too expensive and should wait until infectious diseases are addressed. The influence of global economic factors on chronic disease risks impedes progress, as does the orientation of health systems toward acute care. We identify 3 policy levers to address these impediments elevating chronic diseases on the health agenda of key policymakers, providing them with better evidence about risk factor control, and persuading them of the need for health systems change. A more concerted, strategic, and multisectoral policy approach, underpinned by solid research, is essential to help reverse the negative trends in the global incidence of chronic disease.

Author Affiliations: World Health Organization, Geneva, Switzerland (Drs Yach, Hawkes, and Gould) and Fogarty International Center/US National Institutes of Health, Washington, DC (Dr Hofman). Linn Gould is now at Erda Environmental Services, Inc, Seattle, Wash.

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