Scaling Up Chronic Disease Prevention Interventions in Lower- and Middle-Income Countries

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Abstract

Chronic diseases are increasingly becoming a health burden in lower- and middle-income countries, putting pressure on public health efforts to scale up interventions. This article reviews current efforts in interventions on a population and individual level. Population-level interventions include ongoing efforts to reduce smoking rates, reduce intake of salt and trans–fatty acids, and increase physical activity in increasingly sedentary populations. Individual-level interventions include control and treatment of risk factors for chronic diseases and secondary prevention. This review also discusses the barriers in interventions, particularly those specific to low- and middle-income countries. Continued discussion of proven cost-effective interventions for chronic diseases in the developing world will be useful for improving public health policy.

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Most cited references 62

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Cancer Statistics, 2008

A. Jemal, R. Siegel, E. Ward … (2008)

Each year, the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Incidence and death rates are age-standardized to the 2000 US standard million population. A total of 1,437,180 new cancer cases and 565,650 deaths from cancer are projected to occur in the United States in 2008. Notable trends in cancer incidence and mortality include stabilization of incidence rates for all cancer sites combined in men from 1995 through 2004 and in women from 1999 through 2004 and a continued decrease in the cancer death rate since 1990 in men and since 1991 in women. Overall cancer death rates in 2004 compared with 1990 in men and 1991 in women decreased by 18.4% and 10.5%, respectively, resulting in the avoidance of over a half million deaths from cancer during this time interval. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, education, geographic area, and calendar year, as well as the proportionate contribution of selected sites to the overall trends. Although much progress has been made in reducing mortality rates, stabilizing incidence rates, and improving survival, cancer still accounts for more deaths than heart disease in persons under age 85 years. Further progress can be accelerated by supporting new discoveries and by applying existing cancer control knowledge across all segments of the population.

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Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score.

Paul Ridker, Julie Buring, Nader Rifai … (2007)

Despite improved understanding of atherothrombosis, cardiovascular prediction algorithms for women have largely relied on traditional risk factors. To develop and validate cardiovascular risk algorithms for women based on a large panel of traditional and novel risk factors. Thirty-five factors were assessed among 24 558 initially healthy US women 45 years or older who were followed up for a median of 10.2 years (through March 2004) for incident cardiovascular events (an adjudicated composite of myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death). We used data among a random two thirds (derivation cohort, n = 16 400) to develop new risk algorithms that were then tested to compare observed and predicted outcomes in the remaining one third of women (validation cohort, n = 8158). Minimization of the Bayes Information Criterion was used in the derivation cohort to develop the best-fitting parsimonious prediction models. In the validation cohort, we compared predicted vs actual 10-year cardiovascular event rates when the new algorithms were compared with models based on covariates included in the Adult Treatment Panel III risk score. In the derivation cohort, a best-fitting model (model A) and a clinically simplified model (model B, the Reynolds Risk Score) had lower Bayes Information Criterion scores than models based on covariates used in Adult Treatment Panel III. In the validation cohort, all measures of fit, discrimination, and calibration were improved when either model A or B was used. For example, among participants without diabetes with estimated 10-year risks according to the Adult Treatment Panel III of 5% to less than 10% (n = 603) or 10% to less than 20% (n = 156), model A reclassified 379 (50%) into higher- or lower-risk categories that in each instance more accurately matched actual event rates. Similar effects were achieved for clinically simplified model B limited to age, systolic blood pressure, hemoglobin A(1c) if diabetic, smoking, total and high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and parental history of myocardial infarction before age 60 years. Neither new algorithm provided substantive information about women at very low risk based on the published Adult Treatment Panel III score. We developed, validated, and demonstrated highly improved accuracy of 2 clinical algorithms for global cardiovascular risk prediction that reclassified 40% to 50% of women at intermediate risk into higher- or lower-risk categories.

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Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use.

Perviz Asaria, Dan Chisholm, Colin Douglas Mathers … (2007)

In 2005, WHO set a global goal to reduce rates of death from chronic (non-communicable) disease by an additional 2% every year. To this end, we investigated how many deaths could potentially be averted over 10 years by implementation of selected population-based interventions, and calculated the financial costs of their implementation. We selected two interventions: to reduce salt intake in the population by 15% and to implement four key elements of the WHO Framework Convention on Tobacco Control (FCTC). We used methods from the WHO Comparative Risk Assessment project to estimate shifts in the distribution of risk factors associated with salt intake and tobacco use, and to model the effects on chronic disease mortality for 23 countries that account for 80% of chronic disease burden in the developing world. We showed that, over 10 years (2006-2015), 13.8 million deaths could be averted by implementation of these interventions, at a cost of less than US$0.40 per person per year in low-income and lower middle-income countries, and US$0.50-1.00 per person per year in upper middle-income countries (as of 2005). These two population-based intervention strategies could therefore substantially reduce mortality from chronic diseases, and make a major (and affordable) contribution towards achievement of the global goal to prevent and control chronic diseases.

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Author and article information

Journal

Title: Annual Review of Public Health

Abbreviated Title: Annu. Rev. Public Health

Publisher: Annual Reviews

ISSN (Print): 0163-7525

ISSN (Electronic): 1545-2093

Publication date Created: March 18 2013

Publication date (Print): March 18 2013

Volume: 34

Issue: 1

Pages: 317-335

Affiliations

[1 ]Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; email: ,

[2 ]Harvard School of Public Health, Harvard University, Boston, Massachusetts 02115

Article

DOI: 10.1146/annurev-publhealth-031912-114402

PMC ID: 3686269

PubMed ID: 23297660

SO-VID: c662511f-97aa-4c6a-a71d-54e8fe7c6b02

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ScienceOpen disciplines: Social policy & Welfare,General medicine,Environmental change,Infectious disease & Microbiology,Public health

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ScienceOpen disciplines: Social policy & Welfare, General medicine, Environmental change, Infectious disease & Microbiology, Public health

Scaling Up Chronic Disease Prevention Interventions in Lower- and Middle-Income Countries

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Most cited references 62

Cancer Statistics, 2008

Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score.

Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use.

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