The Pan American Health Organization (PAHO) is promoting CARMEN (Actions for the Multifactorial Reduction of Noncommunicable Diseases) as a general framework for the prevention and control of NCDs in the Americas. This initiative was created in 1997 to reduce risk factors for NCDs, particularly cardiovascular disease, by coordinating health promotion and disease prevention activities in communities and community health services.
PAHO is working with member countries to support capacity building for an interdisciplinary prevention model in primary health care. This model includes the identification of risk factors, early detection of cases, delivery of comprehensive and long-term care, and more active participation of all members of the health team and the community. Management of hypertension and diabetes are particularly important in the model. A regional surveillance system for NCD risk factors is also being established, as member countries adopt a standard methodology.
Other important activities include strengthening collaborative work with various actors and community groups involved in this area, promoting the formation of coalitions between key stakeholders, and developing initiatives based on best practices by supporting information exchange among countries.
CVD and other chronic conditions are rapidly increasing in Africa, and poverty plays a major role in the impact of these diseases on communities. Benin, Cameroon, Mali, Zambia, Zimbabwe and Algeria are participating in WHO Global Programme for Prevention and Control of Rheumatic Fever and Rheumatic Heart Disease. A regional advisory board is being set up to assist with managing the programme. The most important activities for controlling risk factors are related to the Tobacco Free Initiative. Situation analyses are being conducted in Botswana, Kenya, Lesotho, Malawi, Swaziland, Zambia and Zimbabwe. Health education programmes targeting school youngsters are also underway in these countries.
Technical support is being provided to Botswana, Kenya, Lesotho and Zimbabwe to develop anti-tobacco legislation. Support has also been provided to Botswana and Zimbabwe to undertake a situation analysis on CVD and other major NCDs, and the programme will be extended to three other countries in the near future. In addition, two countries will participate in a pilot test of WHO stepwise approach to surveillance. Nigeria is part of the WHO/CDC MEGA country project. Initial steps have already been taken to establish a regional network of NCD-related activities.
The Eastern Mediterranean Regional Office (EMRO) gives high priority to CVD prevention and control programmes. National surveillance programmes for CVD risk factors and community-based prevention programmes have been initiated; and national and international workshops are held to increase awareness and educate health professionals about the CVD epidemic. Healthy lifestyles are also advocated through country workshops and health education programs. In several Member States, EMRO supported the development of national clinical guidelines for cost-effective management of hypertension, with emphasis on primary care.
Many countries are making significant progress in developing national programmes for the surveillance of risk factors and for managing hypertension. The goal is to deliver interventions, which will promote behavioural changes in individuals and in the population as a whole.
The Countrywide Integrated Noncommunicable Diseases Intervention (CINDI) programme aims to reduce modifiable risk factors, such as smoking and high blood pressure, by integrating health promotion and disease prevention. At present, 27 countries participate in the programme.
Two other programmes also aim to improve the quality of life of people with CVDs. The Helsingborg Declaration on stroke management was a follow-up to the 1995 Pan-European Consensus Meeting on stroke management. The meeting was organized in collaboration with the European Stroke Council, the World Confederation of Physiotherapy-Europe, the World Federation of Occupational Therapy, the European Federation of Neurologists Societies and the International Stroke Society. A document on stroke units is under elaboration.
The second programme is a pilot project aimed at improving the education skills of general practitioners. The programme shows practitioners how to educate coronary heart disease patients about improving the quality of their lives, and how rehabilitation and secondary prevention can be improved.
Growing evidence shows that CVD poses an important health threat to disadvantaged and poor segments of population. A top priority of the South-East Asia WHO regional office (SEARO) is thus to promote the development of reliable, inexpensive and sustainable surveillance systems for major NCDs and their risk factors, that can be used at both regional and national levels. Advocacy and technical support aimed at integrating national NCD prevention and control programmes also continue in the region.
SEARO has emphasized the need to shift the focus of policy makers from expensive tertiary care, to primary and secondary prevention through community- and primary healthcare-based interventions. Efforts are also being made to increase public awareness about the harmful effects of tobacco use, and Indonesia, Myanmar, Nepal and Thailand have initiated national CVD control programmes.
The Western Pacific Regional Office of WHO (WPRO) has taken an integrated approach to the prevention and control of NCDs, including CVD. In 2000, the Western Pacific Regional Committee adopted resolution WPR/RC51.R5 on the prevention and control of NCDs. A Declaration and Plan of Action on Diabetes has also been formulated, in addition to a Call for Action on Obesity in the Pacific islands. Technical capacity for surveillance is supported through participation in the global WHO STEPS process in Mongolia, Viet Nam and Pacific island countries.
Integrated community-based interventions on NCDs are being implemented in China, the Philippines, Micronesia, Tonga and Samoa. Several Member States have supported national guidelines for managing hypertension in the community, for example, and a guide to Developing Food-based Dietary Guidelines for the Prevention and Control of NCDs has been developed. Physical Activity Guidelines have also been formulated. The work of the WPRO Tobacco-Free Initiative generates support for the Framework Convention on Tobacco Control and supports national tobacco control activities.