Part Three. What works: the evidence for action
Chapter One. A strategy to achieve rapid results
Rapid health gains can be achieved
It is not necessary to wait decades to reap the benefits of prevention and control activities. Risk factor reduction can lead to surprisingly rapid health gains, at both population and individual levels. This can be observed through national trends (in Finland and Poland, for example, as described on page 93), sub-national epidemiological data and clinical trials.
In the case of tobacco control, the impact of proactive policies and programmes is almost immediate. The implementation of tobacco-free policies leads to quick decreases in tobacco use, rates of cardiovascular disease, and hospitalizations from myocardial infarction.
Improving diet and physical activity can prevent type 2 diabetes among those at high risk in a very short space of time. In China, Finland and the USA, for example, study participants have significantly improved their diet and/or physical activity, and shown improved levels of blood pressure, blood glucose, cholesterol and triglycerides as quickly as one year after starting a programme, with improvements continuing for at least six years. The incidence of diabetes was reduced by almost 60% in both Finland and the USA, and by over 30% in China (Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 2002, 346:393-403. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine, 2001, 344:1343-1350.)
Lowering a person's serum cholesterol concentration results in quick and substantial protection from heart disease. Benefits are related to age: a 10% reduction in serum cholesterol in men aged 40 can result in a 50% reduction in heart disease, while at age 70 there is on average a 20% reduction. Benefits can be realized quickly - after two years - with full benefits coming after five years (Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ, 1994, 308:367-372.)