Chronic diseases and health promotion

Part Four - Taking action: essential steps for success

Chapter One: Providing a unifying framework - the role of government

Planning step 1

STEP 1: Estimate population need and
advocate for action

Although some disease burden information may be available, the distribution of risk factors among the population is the key information required by countries in their planning of prevention and control programmes. This information predicts the future burden of disease; it must then be synthesized and disseminated in a way that successfully argues the case for the adoption of relevant policies.

Estimating need

WHO has developed a tool to help low and middle income countries assess their risk factor profiles - the STEPwise approach to Surveillance (STEPS). WHO STEPS focuses on building capacity in low and middle income countries to collect small amounts of high-quality risk factor data:

  • STEP 1: collect questionnaire-based information about diet and physical activity, tobacco use and alcohol consumption.
  • STEP 2: use standardized physical measurements to collect data
    on blood pressure, height and weight.
  • STEP 3: expand physical measurements with the collection of blood samples for measurement of lipids and glucose status.

Although most countries have the resources for collecting data in the first two stages, the third is resource-intensive and not suited for all settings or sites. STEPS is designed to allow flexibility for local adaptation, and also offers expanded modules (such as oral health and stroke) while encouraging collection of standardized data (STEPS: a framework for surveillance. Geneva, World Health Organization, 2003).