Part Four - Taking action: essential steps for success
Chapter One: Providing a unifying framework - the role of government
Comprehensive action. Spotlight: China
Comprehensive and integrated public health action Comprehensive and integrated policies and plans are vital, because they minimize overlap and fragmentation in the health system. They should therefore:
- cut across specific diseases and focus on the common risk factors;
- encompass promotion, prevention, and control strategies;
- emphasize the management of the entire population over the management of specific subgroups;
- integrate across settings, such as health centres, schools, workplaces and communities;
- make explicit links to other government programmes and community-based organizations.
Programme implementation itself should also be comprehensive and integrated because:
- it is both impossible and unnecessary to have specific programmes for different chronic diseases;
- without a national organizing framework, there is a risk that initiatives may be developed or implemented independently of each other, and opportunities for synergies may not be realized.
Intersectoral action Intersectoral action is necessary because, as reviewed in Part Two of this report, the underlying determinants of the chronic disease burden lie outside the health sector. These include poverty, lack of education and unhealthy environmental conditions. More proximal chronic disease risks, such as unhealthy diets and physical inactivity, are also influenced by sectors outside health, such as transport, agriculture and trade. An intersectoral committee should be created for policy-making. At the national level, it should be convened by the ministry of health, but with representation from other relevant ministries and organizations. Different sectors may have different and sometimes even conflicting priorities. In such situations, the health sector needs the capacity to provide leadership, to provide arguments for a win-win situation and to adapt to the agendas and priorities of other sectors.
Spotlight: China's national strategy for chronic disease control
China’s Ministry of Health, with the support of WHO and the cooperation of relevant sectors, has been developing a national plan for chronic disease prevention and control, which focuses on cardiovascular diseases, cancer, chronic obstructive pulmonary disease and diabetes. It is expected to be applicable to both the medium and long term, and include an action plan for 3–5 years. This follows an earlier Programme of Cancer Prevention and Control in China (2004–2010) developed by the Ministry of Health. The national plan aims to reduce the overall level of risk factors, to improve early detection and treatment and to provide accessible and affordable health services. It includes the development of a national system of prevention and control, which will require comprehensive financing, multisectoral cooperation and the establishment of expert committees at the national and local levels. It will also involve capacity building and the establishment of a national surveillance system, as well as periodic surveys of nutrition and health (Wang L, Kong L, Wu F, Bai Y, Burton R. Preventing chronic diseases in China. Lancet (in press).