Chronic diseases and health promotion

Part Four - Taking action: essential steps for success

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

Life course perspective. Spotlight: Chile

Risk factors accumulate from fetal life through to adulthood. Because risk behaviours are commonly established in childhood and adolescence, prevention strategies should include school health programmes focused on promoting healthy diets, physical activity, and tobacco abstinence. Adolescents who have already adopted risk behaviours such as tobacco use, or who have intermediate risks such as obesity, should be targeted for specialized interventions. Population-wide approaches such as smoke-free environments, advertising bans and taxation of tobacco are also essential to protect child and adolescent health. Rapid population ageing is another factor to be taken into consideration in policy development. The challenge for health policy-makers is to delay the onset of chronic diseases, and to improve functioning and quality of life.

Stepwise implementation

Most countries will not have the resources immediately to do everything implied by the overall policy. Core interventions that are feasible to implement within existing resources in the short term should be chosen first. Other activities are included in the “expanded” and “desirable” steps of implementation.

Spotlight: A changing national health system in Chile

In 2000, a national survey on living conditions and health, coupled with mortality data, clearly showed the large health inequalities and increasing magnitude of chronic diseases in Chile. Based on this information, the Government of Chile made a commitment to improving the health of the population and to improving health among the most disadvantaged groups. This led to the establishment of health objectives for 2010. Targets for chronic diseases include decreasing tobacco use, decreasing the prevalence of obesity in children and pregnant women, reducing physical inactivity and lowering mortality from cardiovascular diseases, cancers and respiratory diseases. Further targets include reducing the disability associated with diabetes, increasing oral health coverage, and increasing coverage of palliative care for people dying at home.

For 56 health conditions, 39 of which relate to chronic diseases, the Government committed itself to universal access to care, opportunity of care, quality of care, and financial coverage. Under this plan, private insurers must comply with the same regulations and guidelines as the public system. Full participation of all stakeholders and of society at large under the stewardship of the Ministry of Health was crucial. Once the needs of the population were estimated, priorities were able to be set, thereby ensuring adequate distribution of resources