Priorities for action
Expanding life expectancy provides the potential for better health expectancy. However, steps towards fulfilling that potential can only be taken if the pathways are clearly marked. In terms of controlling noncommunicable diseases, this means defining realistic priorities for international action.
It is clear from the analysis in this report that many of these diseases share a relatively small number of crucial risk factors. An integrated, coordinated approach to their prevention is therefore necessary. Until now, most interventions have been medical, conducted through traditional disease-specific vertical programmes. The time has now come to build on the best of these and develop integrated packages of disease-specific interventions that incorporate primary and secondary prevention, diagnosis, treatment and rehabilitation for the most prevalent diseases.
There is an urgent need to develop and incorporate activities that raise awareness of, and motivation for, healthy lifestyles and the environments to support them.
This demands a new relationship in which specialists, experts and leaders in various fields look beyond their own professional boundaries. They need to recognize that many diseases have common risk factors and to share their skills and experience so as to tackle them together. This risk factor recognition must be communicated clearly to the public at large.
The relationship between core physical health and mental health services has been complex, and sometimes counterproductive. The separation of the two fields has also often produced fragmentation in the delivery of health services, to the detriment of the clients. A new alliance between the exponents of physical and mental health is required.
In many areas of noncommunicable disease control, an abundance of cost-effective technologies and intervention strategies already exists. Others are being developed. Listed according to their priority for action, they can be grouped as follows: prevention (which includes behaviour change and immunization); medical (which includes screening and early detection, treatment and palliative care); policies (including legislation and regulation); and research. At the same time, ethical issues are becoming more and more important.
Priority areas for international action in health should be:
- Integration of disease-specific interventions in both physical and mental health into a comprehensive chronic disease control package that incorporates prevention, diagnosis, treatment and rehabilitation and improved training of health professionals.
- Wider application of existing cost-effective methods of disease detection and management, including improved screening, taking into account the genetic diversity of individuals.
- A major intensified but sustained global campaign to encourage healthy lifestyles, with an emphasis on the healthy development of children and adolescents in relation to risk factors such as diet, exercise and smoking.
- Healthy public policies, including sustainable financing, and legislation on pricing and taxation, in support of disease prevention programmes.
- Acceleration of research into new drugs and vaccines, and into the genetic determinants of chronic diseases.
- Alleviation of pain, reduction of suffering and provision of palliative care for those who cannot be cured.
The world health report 1997 indicates priorities for action that are intended to improve humanity's ability to prevent, treat, rehabilitate and where possible, cure major noncommunicable diseases, and to reduce the enormous suffering and disability that they cause.
Inevitably, each human life reaches its end. Ensuring that life ends so in the most dignified, caring and least painful way that can be achieved is equally a priority. It is a priority not merely for the medical profession, the health sector or the social services, but also for each society, community, family and individual.