Government Policy ·······························································

Mark A. Strand

North Dakota State University, USA

For professionals concerned with the quality of life for global citizens, United Nations (UN) Secretary-General Ban Ki-moon’s “Remarks to General Assembly Meeting on the Prevention and Control of Noncommunicable Diseases” on September 19, 2011, was a landmark statement.

His statement acknowledges that the demographic transition is happening in many countries of the world, and precious health resources need to be prioritized with noncommunicable diseases (NCDs) in mind. In the rapidly modernizing global village, NCD risk factors such as increased smoking, decreased physical exercise, and unhealthy eating habits are increasing (Kvaavik, Batty, Ursin, Huxley, & Gale, 2010; Yang et al., 2008). Because NCDs are lifelong illnesses that require costly treatment for their end stage symptoms, addressing the burden of NCDs is an important agenda for global health. Secretary-General Ki-moon’s remarks give direction to this agenda and open the possibility of focus and political will by UN member states.

The shift in burdens of disease from communicable to noncommunicable diseases has been recognized since the 1990s (Gwatkin, Guillot, & Heuvelin, 1999). But this shift has not been reflected in global health funding priorities. For example, although HIV causes 3.7% of mortality, it receives 25% of international healthcare aid (England, 2008; Shiffman, 2006). As NCDs increasingly dominate the disease burden around the world, including in African nations, it is high time that funding begins to prioritize prevention and treatment of NCDs. Currently reliable estimates of rates of NCDs in most countries of the world are not even available.

Urbanization and changing lifestyles globally are leading to increased rates of obesity and sedentary living (Ng, Norton, & Popkin, 2009; Van de Poel, O’Donnell, & Van Doorslaer, 2009), and rates of NCDs in developing countries are increasing at an alarming rate (Misra &

Khurana, 2008; Popkin, 2009; van de Poel et al., 2009). Secretary-General Ki-moon’s remarks are recognition that the fastest growing contributor to disease burden globally is rooted in preventive care and early detection. For example, as if diagnosis and treatment of hypertension by current diagnostic criteria isn’t enough, meta-analysis has now shown that persons with prehypertension (130–139/85–89 mm Hg) have a substantially increased risk of stroke (RR 1.79, 95% CI 1.49–2.16), and this is especially relevant in nonelderly persons (Lee et al., 2011).

This shows how important it is to prevent and detect hypertension, and other NCDs, as early as possible as a way of reducing the burden of disease and the morbidity associated with it, and this is just as relevant in developing countries.

The Global Journal of Health and Physical Education Pedagogy Vol. 1, No. 1, pp. 74-76

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Mark A. Strand is Executive Director at Evergreen and Associate Graduate Faculty at North Dakota State University. Please send author correspondence to [email protected].

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Ki-moon wrote, “We should encourage individuals to make the smart choices that will protect their health. Exercise, eat well, limit alcohol consumption and stop smoking.” These behavioral prescriptions are not new (Jin et al., 2011; Shin, Lim, Sung, Shin, & Kim, 2009;

Steemburgo et al., 2009; Strand, Perry, Wang, Liu, & Lynn, in press). What is new is successful application of the behavioral sciences to procure successful modification of these high-risk behaviors (Van Achterberg et al., 2010). Behaviors contributing to NCDs, such as diet and exercise, are among the more modifiable human behaviors, compared with tobacco cessation and high-risk sexual behaviors. Efforts toward behavioral modification through health promotion needs to be done with more verve and political will.

Health behaviors that contribute to the prevention of noncommunicable diseases also contribute to an increased quality of life and to sustainable existence. For example, while driving an automobile contributes to sedentary living and increased rates of NCDs, bicycling to work contributes to prevention of disease, reduces global carbon emissions, and increases the quality of life by the production of endorphins and the enjoyment of the physical world in which we live. In many countries around the world meeting certain choices for the first time, creating environments that support behavior change and providing incentives to reduce lifestyle-related health risks are essential (Maziak & Ward, 2009).

Historically, acute communicable diseases have presented the greatest burden on health systems. Therefore, most health systems prioritize training and expertise in acute disease and underestimate the importance of building human and material capacity for chronic disease care.

Many hospitals and clinics lack basic equipment for effective diagnosis and treatment of NCDs, and few health workers have specialist training in chronic disease management (Aikins et al., 2010). Functional primary health care systems are not found in most countries of the world, and yet the key to managing NCDs in a cost-effective manner is accessible, affordable, and effective primary health care systems (Aikins et al., 2010; Griffiths, 2010; Ministry of Health Services, 2011; Willison, 2007).

Along with urbanization and radical lifestyle changes globally, the burdens of disease are shifting toward an epidemic level of NCDs. Primary health care systems are needed that are able to detect and manage these NCDs in a sustainable way, and systems are needed that carry out health promotion and behavior modification in ways that secure a healthy, enjoyable, and sustainable existence for all global citizens. Secretary-General Ki-moon has made a clarion call.

It is now time for concerned individuals to respond.

References

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Gwatkin, D. R., Guillot, M., & Heuvelin, P. (1999). The burden of disease among the global poor. Lancet, 354(9178), 586–589.

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Jin, L., Huang, Y., Bi, Y., Zhao, L., Xu, M., Xu, Y., . . . Ning, G. (2011). Association between alcohol consumption and metabolic syndrome in 19,215 middle-aged and elderly Chinese.

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Strand, M. A., Perry, J. L., Wang, P., Liu, S.F., & Lynn, H. (in press). The epidemiology of metabolic syndrome in a north China urban middle-aged population. Asia-Pacific Journal of Public Health.

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