Cognizant of asking countries to do too much in too many areas, the WHO experts are emphasizing a menu of “best buys” to prevent, delay and treat chronic illnesses.
They advocate population-wide interventions such as raising taxes on tobacco and alcohol; banning tobacco advertising; reducing salt in processed food; replacing trans-fats with less hazardous oils; and promoting physical activity through mass media campaigns.
The medical interventions include providing a combination of drugs to people with a calculated 30 percent chance of suffering a heart attack or stroke in 10 years; giving aspirin to people having a heart attack; and screening for cervical cancer (which is the leading cause of cancer death for women in sub-Saharan Africa).
Estimates of how much it would cost to put the interventions into effect will be provided in a second document to be released Sunday in New York, on the eve of the General Assembly meeting. Regardless of cost, there is considerable opposition in many places to policies viewed as intrusive or restrictive. But public health experts pushing the noncommunicable disease agenda say that without action by governments, significant prevention won’t occur.
“Government has a responsibility to make the healthy options the easiest options,” said Robert Beaglehole, a physician and epidemiologist at the University of Auckland in New Zealand. “Governments do that all the time.”
The new WHO report provides a one-page profile of each of more than 190 countries, depicting the share of mortality caused by noncommunicable diseases, and rates and trend lines for risk factors such as blood glucose, smoking and body mass index. It also displays an abbreviated score card for recommended interventions. All countries have much room for improvement, according to the report.
For example, there are five recommended strategies for tobacco control. No country has implemented all of them; only one country, Iran, has implemented four. Many countries have implemented none.
The U.S. Department of Health and Human Services announced a campaign Tuesday called “Million Hearts” aimed at preventing 1 million heart attacks and strokes over the next five years. Those diseases cause one-third of American deaths and consume 17 percent of national health spending, roughly $275 billion a year.
The project seeks to focus more attention, not more money, on improving the care of people who have heart disease and lowering the risk for people who don’t. It will do so by incorporating specific targets into activities already underway, including the government’s efforts to get physicians to adopt electronic medical records and to report certain measures of quality care, as well as numerous community-based interventions designed to improve health. Some private companies, such as pharmacies, will be enlisted to screen and educate people.
The U.S. targets are: increasing aspirin use for high-risk people from 47 percent now to 65 percent in 2017; increasing the percentage of people whose high blood pressure is controlled from 46 percent to 65 percent; the same with people with high cholesterol, from 33 percent to 65 percent; cutting the national smoking rate from 19 percent to 17 percent; and reducing daily salt consumption by 20 percent.
“These are simple, low-cost measures,” said Thomas Frieden, director of the Centers for Disease Control and Prevention.
Spending on heart disease and stroke in the United States is expected to triple by 2030. Whether “Million Hearts” will save money is uncertain, but it’s unlikely to increase costs, Frieden said. “What it will do is shift cost from sick care to health care.”
WHO Assistant Director General Alwan and health experts from around the globe will be discussing the crisis in noncommunicable diseases Wednesday at a Washington Post Live conference, which can be viewed starting at 8:30 a.m. at washingtonpostlive.com.
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