The burden of chronic diseases, such as heart disease, cancer, diabetes and mental disorders is high in low-income and middle-income countries and is predicted to increase with ageing populations, urbanisation and globalisation of risk factors. An integrated approach, including salt and tobacco control, cheap combination drugs for cardiovascular disease and simple, easily-applied mental health interventions, must be used to tackle this chronic disease time-bomb. These are the conclusions of the third in a Series of eight papers in the Alma-Ata Special Issue of The Lancet, by Professor Robert Beaglehole, University of Auckland, New Zealand and Professor Shah Ebrahim, London School of Hygiene & Tropical Medicine, London, and colleagues.
The authors advocate for nicotine replacement therapy in addition to increased tobacco taxes, and a reduction of salt in the diet by 15% - equivalent to about a quarter of a teaspoon a day. A combination regimen containing several drugs for people at high risk of cardiovascular disease could cost as little as US$1.10 per person, yet avert almost 18 million deaths in 23 low-income and middle-income countries over the next 10 years. Identification of these high-risk patients could be done using easily measured risk-factors such as body-mass index, alcohol and tobacco history, waist and blood pressure measurements. Expensive laboratory tests would not be necessary. The Lancet Series on Global Mental Health called for community-based and primary health care interventions to tackle the rapidly increasing cases of depression and other mental health disorders in poorer countries. The authors say: "Experience in low-income and middle income countries indicates that to be fully effective, primary care tasks must be limited and feasible."
The authors conclude: "Integrated primary care approaches are of central importance in tackling the growing burden of chronic diseases, irrespective of cause. Management of chronic diseases in primary health care is fundamentally different from that for acute care. Primary health care is probably more effective when complemented by effective public policies to tackle the major risk factors, such as tobacco use, obesity, and excessive salt consumption."
Professor Shah Ebrahim, London School of Hygiene & Tropical Medicine, London WC1E 7HT, T) +44 (0)20 7927 2215 E) shah.ebrahim@lshtm.ac.uk
full paper: http://press.thelancet.com/AA3.pdf
Journal
The Lancet