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| ASSEMBLY EDITION • ORLANDO, FLA |
The only way to successfully halt chronic diseases across the globe is to implement preventive health programs across the street. Those programs must reside in the markets of Kampala, Uganda, as well as in the heart of New York City.
That's because lifestyle behaviors - unhealthy diets, inactivity and tobacco use - have crept throughout the world. Changing those behaviors requires intensive local action that focuses on both individual choices and the sociopolitical environment in which people live, said a renowned health leader yesterday.
Chronic diseases: top killers worldwide
Chronic disease has skyrocketed worldwide, said Dr. Pekka Puska, director general of the National Public Health Institute of Finland and former director of Noncommunicable Disease Prevention and Health Promotion at the World Health Organization.
"Sixty percent of all premature deaths in the world are from chronic disease, not communicable disease, and half of these deaths are due to cardiovascular diseases," Puska said. His plenary session, "Health Behavior and Disease Prevention: Primary Care and Community Perspectives," focused on program elements that change individual behavior and, in turn, positively affect community health.
"Global public health depends on what happens with the growing incidence of chronic disease," said Puska. "The risk factors for chronic disease are moving to poorer and poorer countries."
Within those developing nations, the causes of chronic illness are seeping into poorer and poorer economic levels, according to Puska. World Health Organization data show that, worldwide, more than 5 million people die prematurely due to chronic disease each year. In 25 years, that number will rise to 10 million premature deaths a year "as the tobacco industry moves its products to developing nations," he added.
National program succeeds
Puska pointed to a national program in Finland, through which mortality due to cardiovascular disease plummeted by 75 percent. The effort demonstrated that successful disease prevention depends on several factors, including well-defined health targets; solid monitoring of patient behaviors and progress; flexible interventions; strong community involvement; ability to influence national political processes and health policy, including integration with the public health system; and long-term leadership and commitment.
Act locally, think globally
Puska emphasized the importance of local involvement and accommodation of local social norms and traditions.
"The cultures are different in different parts of the world, so the action we take must be tailor-made to what works in the local traditions," Puska told his audience. "The risk factors are the same throughout the world. Tobacco kills everywhere, high blood pressure kills everywhere."
Moreover, primary care doctors assume leadership because they reach the most people and because they lend medical prestige to preventive messages.
"Lifestyle change involves all sectors of society, but it also must have medical leadership," said Puska. "The individual has responsibility for his behavior, but the individual behavior does depend on the doctor.
"Our challenge is to make healthy choices easier, which relates to (changing) public health policies. Our work is to influence policy-makers, but even more, to mobilize the people to make changes in society."
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Copyright © 2003 by American Academy of Family Physicians.