Abstract
BackgroundThe “25×25” strategy to tackle the global challenge of non-communicable diseases takes a traditional approach, concentrating on a few diseases and their immediate risk factors.DiscussionWe propose elements of a comprehensive strategy to address NCDs that takes account of the evolving social, economic, environmental and health care contexts, while developing mechanisms to respond effectively to local patterns of disease. Principles that underpin the comprehensive strategy include: (a) a balance between measures that address health at the individual and population level; (b) the need to identify evidence-based feasible and effective approaches tailored to low and middle income countries rather than exporting questionable strategies developed in high income countries; (c) developing primary health care as a universal framework to support prevention and treatment; (d) ensuring the ability to respond in real time to the complex adaptive behaviours of the global food, tobacco, alcohol and transport industries; (e) integrating evidence-based, cost-effective, and affordable approaches within the post-2015 sustainable development agenda; (f) determination of a set of priorities based on the NCD burden within each country, taking account of what it can afford, including the level of available development assistance; and (g) change from a universal “one-size fits all” approach of relatively simple prevention oriented approaches to more comprehensive multi-sectoral and development-oriented approaches which address both health systems and the determinants of NCD risk factors.SummaryThe 25×25 is approach is absolutely necessary but insufficient to tackle the the NCD disease burden of mortality and morbidity. A more comprehensive approach is recommended.
Highlights
The “25×25” strategy to tackle the global challenge of non-communicable diseases takes a traditional approach, concentrating on a few diseases and their immediate risk factors
In 2011 world leaders met at the United Nations (UN) to state their commitment to “to address the prevention and control of non-communicable diseases worldwide” [1]
The World Health Organization, as the UN’s specialised agency for health, subsequently published its Global non-communicable diseases (NCDs) Action Plan 2013–2020 [2,3]. This proposes a series of voluntary targets to tackle the emerging global epidemic of NonCommunicable Diseases (NCDs) [4,5], with the goal of achieving a 25% relative reduction in mortality from four conditions
Summary
Balancing collective and individual responses A comprehensive strategy should include an appropriate balance of actions to prevent disease acting at the individual and the collective and the local and the global levels. We do not offer a fully-developed strategy; rather, we argue that such a strategy is needed and highlights some key features that it should contain These include: a) balancing collective and individual responses in ways that protect health at the individual level and view health as a common good; b) identifying effective approaches tailored to LMICs rather than exporting questionable strategies developed in HICs; c) strengthening health systems to support prevention and treatment efforts, with an emphasis on primary health care; d) creating the ability to react in real time to emerging threats, such as the complex adaptive behaviours of the global food, tobacco, alcohol and transport industries; e) adopting measures that promote sustainable development, thereby advancing the post2015 agenda; f ) supporting prioritisation processes within health systems that respond to the local disease burden, what the country can afford, and the level of development assistance, and that are informed by but not overridden by global priorities; g) change from a universal “one-size fits all” approach to a progression from relatively simpler, public health oriented and affordable approaches to more complex, multi-sectoral and development oriented approaches.
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