Chronic Disease In Low- And Middle-Income Countries Should Be Addressed: Tobacco Control, Salt Control, Cardiovascular Drugs, And Mental Health

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Main Category: Public Health
Also Included In: Smoking / Quit Smoking;  Pediatrics / Children's Health;  Cardiovascular / Cardiology
Article Date: 15 Sep 2008 - 0:00 PST

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Low- and middle-income countries are subject to a substantial burden from chronic diseases, and an integrated approach of intervention must be employed to help prevent this issue from exploding in the future as the population ages. These points were made by a paper released on September 12, 2008 in The Lancet which discuss features of the Alma-Ata movement.

Chronic diseases such as heart disease, cancer, diabetes, and various mental disorders are becoming more a group with greater disease burden as the populations of countries gradually become composed of older people, and the world undergoes further urbanization and globalization. Many of these diseases can be partially prevented by controlling tobacco use, limiting salt consumption, administering cheap combination drugs, or simple mental health interventions.

The authors of this piece advocate several specific policies. These include nicotine replacement therapy for smokers. The authors advocate dietary salt reduction by 15%, which is equivalent to about one-quarter of a teaspoon each day. They discuss a combination drug regimen which could provide prophylaxis for people who are at high risk of cardiovascular disease, who could be identified using easily measured risk-factors such as body mass index (BMI), history of alcohol or tobacco use, weight, and blood pressure. This measure would cost as little as $1.10 USD per person and avert almost 18 million deaths in 23 low- and middle-income countries over the next 10 years.

Concerning mental health, The Lancet has had authors advocate for community-based and primary health care interventions in order to address the quickly expanding number of cases of depression and other mental health disorders in poorer countries. The authors of the report say: "Experience in low-income and middle income countries indicates that to be fully effective,  primary care tasks must be limited and feasible." 

They conclude, pointing out that this complex problem must be tacked using an integrative approach: "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."

Alma-Ata: Rebirth and Revision 3
Improving the prevention and management of chronic  disease in low-income and middle-income countries:  a priority for primary health care
Robert Beaglehole, JoAnne Epping-Jordan, Vikram Patel, Mickey Chopra, Shah Ebrahim, Michael Kidd, Andy Haines
Lancet 2008; 372: 940-49
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Written by Anna Sophia McKenney
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