From the Americas: Successes in the Fight Against Disease

PAHO/WHO report cites model efforts that can be replicated in both high- and lower-income countries

New York, 21 September 2011 (PAHO/WHO) — Countries in the Americas have pioneered effective ways to fight the growing epidemic of noncommunicable diseases (NCDs), setting examples that other countries around the world can follow, says a new report released by the Pan American Health Organization/World Health Organization (PAHO/WHO) this week during the historic U.N. summit on NCDs in New York.

In presenting the report on Tuesday at a special “Americas” event coinciding with the U.N. summit, PAHO Director Dr. Mirta Roses announced a new NCD Forum that brings together governments, the private sector and civil society to support efforts to prevent and control noncommunicable diseases. Some 3 million deaths could be prevented in the next 10 years through collaborative implementation of effective policies and practices, she said.

“We, all of us, got ourselves into this mess,” Dr. Roses said. “The NCD tsunami is a product of human action, and human action is what is going to take us out of this. We have one goal: to work together to do what has to be done, and we can do it right now.”

NCDs such as cancer, heart disease, chronic respiratory illness and diabetes are today the leading causes of death in the Americas. Three out of four deaths in the hemisphere are due to NCDs, and the number of NCD deaths and illnesses in the Region is expected to increase more than 40 percent by 2030 if current trends continue.

To confront this challenge, countries throughout the Americas have implemented a range of initiatives to improve care for NCDs, to raise public awareness of prevention, and to encourage healthier lifestyle choices by individuals, including by changing the environments in which people make such choices, particularly about tobacco and alcohol use, physical activity, and diet.

The “success stories” described in the PAHO/WHO report, Non-Communicable Diseases in the Americas: Building a Healthier Future, are examples of the kinds of programs and policies called for by this week’s United Nations High-Level Meeting on Noncommunicable Diseases. The initiatives range from tax increases on tobacco sales to “Sunday bikeways” and universal health insurance schemes. Among the examples cited are public health policies implemented in New York City under the leadership of Mayor Michael Bloomberg as well as initiatives pioneered by countries and cities in Latin America and the Caribbean, including the following:

• Jamaica’s National Health Fund, which uses tobacco and payroll taxes to finance health education and health infrastructure improvements and to ensure affordable access to medicines for people suffering from chronic NCDs. The fund invests in public programs on issues ranging from road safety to youth sports and dietary salt.

• In Peru, a cervical cancer screening project—the TATI project—which demonstrated that the technique of “visual inspection with acetic acid” (VIA) was as or more effective than cytology when used in rural settings. VIA has since been introduced in more than 40 low-income countries around the world, including nine countries in Latin America and the Caribbean.

• Brazil’s National School Meal Program, which provides healthy school meals as the basic right of every student, while supporting local agriculture. The program uses at least 30 percent of school meal funds to purchase locally produced foods. As of 2009, the program was investing $1.7 billion to provide 47 million meals per day to students while directing hundreds of millions of dollars to family farms.

• Bans on smoking in public places in Argentina, Barbados, Canada, Colombia, Ecuador, Guatemala, Honduras, Panama, Peru, Trinidad and Tobago, Uruguay and Venezuela. In all, 29 countries in the Americas have pledged to progressively implement similar bans and other tobacco-control measures recommended in the WHO Framework Convention on Tobacco Control (FCTC).

• Efforts to reduce salt consumption at the population level in Argentina, Brazil, Chile and the United States. The efforts include voluntary commitments by industry to reformulate products (especially bread), labeling requirements to inform consumer choice, and awareness raising to increase demand for lower-sodium products.

• Caribbean Wellness Day (CWD), celebrated each year on the third Saturday of September by the countries of the Caribbean. CWD promotes physical activity in communities, workplaces, and schools, along with healthy food choices and smoke-free environments. CARICOM countries are now advocating for a “global wellness week.”

• ActNowBC, a health promotion effort in the Canadian province of British Columbia that includes public health messaging and preventive healthcare interventions as well as tobacco control legislation, restrictions on trans fats in foods, and strong guidelines for healthy foods in vending machines in public buildings.

• In Mexico, hypertension programs that seek to raise public awareness and improve detection and treatment of at-risk patients. A World Bank study showed that each dollar the program invested in targeted detection and treatment saved between $84 and $323 over 20 years.

• The CARMEN network, which shares effective evidence-based practices and policies on prevention and control of NCDs among health professionals from throughout the Americas. The network has 32 member countries and numerous civil society organizations ranging from WHO collaborating centers to the Inter American Heart Federation and Ciclovias de las Americas.

• The CAMDI program in Central America, which builds integrated care for NCDs by improving the clinical skills of health providers and providing education and support at the community level for people with NCDs. The program has helped prevent premature deaths among people with NCDs in Guatemala, El Salvador, Nicaragua and Honduras.

• Chile’s AUGE Plan, which guarantees access to timely care for 69 pre-defined health conditions, 75 percent of which are NCDs. The plan has improved case-fatality rates for all conditions that are covered while reducing hospitalizations and increasing overall health coverage in the population.

• Ciclovias, which were piloted in Bogota and Ottawa in the 1960s and 1970s and which have spread throughout the Americas. The initiatives close off portions of city streets to traffic, typically on Sundays and holidays, to create open spaces for bikers, walkers, and joggers. A parallel program, Recrovia, provides free dance, aerobic and yoga classes throughout the city.

• New York City’s path-breaking public health policies, including a ban on smoking in all workplaces—including bars and restaurants—and most recently in city parks and beaches. New York has also eliminated trans fats in restaurant foods, implemented a campaign against sugar-sweetened beverages, required chain restaurants to display the calorie content of foods, and partnered with cooking celebrities, garden advocates and local farmer to increase the availability and consumption of fresh foods.

• The Active Cities, Healthy Cities contest, sponsored by PAHO/WHO to recognize innovative efforts to shape healthy urban environments. The contest combines public voting with expert panels of judges and has so far honored 12 projects from throughout the Americas. Co-sponsors include the U.S. Centers for Disease Control and Prevention (CDC), and the Center for Sustainable Transport (EMBARQ) of the World Resources Institute.

“As the international community charts its path, it is important to recognize the political leadership and emerging programmatic innovations that are shaping successful responses to NCDs in the Americas,” said PAHO Director Dr. Roses in the report’s foreword.

Links:

Non-Communicable Diseases in the Americas: Building a Healthier Future (PAHO/WHO report)

Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non communicable Diseases

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