The Non-communicable Disease Training Seminar in Helsinki, Finland is fantastic! I highly recommend it to anyone who is interested in public health and population-based interventions for chronic diseases. It is based on the North Karelia Project that took a truly population-based approach to treat cardiovascular disease (CVD) in a population of lumberjacks and farmers that were dying at a young age of CVD. They were the folks who claimed, "Veggies are for rabbits" and said "I'll have some bread with my chunk of butter, kiitos (thank you)" who consumed 40 pounds of butter per year! Therefore, their diet (and tobacco use) contributed to their high cholesterol, blood pressure and mortality rates in the 1970s. Simple interventions - smoke-free workplace campaigns, margarine for butter, substituting skim milk for whole milk in schools, increased vegetable subsidies and consumption, and increased physical activity - made a dramatic difference for this community.
Who are we?
I am one of two people from the USA attending the seminar, which thankfully is held in English. There are 24 of us who come from all over he globe: Tanzania, Ethiopia, Thailand, Iran, Finland, Japan, UK, Australia, Bahrain, and the USA. The goal of the seminar is to discuss theories and share ideas for us to bring back to our countries or institutions in order to promote prevention. Specifically, the World Health Organization has emphasized four factors: tobacco, diet, exercise, and alcohol use. I've said it before, but let me re-emphasize, the global burden of cardiovascular disease is HUGE! Eighty percent of all CVD is in developing countries. The costs of pain and suffering from both chronic and infectious diseases are disproportionately affecting the poor. Many of the deaths from these causes are avertable - either preventable or treatable. Building cath labs is not going to solve this problem. Prevention is the only sustainable, affordable, and feasible public health intervention that has been shown to decrease this epidemic and decrease other chronic disease as well as delay or post-pone mortality so that people can live more healthy, productive lives and contribute to development and decreasing poverty in their countries. Often, the factors that contribute to disease are outside of the control of the individual and are deeply rooted in society (socioeconomic, cultural and environmental factors).
Get Healthy Before Wealthy
Some argue that helping get people out of poverty - for example, providing clean water, sanitation, and education - would improve their health so why bother with chronic disease management? Well, the truth is development is slow to decrease poverty and not real effective for improving health. If we help strengthen the health systems and make people healthier now, they in turn will do more to help improve development and decrease poverty.
In a nutshell
How to start a prevention program? First, involve the stakeholders, policymakers, and community as managers and directors of programs from the beginning. Then, use working groups to try to understand all the health and non-health existing resources and challenges in the community. Then, target the primordial, primary and secondary interventions using medical and social behavioral methods. Examples include individual behavorial changes like quitting smoking to lifestyle changes in the community, like smoke-free campaigns. Improving nutrition, encouraging physical activity, and improving medication adherence for treatment of disease are also important interventions. Finally, building infrastructure to treat the high risk people in the community.
"Make the healthy lifestyle the easy one."
Successful programs are those that are multi-dimensional, target the whole population, complement initiatives in place, are sustainable, and have adequate time and funding to complete the intervention(s). In all cases, making the healthy lifestyle or behavior the easier choice is key for a sustainable and effective intervention program. If only we could do this in the US too!
"Only those who see the invisible can do the impossible."
No comments:
Post a Comment