Health Topics

Integrated Approach to Chronic Disease

What is an integrated approach?

An integrated intervention is one that includes:

• Simultaneous prevention and reduction of a set of risk factors common to major non-communicable diseases (NCD);
• Simultaneous use of community resources and health services;
• Combined and balanced efforts for preventive health care and general health promotion to enable communities to become active participants in decisions concerning their health;
• Strategic consensus building among different stakeholders, such as governmental, non-governmental, and private sector organizations in an effort to increase cooperation and responsiveness to population needs.

Moving towards an integrated approach to chronic diseases

On the issue of "Integrated Non-Communicable Disease Prevention", the World Health Organization recently stated that:

"No longer can each chronic illness be considered in isolation. Awareness is increasing that they (chronic illnesses) share common, usually related risk factors, and that integrated strategies can be effective for many different conditions."

The concept of an integrated approach is not a new one. It was first introduced by WHO in 1981 and later endorsed by the World Health Assembly in 1985, which led to WHO program to test and evaluate comprehensive, integrated, community-based approaches to chronic disease prevention and control (WHO's Countrywide Integrated and Non-Communicable Disease Intervention (CINDI) Program.

Promotion of Health Equity

Traditionally, chronic diseases were related to high socioeconomic levels. Currently there exists sufficient evidence to indicate that this relation has been inverted. Evidence clearly shows that the risk for some NCDs, such as cardiovascular disease and certain forms of cancers, are higher at low socioeconomic levels, with an apparent increase in recent years.

Prevention strategies should consider underlying influences on health inequalities such as education, income distribution, public safety, housing, work environment, employment, social networks, and transportation among others. It is important that strategies be aimed at reducing overall population risk while simultaneously reducing the gap among different population groups. In many instances, this requires a redesign and an evaluation of interventions of well documented efficacy. It also entails the identification and special attention to key population groups, such as aboriginals, new urban migrants and women.

Development and implementation of policies for the non-communicable disease prevention

Preventive strategies for NCDs have evolved and today they are known as an effective means of control. Policy development and implementation, in particular, is highly cost-effective and can obtain a great impact on the health of the population.

Policies and decisions external to the health sector are those that may have a high positive influence on preventing and controlling NCDs. This takes into account that the actions carried by health services, have at times a limited population effect.

The development and implementation of policies for NCD prevention requires support from a diversity of stakeholders: governmental and non-governmental institutions, opinion-makers, and the private sector, among others.

Community Based Interventions

Community interventions have demonstrated that they have a great effect on non-communicable disease prevention, since the interventions intend to act not only on the individual and its nearby social nucleus, but additionally on the social environment that determines behaviours.

These interventions imply:

• The active participation of families and communities, pooling and sharing resources to ensure integrated preventions.
• The identification of leaders, organized groups and institutions.
• The development of strategic coalitions and alliances.

Increase of non-communicable disease prevention actions in health services

Developing NCD prevention activities can be achieved through:

• Developing health policies and legislation that support the incorporation of preventive care in primary health care services;
• Establishing ties between primary health care services and community;
• Providing knowledge and necessary information for non-communicable disease prevention to the population;
• Implementing primary health care skill-training programs for non-communicable disease prevention; and
• Following up and evaluating the preventive action of primary health care services

Research and Surveillance

• More fundamental research is needed in order to transfer effectively the scientific knowledge into policy and practice. If policy-makers are to be more effectively engaged in applying measures that have proven benefits in risk reduction, the political context of knowledge transfer needs to be better understood and utilized. Some key research priorities identified at the WHO NCD Research Partners Meeting (Geneva, December 10-12, 2001) include, among others:
• Operational research to identify the optimal mix and sequencing of strategies for NCD prevention;
• Development or identification of cost-effective strategies to control NCDs; and
• Research on the impact of globalization on NCD risk factor prevalence.
• Surveillance information is required to guide appropriate policies and programs. In spite of the importance of chronic disease, Coordination among varied organizations and responsibility centres, at the local, national and international levels will be essential to establish comprehensive NCD surveillance systems.

The Burden of Chronic Disease in Canada

Individuals and Families:

• 16,000,000 live with chronic illness
• Chronic Disease accounts for 87% of disability

High Risk Groups:

• Increased prevalence in vulnerable communities (e.g. Aboriginals and in socio-economically disadvantaged groups

Economy:

• Direct health care costs: 67% of total direct costs are expended on chronic diseases
• Indirect costs: 60% of total indirect costs ($52B), translating into loss of productivity and foregone income

Global Reality:

• Non-communicable diseases (NCD) contribute 60% of deaths and 43% of the global burden of disease
• By 2020, NCD will account for 73% of deaths and 60% of the disease burden
• Half of NCD are attributable to cardiovascular diseases
• There are more cardiovascular disease deaths in India and China than in all developed countries added together

• Chronic Disease
  

For more information on integrated approaches to chronic diseases, please browse the following sites:

• http://www.who.int/whr/en/
• http://www.who.int/whr/2002/en/