01.03.2014 "More than half of all non-communicable diseases could be prevented by a healthy lifestyle."

Five questions to Eva Bruhin. Non-communicable diseases are now the number-one cause of death worldwide. The increase is due primarily to lifestyle changes. Eva Bruhin, Head, Administrative Office of the "National Strategy on Non-communicable Diseases" at the Federal Office of Public Health, talks about the goals of this strategy.

Pictures "More than half of all non-communicable diseases could be prevented by a healthy lifestyle."

TODO CHRISTIAN

Non-communicable diseases, NCDs for short, have recently become a focus of intense interest in the healthcare and prevention sector. Have NCDs become more widespread?

Improved living conditions and advances in medical care have led to an impressive rise in life expectancy. How­ever, this often means longer lifetimes overshadowed by chronic health problems, particularly in the elderly. Non-communicable, chronic diseases are of long duration and generally slow progression, and require care for periods ranging from several months to decades. They include cardiovascular diseases, cancer, respiratory diseases, diabetes and musculoskeletal diseases (conditions of the locomotor system such as chronic back pain).

In Switzerland, 74.6 percent of fatalities among men and 75.9 percent of those among women are due to four NCDs: cardiovascular diseases, cancer, respiratory diseases and dementia (Federal Statistical Office, 2013).

Why do we actually need a national strategy on NCDs?

Because we cannot simply stand by and watch non-communicable diseases increase without doing anything. More than half of all non-communicable diseases could be prevented by a healthy lifestyle. They are promoted by the following risk factors: an unbalanced diet, lack of physical activity, alcohol abuse and smoking. So we really can do something about them. Health policy must focus on investing in the prevention of non-communicable diseases and in health promotion.
Since 2008, there have been three national prevention programmes in Switzer­land that target the main risk factors of non-communicable diseases: the tobacco, alcohol and diet & physical activity programmes. They constitute an umbrella for the different national, cantonal and municipal prevention activities in these fields and are implemented in cooperation with the cantons, NGOs and – in accordance with the multisectoral approach – additional players from fields such as spatial development, business or education. However, these programmes only run until 2016. We therefore have to think today about how we should proceed in future. This is why the "Dialogue on National Healthcare Policy"– a permanent platform of the Federal Government and the cantons – decided at the end of November that work should start on drawing up a national strategy for the prevention of non-communicable diseases, to be completed by 2016. The aim of the strategy is to improve the health literacy of the population and create general conditions that make it easier for people to live in a healthy manner.

Alternative question: in which areas will the new strategy have an impact?

The NCD Strategy is a cross-sectoral strategy designed to improve prevention of the most widespread non-communicable diseases. The WHO defines cancer, diabetes, cardiovascular and respira­tory diseases as the four main types of NCD. Because of the specific situation in Switzerland, the national strategy additionally requires the inclusion of musculoskeletal diseases (see figure). The NCD Strategy encompasses health promotion and primary prevention and has an interface with medical care. It thus establishes a link to early identification and early intervention in individuals with increased health risks, and to preventive services in integrated healthcare management aimed at improving patients' quality of life.

But the strategy is not a substitute for disease-specific strategies or programmes, for instance in the field of cancer; it supplements them and reinforces their preventive effect. The areas of addiction and mental health are to be developed separately, with coordination of the interfaces.

The Federal Government is launching the strategy in cooperation with the cantons. Which other partners are being invited to take part? What role will Health Promotion Switzerland play?

The development process is designed to function in both a top-down and bottom-up manner. The Confederation, cantons and Health Promotion Switzerland are represented in the executive committee. The extended executive committee also includes NGOs, research experts and additional players. Also, the individual project work streams are being drawn up by working groups in which the different players can participate. An initial information event, at which the content of the strategy and work streams, the project structure and the development timetable will be presented and discussed, is to be held in Berne on 31 March 2014. All interested partners are welcome to take part; they should register by sending an e-mail to ncd-mnt@bag.admin.ch.

How will current prevention programmes be integrated into the strategy? Is it to act as an umbrella for all existing programmes? Will some programmes be replaced?

The existing programmes were extended by the Federal Council to the end of 2016. This means that the continuity and sustainability of prevention work have been safeguarded and cooperation between all prevention players can be further strengthened.

However, the increase in non-communicable diseases requires comprehensive approaches that go beyond prevention geared to risk factors. International developments such as the WHO's efforts in this field demonstrate such an approach. The focus has to be on improving prevention and early identification of non-communicable diseases. There is also a need for much closer cooperation between the Federal Government, cantons and NGOs. It goes without saying that the experience and knowledge generated by the existing programmes will feed into the development of the new strategy. But I cannot yet say whether or in what form the programmes will be continued from 2017 on.

NCD Strategy: the main facts in brief

– The Federal Government and the cantons are jointly drawing up a new strategy for preventing non-communicable diseases (called the NCD Strategy for short).
– The NCD Strategy encompasses the prevention of cancer, diabetes and cardiovascular, respiratory and musculoskeletal diseases.
– The NCD Strategy is a cross-sectoral strategy that does not compete with existing disease-specific sub-strategies but improves prevention-related aspects, identifies opportunities for the further development of national and cantonal prevention programmes (alcohol, tobacco, and diet & physical activity) and of health promotion, and strengthens prevention in primary healthcare.
– The NCD Strategy attaches great importance to the inclusion and participation of specialist and support organisations.
– The areas of addiction and mental health are to be developed separately, with coordination of the interfaces.

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