01.03.2013 Non-communicable diseases – a "slow motion disaster"
Non-communicable diseases. Cancer, cardiovascular diseases or diabetes mellitus: non-communicable diseases are now the number-one cause of death all over the world. WHO Director-General Margaret Chan described the spread of these diseases as a "slow motion disaster" and one of the biggest health challenges of the future.
While improving public health as a whole, medical progress in the last hundred years has also changed the spectrum of diseases that occur and the causes of death. In the early 20th century, infections such as tuberculosis were the primary causes of illness and premature death; now their place has been taken by chronic, non-communicable diseases. According to estimates of the World Health Organization (WHO), they account for 77 per cent of the burden of disease in the WHO European Region. In Switzerland, they were responsible for 90 per cent of the burden of disease in 2004. "Burden of disease" is understood as the years of life lost as a result of premature death (before the age of 70) and the years of life lived in a state of illness or disability.
Preventing diseases of civilisation
The WHO believes that non-communicable diseases will continue to rise in the next few years. The increase is due primarily to lifestyle changes: in modern societies, lack of exercise, an unbalanced diet, alcohol abuse and smoking are widespread risk factors that significantly promote non-communicable diseases. These diseases not only cause a great deal of suffering and impairment of life quality, they also pose major challenges to the healthcare system at the financial, structural and human-resources level. Healthcare policy therefore needs to focus on strengthening integrated, cross-sector prevention activities and thereby enable people to age healthily.
In Switzerland, social differences with regard to risk factors are very wide, with population groups characterised by a low level of education, a low income and a migration background being at a particular disadvantage. In 2011, the WHO's Regional Office for Europe approved an action plan to implement the strategy for preventing and combating non-communicable diseases. The measures it involves are aimed above all at creating health-promoting structures, general conditions and environments that enable the population as a whole and risk groups in particular to engage in healthier behaviour. Switzerland's national prevention programmes are geared to the WHO's action plan.
Prevention: multilevel and cross-sector
Prevention comprises three different approaches: primary prevention or health promotion (aimed at the healthy), secondary prevention or early identification & early intervention (at the first signs of a disease) and tertiary prevention or disease management (on occurrence of a disease). A distinction is also drawn between behavioural and structural prevention. Tobacco-control campaigns aimed at motivating people to quit smoking are examples of behavioural prevention. Structural prevention involves measures that promote or facilitate a healthy lifestyle. These include structural measures such as the expansion of bicycle paths and local recreation areas, financial incentives such as tobacco tax hikes or legislative measures such as a ban on the sale of alcohol to under-18 year olds.
Above all, efforts to combat non-communicable diseases require greater institutionalisation of prevention in the basic healthcare system (including interdisciplinary cooperation) (see article on page 4). However, there is also a need to push new technologies such as e-health (see spectra no. 94), promote integrated healthcare models and strengthen the health skills of the population as a whole and patients in particular. But as with any cross-sector approach, action needs to be taken not only in the area of healthcare but also at the political, business, education and even environmental and social policy levels.
Prevention programmes to combat risk factors
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 each provide frameworks for the different nationwide, cantonal and municipal prevention activities in these areas. They are implemented in collaboration with the cantons, NGOs and – following the cross-sector approach – other players from various fields (spatial development, business, education, etc.). The National Programme on Migration & Health and the Mental Health Switzerland Network supplement the programmes by focusing on sectors of the population particularly at risk. Migration & Health is a programme of the Federal Office of Public Health, while the Mental Health Switzerland Network is sponsored by the Swiss Confederation, Health Promotion Switzerland and the State Secretariat for Economic Affairs (SECO). In 2012, the Swiss Government extended the national prevention programmes by a further four years. Running them until 2016 will safeguard the continuity of the prevention work performed in years past. The importance of such continuity is all the greater given that prevention measures only start impacting in the medium to long term.
Greater focus on research
Measures to combat non-communicable diseases require a bedrock of scientific data and regular monitoring. These diseases will therefore constitute the research focus of the 2015 Swiss Health Survey. There are also plans to carry out a study of the consequential costs of such diseases. In addition, the FOPH is concentrating on research relating to healthcare provision (see article on page 4) in order to generate solid data for developing integrated healthcare models that treat prevention as an intrinsic component of healthcare. A number of cantons have already launched programmes which, in accordance with international recommendations, target chronic diseases on a comprehensive basis. They include the cancer programme initiated by the Canton of Zug and the diabetes programme of the Canton of Vaud.
By international standards, the health of the Swiss population is better than average. This status is likely to be maintained in the long term only if prevention is treated at all levels and in all sectors as an integrated, positively perceived concept. After all, containing the epidemic of non-communicable diseases will mean harnessing the commitment and cooperation of all players within and beyond the healthcare system and the active involvement of the public.
joint head of the National Prevention Programmes Division, email@example.com