The global burden of chronic diseases - Overcoming impediments to prevention and control
The global burden of chronic diseases - Overcoming impediments to prevention and control
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DOI：
10.1001/jama.291.21.2616
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发表时间：
2004-06-02
影响因子：
120.7
通讯作者：
Hofman, KJ
中科院分区：
文献类型：
--
作者：
Yach, D;Hawkes, C;Hofman, KJ
慢性病是世界上最大的死亡原因。2002年，主要的慢性疾病心血管疾病、癌症、慢性呼吸道疾病和糖尿病在全世界造成2900万人死亡。尽管有越来越多的证据表明这一问题对流行病和经济造成了影响，但全球对这一问题的反应仍然不够。利益攸关方包括各国政府、世界卫生组织和其他联合国机构、学术和研究团体、非政府组织和私营部门。缺乏财政支助阻碍了大多数发展中国家的预防、治疗和研究能力发展。其原因包括，决策者并不掌握有关慢性病负担性质的最新证据，而且人们仍然坚信慢性病只影响富人和老年人，慢性病完全是由自由获得的风险引起的，控制慢性病既无效又过于昂贵，应等到传染病得到解决之后再进行。全球经济因素对慢性病风险的影响阻碍了进展，卫生系统向急性护理的方向也是如此。我们确定了3个政策杠杆来解决这些障碍：将慢性病提升到关键政策制定者的健康议程上，为他们提供更好的风险因素控制证据，并说服他们改变卫生系统的必要性。在扎实研究的基础上，采取更加协调一致、战略性和多部门的政策方法对于帮助扭转全球慢性病发病率的负面趋势至关重要。
Chronic diseases are the largest cause of death in the world. In 2002, the leading chronic diseases-cardiovascular disease, cancer, chronic respiratory disease, and diabetes-caused 29 million deaths worldwide. Despite growing evidence of epidemiological and economic impact, the global response to the problem remains inadequate. Stakeholders include governments, the World Health Organization and other United Nations bodies, academic and research groups, nongovernmental organizations, and the private sector. Lack of financial support retards capacity development for prevention, treatment, and research in most developing countries. Reasons for this include that up-to-date evidence related to the nature of the burden of chronic diseases is not in the hands of decision makers and strong beliefs persist that chronic diseases afflict only the affluent and the elderly, that they arise solely from freely acquired risks, and that their control is ineffective and too expensive and should wait until infectious diseases are addressed. The influence of global economic factors on chronic disease risks impedes progress, as does the orientation of health systems toward acute care. We identify 3 policy levers to address these impediments: elevating chronic diseases on the health agenda of key policymakers, providing them with better evidence about risk factor control, and persuading them of the need for health systems change. A more concerted, strategic, and multisectoral policy approach, underpinned by solid research, is essential to help reverse the negative trends in the global incidence of chronic disease.