Long term conditions (LTCs), mainly cardiovascular diseases, cancers, chronic respiratory diseases and diabetes plus mental wellbeing and musculoskeletal conditions, represent a leading threat to human health and development (World Health Organisation, 2008). The United Nations (UN) General Assembly issued a political declaration to address the prevention and control of non communicable diseases (an alternative name for long term conditions) on 16 September 2011.
Regional Public Health (RPH) is pleased to share our Strategic and Operational Plan for the Prevention of Long Term Conditions in the greater Wellington region. The document is in three sections:
- Section A: Background and philosophy including the burden of disease
- Section B: Developing a framework for action including existing frameworks
- Section C: Proposed intervention framework, key intervention domains and guiding principles for action
Rather than an outcomes framework, this document is a tool for developing actions that will move in the direction of the desired outcomes. It contains much information gathered globally, internationally, nationally and locally on which to make decisions for action. As a Member State, New Zealand has committed to the WHO Voluntary Global Targets (p31). The Proposed Framework (p50) can be used to guide organisations in deciding what actions can contribute to the WHO targets and Ministry of Health outcomes. The eight Key Intervention Domains indicate how and where actions may be most useful. The Guiding Principles (p51) help shape up what to do.
It is an evolving document and your feedback will be most useful in refining how to go forward.
The Plan is a New Zealand development from a course attended in Oxford, England on Prevention of Non Communicable Diseases (now called long term conditions). Two quotes from the course set the scene for long term condition prevention work:
Prevention is better than cure
“He is a better physician that keeps diseases off us, than he that cures them being on us; prevention is so much better than healing because it prevents the labour of being sick.” Thomas Adams 1618
The story of a physician trying to explain the dilemmas of modern medical practice
“You know,” he said, sometimes it feels a little like this. There I am standing by the shore of a swiftly flowing river and I hear the cry of a drowning man. So I jump into the river, put my arms around him, pull him to the shore, and apply artificial respiration and then just when he begins to breathe, another cry for help.
So back into the river again, reaching, pulling, applying, breathing then another yell. Again and again without end, goes the sequence.
You know, I am so busy jumping in, pulling them to shore, applying artificial respiration, that I have no time to see who the hell is upstream pushing them in.” GP Irving Zola 1970
The World Health Organisation (WHO) produced a Global Action Plan for the Prevention and Control of Non Communicable Diseases 2013-2020 with a vision of “A world free of the avoidable burden of non communicable diseases”. The main non communicable diseases (long term conditions) share a common set of risk factors, namely tobacco use, alcohol misuse, inadequate diet and insufficient physical activity.
There are nine voluntary targets in this WHO action plan, addressing the diseases and the risk factors:
- A 25% relative reduction in risk of premature mortality from cardiovascular disease, cancer, diabetes or chronic respiratory diseases
- At least a 10% relative reduction in the harmful use of alcohol, as appropriate, within a national context
- A 10% relative reduction in prevalence of insufficient physical activity
- A 30% relative reduction in mean population intake of salt/sodium
- A 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years
- A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances
- Halt the rise in diabetes and obesity
- At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes
- An 80% availability of the affordable basic technologies and essential medicines, required to treat major non communicable diseases in both public and private facilities.
This web page is designed to shine a light on ‘who is upstream pushing people into the river’ as well as the conditions on the river bank. It examines the burden of long term conditions, the causes (risk factors of tobacco, alcohol, diet and physical inactivity), the causes of the causes (social determinants of health), and the causes of the causes of the causes (market forces, economics, politics – the socio-economic environment). Action requires a framework and trained practitioners.
The report from the Oxford, England course is provided here. Some of this material will be useful in developing your own thoughts on actions that you can take for prevention of long term conditions. More material is available on request.