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WHO: 中国癌症发病率居世界首位 肺癌致死最多
作者:USMedEdu
发表时间:2014-02-04
更新时间:2014-02-04
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中国癌症发病率居世界首位 肺癌致死最多

2014-02-04 08:16:59 搜狐


  每年的2月4日是“世界癌症日”,世界卫生组织日前发布《世界癌症报告》称,癌症已经成为全世界人类的最大致死原因,而中国大陆的癌症发病率已经处于世界首位。肺癌目前已成全球最大杀手,在中国也成为致死率最高的癌症。有专家表示,中国阴霾严重是肺癌高发的重要原因。

  世卫组织:中国癌症多 肺癌成杀手

  世界卫生组织在2014年的世界癌症日到来之际发表《世界癌症报告》称,癌症已经成为全世界人类最大致死原因,发病率与死亡率均呈持续上升趋势。全球癌症发病率四年中升高11%,到2012年约有 1410万病例,因癌症死亡人数高达820万。并预测在未来20年内,世界癌症病例将增长75%,达到近2500万。

  2012年的全球癌症新病例中有一半发生在亚洲,其中大部份发生在中国大陆。而肺癌在全球癌症病例中上升最快,目前已经成为全球最大的杀手,死亡率占癌症死亡数的19.4%;第二位肝癌的死亡率占9.1;第三位胃癌的死亡率占8.8%。

  专家:中国癌症死者最多 约占全球一半

  据陆媒报导,近期在天津举行的第22届亚太抗癌会议发出公布,称中国每年新增癌症病例占全球新增病例的20%以上,有8种癌症的共计死亡人数约占中国癌症总死亡人数的80%以上,分别为肺癌、肝癌、胃癌、食管癌、结直肠癌、宫颈癌、乳腺癌和鼻咽癌。

  中国工程院院士郝希山称,亚太地区癌症新增病例占全球癌症新增病例的45%,死亡人数约占全球癌症死亡人数的一半。亚洲国家最常见的癌症是肺癌、胃癌和肝癌3种,其中肺癌是最主要的致死疾病。

  中国疾病预防控制中心原副主任杨功焕称,癌症已经成为中国民众的第一位死亡原因,在世界上也处于较高水平,并且出现越来越多的年轻人患病。有专家预计,中国每年的癌症新发病例总数到2020年将达到400万左右,每年病例总数将达到600万。

  统计结果:每年死亡超200万 肺癌致死最多

  中国肿瘤登记中心2013年初发布《2012中国肿瘤登记年报》显示,中国每年新发癌症病例约达312万,死亡病例超过200万,每分钟有6个人被确诊为癌症,每天有8550人成为癌症患者,每7到8人中就有一人因癌症而死。肺癌、胃癌、直肠癌、肝癌、食管癌成为中国人患病最多的癌症,乳腺癌、结直肠癌等癌症患者亦呈明显上升趋势。

  其中死亡病例最多的癌种是肺癌。大陆第三次居民死亡原因调查结果显示,肺癌死亡率在过去30年间上升了465%,取代肝癌成为中国致死率最高的恶性肿瘤,排在因癌症死亡的病例数据的首位。

  官方首认:“癌症村”多发 与水污染有关

  水源污染可以导致癌症高发,这已经被中共官方所承认。目前中国各地有很多“癌症村”出现,大多数都是因水源遭污染所导致。由于化工产业废物污染水源,导致中国半数以上的江河湖泊受到严重污染,变为“毒水”,多地出现“癌症村”。有公益人士制作“中国癌症村地图”显示,中国癌症村有247个,如果包括非官方数据,大陆“癌症村”多达459 个。

  中共环保部2013年2月份发布《化学品环境风险防控十二五规划》,首度承认了 “癌症村”的存在。杨功焕称,相关研究初步发现,水污染与肿瘤具有相关性, 即“癌症村”的出现与水污染有关。目前中共官方承认的癌症村有259个,大部份和周边高污染企业污染附近河流、水源有关。

  各国专家:中国癌症上升 环境污染是主因

  广州市第一人民医院呼吸科主任医师曾军认为,中国大陆越来越严重的阴霾天气和空气污染也是导致肺癌增加的一个重要原因。目前中国肺癌发病率明显增加并且成为主要疾病,主要原因是大气污染所致。目前中国环境污染问题已经变得非常突出,各个城市都会看到阴霾天气的出现,并且时时刻刻都在影响人类生存。

  美国某制药企业研究员李峰也认为,环境污染才是中国癌症发病率上升的主要原因。

  美国纽约美中科技文化交流协会负责人谢家叶则认为,中国癌症近年来呈高发态势,是经济发展数十年来对环境、人口结构和生活方式影响的综合结果。

  阴霾重地北京医院癌症患者多 看病住院要预约

  中国大陆从2013年开始,几乎全部国土都被阴霾笼罩,浓密的阴霾导致空气中悬浮着大量可吸入颗粒物,PM2.5开始令人呼吸困难,咽喉肿痛,路人行人带口罩已经成为所有城市的“风景”。各地医院呼吸道疾病患者越来越多,阴霾也越来越重,并且还伴随着浓浓的焚烧味道。目前在阴霾最为严重的北京市,各医院癌症患者也特别多。

  大纪元记者致电北京市肿瘤医院,一位男性工作人员称,目前该院肺癌患者很多,全国各地的都有,要想看病需要提前预约,不能马上就看。

  北京大学肿瘤医院一位女性工作人员表示,目前该院因患者太多,看病需要预约,住院还要排队等待床位,因为没有空床。

  北京市密云肿瘤医院的张医生也对大纪元表示,目前中国的癌症患者非常多,几乎每分钟就会有五六个新增病例出现,死亡率也很高。尤其是现在阴霾严重,也容易诱发肺癌。该院的病床因癌症患者太多,长期处于满员状态,目前正准备扩建并增加床位。



Cancer mortality and morbidity

http://www.who.int/gho/ncd/mortality_morbidity/cancer_text/en/index.html

Situation and trends

Cancer is a leading cause of death and accounted for 7.6 million deaths (around 13% of all deaths) in 2008.

Lung, breast, colorectal, stomach, and prostate cancers cause the majority of cancer deaths. Important risk factors for cancer include tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol.

The WHO Regions for Europe and the Americas had the highest incidence of all types of cancer combined for both sexes. Countries in the WHO Eastern Mediterranean Region had the lowest incidence rates. Except in AFRO and SEARO, men have higher rates for all types of cancer combined than women. Lung cancer rates among both sexes combined were highest in the WHO Western Pacific Region, followed by Europe and the Americas. They were lowest in Africa. Women in the WHO African Region had the highest incidence of cancer of the cervix uteri, followed by the WHO South East Asia Region. Women in the WHO Eastern Mediterranean Region had the lowest cervical cancer incidence. For breast cancer, women in the WHO European Region had the highest rates followed by the Americas. These rates were more than double those of the other WHO regions. Men in the WHO Americas Region had the highest rates of prostate cancer, followed by the WHO Europe Region. The lowest rate of prostate cancer was in the WHO South East Asia Region. Among the WHO Regions, the countries in the WHO Western Pacific Region had by far the highest incidence of stomach cancer and liver cancer. The lowest incidence of stomach cancer was in Africa. Men in the WHO Western Pacific Region had five times the rate of liver cancer of men in all other regions, except for Africa, where it was more than double the rate. Women in the WHO Western Pacific Region also had a considerably higher liver cancer incidence rate than women in other WHO regions. The WHO European Region had the highest incidence of colorectal cancer followed by the WHO Americas Region. The WHO African Region had the lowest incidence.



According to the World Bank income groups for countries, the cancer rates for all cancers combined (excluding non-melanoma skin cancers) rose with increasing levels of country income. High income countries had more than double the rate of all cancers combined of low income countries. Except in low income countries, men have considerably higher rates of all types of cancer combined than women. This exception is probably explained by the high rates of cervical cancer among women in Africa. High income countries had more than double the lung cancer incidence rates those in low income countries. Across all the income groups, men’s lung cancer incidence rates were more than double those of women, and in upper middle income countries the men’s lung cancer incidence rates were four times higher. High income countries had approximately ten times the rate of prostate cancer incidence of the lower middle income countries. For breast cancer, incidence rates rose rapidly with level of country income. High income countries had more than three times the rate of low income countries. Similarly, colorectal cancer incidence rates also rose by level of country income. High income countries had considerably higher colorectal cancer incidence rates than any other income group. This was nearly five times higher than the rate in low income countries. Conversely, high income countries had considerably lower cervical cancer incidence rates than low and middle income countries. And for liver cancer, low and lower middle income countries also had the highest rates.

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共有3条评论
1   [dokknife 于 2014-02-04 20:00:48 提到] [FROM: 72.]
世卫发最强警告:2032全球掀“癌症海啸”

2014-02-04 15:39:31 卫报

  汽水除了可致心血管病,亦与癌症有关。世界衞生组织前天(周一)警告,由酗酒、吸烟及痴肥等不良生活习惯引致的癌症,将会在未来20年激增70%。预料到2032年全球将掀起一场「癌症海啸」,每年涌现2,500万宗癌病新症。








  相隔五年,世衞前天趁世界癌症日前夕再发表《世界癌症报告》,指前年全球有141万人患癌,较2008年的127万人增加11%,数字将持续增加,到2032年全球每年会有2,500万宗癌病新症。

  报告预料,这些新症当中有半数属可预防、与生活习惯有关的癌症,而且普遍会出现在高收入国家,事关这些国家会越来越多人吸烟、饮酒、食加工肉类及缺乏运动,低收入国家则主要会受子宫颈癌一类感染性癌症困扰。

  世衞警告患癌人数飙升的同时,也要求大家应正视痴肥问题,这个问题比癌病的威胁还要大。有份撰写报告的新南威尔斯大学专家斯图尔德认为,「要抗衡这场癌症海啸,预防相当重要」,呼吁与会者讨论如何鼓励人改变饮食习惯,包括应把食物的添加糖份含量减少列为首要任务、对汽水和含糖饮品徵税,以便遏抑痴肥引致的癌病问题。
 
2   [dokknife 于 2014-02-04 19:57:12 提到] [FROM: 72.]
每天一罐汽水 死于心血管病风险增三成

2014-02-04 15:35:13 美联社


  汽水含糖量高,人人皆知,但不少都巿人为一时之快,爱将汽水当饮料。美国最新一项研究发现,每天喝一罐汽水,死于心血管疾病的风险大增三成,再加上很多加工食品都添加糖份,令嗜甜人士每天摄取的糖份严重超标,死于中风和心脏病发的机率高两倍。








  现代人日常饮食含糖量惊人,汽水、加工食品均含不少添加糖,即使一些味道不甜的食物,如茄汁、沙律酱也添加糖份,令人们每天不知不觉地吃了很多糖份落肚。科学家知道多吃糖不但会令人肥胖,也会引致血压和坏胆固醇增高,但究竟要摄取多少糖份才会引致心脏病却不清楚,因此美国疾病控制及预防中心(CDC)的华裔科学家杨泉河(译音)进行了全国有关糖份导致心脏病死亡的追踪研究。

  每天饮两罐已超标

  杨泉河于1988-2010年间分析全国健康调查,访问了30,000名年龄平均40岁的成年男女,询问他们的饮食习惯,再利用全国死亡数据来计算摄取过多糖份的心血管病死亡风险。杨泉河根据参与者的摄糖份量而分成五组,由每天佔卡路里少于10%(安全水平)到逾25%。大部份参与者摄糖量超出安全水平,1/10人的添加糖份佔每天应摄取热量逾25%。

  研究员有近12,000人的死亡数据,包括831人在这段期间死于心脏病,并发现摄糖量越多,死亡的风险越高。以一罐12安士(350毫升)汽水为例,含糖量相当于9茶匙砂糖,热量相当于140千卡路里,相当于每天应摄取2,000千卡路里热量的7%,每天饮两罐汽水就已超标。

  研究结果发现,每天喝一罐汽水的人,死于心血管疾病的风险,较每周只喝一罐汽水的人高29%。每天喝两罐汽水(从糖份摄取15%热量)的人,死于心血管病的风险,较每天从糖份摄少于10%的人高20%;至于每天从糖份摄取至少25%热量的人,死于心血管病的风险高两倍。

  加州大学三藩市分校的衞生政策专家施密特(Laura Schmidt)坦言,民众可能没想过汽水的祸害如此严重,「我每天摄取2,000千卡,没有暴饮暴食,也没有超重,但原来我每天只喝一罐汽水,死于心脏病的机会增1/3」。

  添加糖并非汽水独有,很多加工食物都是人类摄取过量添加糖的元凶,包括蛋糕、批饼、果汁、糖果、雪糕、乳制品等。另外,被视为健康的沙律酱、面包、茄汁甚至乳酪等也含糖量惊人,施密特坦言,巿面77%包装食物也有添加糖,「基本上你觉得美味的东西也有添加糖,消费者实在很难知道自己原来摄取过量糖份」。

  英组织促徵「糖税」

  英国健康组织「Act On Sugar」形容,汽水已是「新烟草」,促请当局效法烟草税,开徵「糖税」或「汽水税」,及在包装上强制加警告字句等,打击添加糖,又促请世界衞生组织将建议添加糖摄取量,由佔总身体摄取的总热量最好低于10%,减至少于5%。
 
3   [USMedEdu 于 2014-02-04 13:28:45 提到] [FROM: 72.]
Global Status Report on NCDs

http://www.who.int/chp/ncd_global_status_report/en/index.html

The Global Status Report on Noncommunicable Diseases 2010 is the first report on the worldwide epidemic of cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, along with their risk factors and determinants.

Noncommunicable diseases killed tens of millions of people in 2008, and a large proportion of these deaths occurred before the age of 60, so during the most productive period of life. The magnitude of these diseases continues to rise, especially in low- and middle-income countries.

This report reviews the current status of noncommunicable diseases and provides a road map for reversing the epidemic by strengthening national and global monitoring and surveillance, scaling up the implementation of evidence-based measures to reduce risk factors like tobacco use, unhealthy diet, physical inactivity and harmful alcohol use, and improving access to cost-effective healthcare interventions to prevent complications, disabilities and premature death. This report, and subsequent editions, also provide a baseline for future monitoring of trends and for assessing the progress Member States are making to address the epidemic.

The Global Status Report on Noncommunicable Diseases was developed as part of the implementation of the 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases, which was endorsed by the World Health Assembly in 2008.


Global status report on noncommunicable diseases 2010

Description of the global burden of NCDs, their risk factors and determinants

http://www.who.int/nmh/publications/ncd_report2010/en/

Executive summary
1
Executive summary
Noncommunicable diseases (NCDs) are the leading global causes of death, causing more deaths than
all other causes combined, and they strike hardest at the world’s low- and middle-income populations.
These diseases have reached epidemic proportions, yet they could be signifi cantly reduced, with
millions of lives saved and untold suffering avoided, through reduction of their risk factors, early
detection and timely treatments. The Global Status Report on Noncommunicable Diseases is the fi rst
worldwide report on the state of NCDs and ways to map the epidemic, reduce its major risk factors and
strengthen health care for people who already suffer from NCDs.
This report was prepared by the WHO Secretariat under Objective 6 of the 2008–2013 Action Plan for
the Global Strategy for the Prevention and Control of NCDs. It focuses on the current global status of
NCDs and will be followed by another report to assess progress in 2013. One of the main objectives
of this report is to provide a baseline for countries on the current status of NCDs and their risk factors,
as well as the current state of progress countries are making to address these diseases in terms of
policies and plans, infrastructure, surveillance and population-wide and individual interventions. It
also disseminates a shared vision and road map for NCD prevention and control. Target audiences
include policy-makers, health offi cials, nongovernmental organizations, academia, relevant non-health
sectors, development agencies and civil society.
Burden
Of the 57 million global deaths in 2008, 36 million, or 63%, were due to NCDs, principally
cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. As the impact of NCDs
increases, and as populations age, annual NCD deaths are projected to continue to rise worldwide, and
the greatest increase is expected to be seen in low- and middle-income regions.
While popular belief presumes that NCDs affl ict mostly high-income populations, the evidence tells a
very different story. Nearly 80% of NCD deaths occur in low-and middle-income countries and NCDs
are the most frequent causes of death in most countries, except in Africa. Even in African nations,
NCDs are rising rapidly and are projected to exceed communicable, maternal, perinatal, and nutritional
diseases as the most common causes of death by 2030.
Mortality and morbidity data reveal the growing and disproportionate impact of the epidemic in lowerresource
settings. Over 80% of cardiovascular and diabetes deaths, and almost 90% of deaths from
chronic obstructive pulmonary disease, occur in low- and middle-income countries. More than two
thirds of all cancer deaths occur in low- and middle-income countries. NCDs also kill at a younger
age in low- and middle-income countries, where 29% of NCD deaths occur among people under the
age of 60, compared to 13% in high-income countries. The estimated percentage increase in cancer
incidence by 2030, compared with 2008, will be greater in low- (82%) and lower-middle-income
countries (70%) compared with the upper-middle- (58%) and high-income countries (40%).
A large percentage of NCDs are preventable through the reduction of their four main behavioural risk
factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet. The infl uences
of these behavioural risk factors, and other underlying metabolic/physiological causes, on the global
NCD epidemic include:
Tobacco: Almost 6 million people die from tobacco use each year, both from direct tobacco use and
second-hand smoke. By 2020, this number will increase to 7.5 million, accounting for 10% of all deaths.
Smoking is estimated to cause about 71% of lung cancer, 42% of chronic respiratory disease and nearly
10% of cardiovascular disease. The highest incidence of smoking among men is in lower-middle-income
countries; for total population, smoking prevalence is highest among upper-middle-income countries.
Insuffi cient physical activity: Approximately 3.2 million people die each year due to physical inactivity.
People who are insuffi ciently physically active have a 20% to 30% increased risk of all-cause mortality.
Regular physical activity reduces the risk of cardiovascular disease including high blood pressure, diabetes,
Executive summary
2
breast and colon cancer, and depression. Insuffi cient physical activity is highest in high-income countries,
but very high levels are now also seen in some middle-income countries especially among women.
Harmful use of alcohol: Approximately 2.3 million die each year from the harmful use of alcohol,
accounting for about 3.8% of all deaths in the world. More than half of these deaths occur from NCDs
including cancers, cardiovascular disease and liver cirrhosis. While adult per capita consumption is
highest in high-income countries, it is nearly as high in the populous upper-middle-income countries.
Unhealthy diet: Adequate consumption of fruit and vegetables reduces the risk for cardiovascular
diseases, stomach cancer and colorectal cancer. Most populations consume much higher levels of
salt than recommended by WHO for disease prevention; high salt consumption is an important
determinant of high blood pressure and cardiovascular risk. High consumption of saturated fats and
trans-fatty acids is linked to heart disease. Unhealthy diet is rising quickly in lower-resource settings.
Available data suggest that fat intake has been rising rapidly in lower-middle-income countries since
the 1980s.
Raised blood pressure: Raised blood pressure is estimated to cause 7.5 million deaths, about 12.8% of
all deaths. It is a major risk factor for cardiovascular disease. The prevalence of raised blood pressure
is similar across all income groups, though it is generally lowest in high-income populations.
Overweight and obesity: At least 2.8 million people die each year as a result of being overweight or
obese. Risks of heart disease, strokes and diabetes increase steadily with increasing body mass index
(BMI). Raised BMI also increases the risk of certain cancers. The prevalence of overweight is highest
in upper-middle-income countries but very high levels are also reported from some lower-middle
income countries. In the WHO European Region, the Eastern Mediterranean Region and the Region
of the Americas, over 50% of women are overweight. The highest prevalence of overweight among
infants and young children is in upper-middle-income populations, while the fastest rise in overweight
is in the lower-middle-income group.
Raised cholesterol: Raised cholesterol is estimated to cause 2.6 million deaths annually; it increases
the risks of heart disease and stroke. Raised cholesterol is highest in high-income countries.
Cancer-associated infections: At least 2 million cancer cases per year, 18% of the global cancer burden,
are attributable to a few specifi c chronic infections, and this fraction is substantially larger in low-income
countries. The principal infectious agents are human papillomavirus, Hepatitis B virus, Hepatitis C virus
and Helicobacter pylori. These infections are largely preventable through vaccinations and measures to
avoid transmission, or treatable. For example, transmission of Hepatitis C virus has been largely stopped
among high-income populations, but not in many low-resource countries.
Impact on development
The NCD epidemic strikes disproportionately among people of lower social positions. NCDs and poverty
create a vicious cycle whereby poverty exposes people to behavioural risk factors for NCDs and, in turn, the
resulting NCDs may become an important driver to the downward spiral that leads families towards poverty.
The rapidly growing burden of NCDs in low- and middle-income countries is accelerated by the
negative effects of globalization, rapid unplanned urbanization and increasingly sedentary lives.
People in developing countries are increasingly eating foods with higher levels of total energy and are
being targeted by marketing for tobacco, alcohol and junk food, while availability of these products
increases. Overwhelmed by the speed of growth, many governments are not keeping pace with everexpanding
needs for policies, legislation, services and infrastructure that could help protect their
citizens from NCDs.
People of lower social and economic positions fare far worse. Vulnerable and socially disadvantaged
people get sicker and die sooner as a result of NCDs than people of higher social positions; the factors
determining social positions are education, occupation, income, gender and ethnicity. There is strong
evidence for the correlation between a host of social determinants, especially education, and prevalent
levels of NCDs and risk factors.
Executive summary
3
Since in poorer countries most health-care costs must be paid by patients out-of-pocket, the cost of
health care for NCDs creates signifi cant strain on household budgets, particularly for lower-income
families. Treatment for diabetes, cancer, cardiovascular diseases and chronic respiratory diseases
can be protracted and therefore extremely expensive. Such costs can force families into catastrophic
spending and impoverishment. Household spending on NCDs, and on the behavioural risk factors
that cause them, translates into less money for necessities such as food and shelter, and for the basic
requirement for escaping poverty – education. Each year, an estimated 100 million people are pushed
into poverty because they have to pay directly for health services.
The costs to health-care systems from NCDs are high and projected to increase. Signifi cant costs to
individuals, families, businesses, governments and health systems add up to major macroeconomic
impacts. Heart disease, stroke and diabetes cause billions of dollars in losses of national income each
year in the world’s most populous nations. Economic analysis suggests that each 10% rise in NCDs is
associated with 0.5% lower rates of annual economic growth.
The socioeconomic impacts of NCDs are affecting progress towards the UN Millennium Development
Goals (MDGs). MDGs that target health and social determinants such as education and poverty are
being thwarted by the growing epidemic of NCDs and their risk factors.
Lack of monitoring
Accurate data from countries are vital to reverse the global rise in death and disability from NCDs. But
a substantial proportion of countries have little usable mortality data and weak surveillance systems and
data on NCDs are often not integrated into national health information systems. Improving country-level
surveillance and monitoring must be a top priority in the fi ght against NCDs. In low-resource settings
with limited capacity, viable and sustainable systems can be simple and still produce valuable data.
Three essential components of NCD surveillance constitute a framework that all countries should
establish and strengthen. These components are: a) monitoring exposures (risk factors); b) monitoring
outcomes (morbidity and disease-specifi c mortality); and c) health system responses, which also include
national capacity to prevent NCDs in terms of policies and plans, infrastructure, human resources and
access to essential health care including medicines.
In order to remedy the serious defi ciencies in surveillance and monitoring of NCDs, key steps must be taken:
• NCD surveillance systems should be strengthened and integrated into existing national
health information systems.
• All three components of the NCD surveillance framework should be established and
strengthened. Standardized core indicators for each of the three components should be
adopted and used for monitoring.
• Monitoring and surveillance of behavioural and metabolic risk factors in low-resource
settings should receive the highest priority. Markers of cancer-associated infections
may have to be monitored in some countries. Vital registration and reporting of causespecifi
c mortality should be strengthened. Reliable recording of adult mortality is a critical
requirement for monitoring NCDs in all countries. Monitoring country capacity for health
system response to NCDs is necessary.
• A signifi cant acceleration in fi nancial and technical support is necessary for health
information system development in low- and middle-income countries.
Strengthening surveillance is a priority at the national and global levels. There is an urgent and pressing
need for concerted efforts to improve the coverage and quality of mortality data, to conduct regular risk
factor surveys at a national scale with standardized methods, and to regularly assess national capacity
to prevent and control NCDs.
Population-wide interventions
Interventions to prevent NCDs on a population-wide basis are not only achievable but also cost effective.
And the income level of a country or population is not a barrier to success. Low-cost solutions can work
anywhere to reduce the major risk factors for NCDs.
Executive summary
4
While many interventions may be cost effective, some are considered ‘best buys’ – actions that should
be undertaken immediately to produce accelerated results in terms of lives saved, diseases prevented
and heavy costs avoided.
Best buys include:
• Protecting people from tobacco smoke and banning smoking in public places;
• Warning about the dangers of tobacco use;
• Enforcing bans on tobacco advertising, promotion and sponsorship;
• Raising taxes on tobacco;
• Restricting access to retailed alcohol;
• Enforcing bans on alcohol advertising;
• Raising taxes on alcohol;
• Reduce salt intake and salt content of food;
• Replacing trans-fat in food with polyunsaturated fat;
• Promoting public awareness about diet and physical activity, including through mass media.
In addition to best buys, there are many other cost-effective and low-cost population-wide interventions
that can reduce risk factors for NCDs. These include:
• Nicotine dependence treatment;
• Promoting adequate breastfeeding and complementary feeding;
• Enforcing drink-driving laws;
• Restrictions on marketing of foods and beverages high in salt, fats and sugar, especially to
children;
• Food taxes and subsidies to promote healthy diets.
Also, there is strong evidence, though currently a shortage of cost—effectiveness research, for the
following interventions:
• Healthy nutrition environments in schools;
• Nutrition information and counselling in health care;
• National physical activity guidelines;
• School-based physical activity programmes for children;
• Workplace programmes for physical activity and healthy diets;
• Community programmes for physical activity and healthy diets;
• Designing the built environment to promote physical activity.
There also are population-wide interventions that focus on cancer prevention. Vaccination against
Hepatitis B, a major cause of liver cancer, is a best buy. Vaccination against human papillomavirus
(HPV), the main cause of cervical cancer, is also recommended. Protection against environmental or
occupational risk factors for cancer, such as afl atoxin, asbestos and contaminants in drinking-water
can be included in effective prevention strategies. Screening for breast and cervical cancer can be
effective in reducing the cancer burden.
Individual health-care interventions
In addition to population wide interventions for NCDs, country health-care systems should undertake
interventions for individuals who either already have NCDs or who are at high risk of developing
them. Evidence from high-income countries shows that such interventions can be very effective
and are also usually cost effective or low in cost. When combined, population-wide and individual
interventions may save millions of lives and considerably reduce human suffering from NCDs.
The long-term nature of many NCDs demands a comprehensive health-system response, which
should be the long-term goal for all countries. In recent years, many low- and middle-income
Executive summary
5
countries have invested, sometimes with the help of donors, in national ‘vertical’ programmes to
address specifi c communicable disease problems. While this has scaled up service delivery for those
diseases, it also has distracted governments from coordinated efforts to strengthen overall health
systems, creating large gaps in health care.
Currently, the main focus of health care for NCDs in many low- and middle-income countries is hospitalcentred
acute care. NCD patients present at hospitals when cardiovascular disease, cancer, diabetes and
chronic respiratory disease have reached the point of acute events or long-term complications. This is
a very expensive approach that will not contribute to a signifi cant reduction of the NCD burden. It also
denies people the health benefi ts of taking care of their conditions at an early stage. To ensure early
detection and timely treatment, NCDs need to be integrated into primary health care. Expanding the
package of primary health care services to include essential NCD interventions is central to any health
system strengthening initiative.
Evidence from high-income countries shows that a comprehensive focus on prevention and
improved treatment following cardiovascular events has led to dramatic declines in mortality rates.
Similarly, progress in cancer treatment combined with early detection and screening interventions
have improved survival rates for many cancers in high-income countries. Survival rates in lowand
middle-income countries, however, remain very low. A combination of population-wide and
individual interventions can reproduce successes in many more countries through cost-effective
initiatives that strengthen overall health systems.
A strategic objective in the fi ght against the NCD epidemic must be to ensure early detection and
care using cost-effective and sustainable health-care interventions:
High-risk individuals and those with established cardiovascular disease can be treated with regimens
of low-cost generic medicines that signifi cantly reduce the likelihood of death or vascular events.
A regimen of aspirin, statin and blood pressure-lowering agents could signifi cantly reduce vascular
events in people at high cardiovascular risk and is considered a best buy. When coupled with
preventive measures such as smoking cessation, therapeutic benefi ts can be profound. Another best
buy is administration of aspirin to people who develop a myocardial infarction. In all countries,
these best buys need to be scaled up and delivered through a primary health-care approach.
Cancer: Cost-effective interventions are available across the four broad approaches to cancer
prevention and control: primary prevention, early detection, treatment and palliative care. Early
diagnosis based on awareness of early signs and symptoms and, if affordable, population-based
screening improve survival, particularly for breast, cervical, colorectal, skin and oral cancers. Some
treatment protocols for various forms of cancer use drugs that are available in generic form. In many
low- and middle-income countries, access to care, oral morphine and staff trained in palliative care
are limited, so most cancer patients die without adequate pain relief. Community- and home-based
palliative care can be successful and cost effective in these countries.
Diabetes: At least three interventions for prevention and management of diabetes are shown to
reduce costs while improving health. Blood pressure and glycaemic control, and foot care are
feasible and cost-effective interventions for people with diabetes, including in low- and middleincome
countries.
Chronic respiratory disease: In many low-income countries, drugs for inhalation use, such as
inhaled steroids, are still not fi nancially accessible. Countries could explore procurement of qualityassured
inhaled drugs at affordable costs. Lung health programmes developed to address tuberculosis
might be integrated with interventions for chronic respiratory diseases.
In order for low- and middle-income country health systems to expand individual health-care
interventions, they need to prioritize a set of low-cost treatments that are feasible within their
budgets. Many countries could afford a regimen of low-cost individual treatments by addressing
ineffi ciencies in current operations for treating advanced-stage NCDs. Experiences from maternal
and child health and infectious disease initiatives show that health priorities can be rearranged and
low-cost individual treatments improved with only a modest injection of new resources.
Like population-wide interventions, there also are best buys* and other cost-effective approaches in
individual health-care interventions.
Executive summary
6
Among the best buys* and other cost-effective interventions are:
• Counselling and multidrug therapy, including glycaemic control for diabetes for
people ≥ 30 years old with a 10-year risk of fatal or nonfatal cardiovascular events
≥ 30%*;
• Aspirin therapy for acute myocardial infarction*;
• Screening for cervical cancer, once, at age 40, followed by removal of any discovered
cancerous lesion*;
• Early case fi nding for breast cancer through biennial mammographic screening
(50–70 years) and treatment of all stages;
• Early detection of colorectal and oral cancer;
• Treatment of persistent asthma with inhaled corticosteroids and beta-2 agonists.
Financing and strengthening health systems to deliver the cost-effective individual interventions
through a primary health-care approach is a pragmatic fi rst step to achieving the long-term vision of
universal care coverage.
Improving country capacity
In 2000 and 2010, WHO conducted surveys to assess capacity for NCD prevention and control
in Member States. The surveys found that some progress has been made in the past decade. But
progress is uneven, with advancements greatest in higher-income countries. More countries are
developing strategies, plans and guidelines for combating NCDs and risk factors, and some countries
have created essential components of the health infrastructure, as well as advances in funding, policy
development and surveillance. Many countries have units within their health systems and some
funding to specifi cally address NCDs.
But in many countries, these advancements are either on paper only – not fully operational – or their
capacity is still not at the level to achieve adequate interventions. And many countries still have no
funding or programmes at all. However, the fact that some progress has been made in addressing
NCDs shows that strengthening is possible.
The delivery of effective NCD interventions is largely determined by the capacity of health-care systems.
Gaps in the provision of essential services for NCDs often result in high rates of complications such as
heart attacks, strokes, renal disease, blindness, peripheral vascular diseases, amputations, and the late
presentation of cancers. This can also mean catastrophic spending on health care and impoverishment
for low-income families. Strengthening political commitment and according a higher priority to NCD
programmes are key to expanding health system capacity to tackle NCDs.
Improvements in country capacity are particularly needed in the areas of funding, health information,
health workforce, basic technologies, essential medicines, and multisectoral partnerships.
Approaches to address these gaps are discussed in Chapters 5 and 6. Greater focus is required on
expanding the package of essential services delivered in primary health care, particularly the costeffective
NCD health-care interventions mentioned above. Adequate funding for this package of
essential services is key to reversing the NCD epidemic.
Supplementing domestic government funding – and in some countries expanding offi cial
development assistance (ODA) – through innovative non-state sector fi nancing will help to bridge
the existing funding gaps, which constitute the biggest stumbling block to strengthening primary
health care and the response to NCDs. The World Health Report 2010 outlines numerous examples
of innovative fi nancing mechanisms that can be considered to complement national health budgets.
In this respect, there are examples of countries that have successfully implemented innovative
fi nancing through raising tobacco and alcohol taxes and allocating part of the revenue for health
promotion or expanding health insurance services at the primary health-care level.
In addition to capacity improvements in health systems, progress must also be made in advancing
health policies in relevant non-health sectors.
Executive summary
7
NCD programmes and policies need to be aligned with strong national plans that strive to achieve
people-centred care delivered through strong integrated health systems. Innovative fi nancing
and funding plans, support for NCD prevention and control in offi cial development assistance,
effective health information systems, improved training and career development for health
workers, and effective strategies for obtaining essential medicines and technology are also both
urgent and vital.
Priorities for action
While the magnitude of the NCD epidemic has been rising in recent years, so has the knowledge
and understanding of its control and prevention. Evidence shows that NCDs are to a great extent
preventable. Countries can reverse the advance of these diseases and achieve quick gains if
appropriate actions are taken in the three components of national NCD programmes: surveillance,
prevention, and health care. Those actions include:
A comprehensive approach: Risk factors for NCDs are spread throughout society, and they often
begin early in life and continue throughout adulthood. Evidence from countries where there have
been major declines in certain NCDs indicates that both prevention and treatment interventions are
necessary. Therefore, reversing the NCD epidemic requires a comprehensive approach that targets a
population as a whole and includes both prevention and treatment interventions.
Multisectoral action: Action to prevent and control NCDs requires support and collaboration
from government, civil society and the private sector. Therefore, multiple sectors must be brought
together for successful action against the NCD epidemic. In this respect, policy-makers must follow
successful approaches to engage non-health sectors based on international experience and lessons
learnt. Guidelines on promoting intersectoral action are included in Chapter 7 of this report.
Surveillance and monitoring: Measuring key areas of the NCD epidemic is crucial to reversing
it. Specifi c measurable indicators must be adopted and used worldwide. NCD surveillance must be
integrated into national health information systems. This is achievable even in the lowest-resourced
countries by considering the actions recommended above under “lack of monitoring”.
Health systems: Strengthening of country health-care systems to address NCDs must be undertaken
through reorienting existing organizational and fi nancial arrangements and through conventional
and innovative means of fi nancing. Reforms, based on strengthening the capacity of primary health
care, and improvements in health-system performance must be implemented to improve NCD
control outcomes.
Best buys: As highlighted above, prevention and control measures with clear evidence of
effectiveness and high cost-effectiveness should be adopted and implemented. Population-wide
interventions must be complemented by individual health-care interventions. Best buys are
described in Chapters 4 and 5.
Sustainable development: The NCD epidemic has a substantial negative impact on human and social
development. NCD prevention should therefore be included as a priority in national development
initiatives and related investment decisions. Depending on the national situation, strengthening the
prevention and control of NCDs should also be considered an integral part of poverty reduction and
other development assistance programmes.
Civil society and the private sector: Civil society institutions and groups are uniquely placed to
mobilize political and public awareness and support for NCD prevention and control efforts, and
to play a key role in supporting NCD programmes. Strong, united advocacy is still required for
NCDs to be fully recognized as a key priority of the global development agenda. Businesses can
make a decisively important contribution to addressing NCD prevention challenges. Responsible
marketing to prevent the promotion of unhealthy diets and other harmful behaviours, and product
reformulation to promote access to healthy food options, are examples of approaches and actions
that should be implemented by the corporate sector. Governments are responsible for monitoring the
required actions.
Executive summary
8
The NCD epidemic exacts an enormous toll in terms of human suffering and infl icts serious damage
to human development in both the social and economic realms. The epidemic already extends far
beyond the current capacity of lower-income countries to cope with it, which is why death and
disability are rising disproportionately in these countries. This state of affairs cannot continue. There
is a pressing need to intervene. Unless serious action is taken, the burden of NCDs will reach levels
that are beyond the capacity of all stakeholders to manage.
 
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