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WHY WE SHOULD EMPHASIZE PREVENTION OVER TREATMENT OF NCDs

Thursday, 22nd of September 2011

WHY WE SHOULD EMPHASIZE PREVENTION OVER TREATMENT OF NCDs

BMJ 2011; 343:d4888 doi: 10.1136/bmj.d4888 (Published 2 August 2011)

http://www.bmj.com/content/343/bmj.d4888.full?sid=2ae295f3-182b-47b5-adb0-642c149ba0ad

Cite this as: BMJ 2011; 343:d4888

Letter

Non-communicable disease

Why we should emphasise prevention over treatment of non-communicable disease

Richard Smith, director, UnitedHealth Chronic Disease Initiative1

+ Author Affiliations

1London SW4 0LD, UK

richardswsmith@yahoo.co.uk

I sympathise with Heath’s anxiety about turning people into “patients” by identifying those at risk of developing non-communicable diseases (NCDs), but is she really advocating that we wait until people are “sick” and then have them looked after by doctors?1 She seems to argue for treatment rather than prevention.

Her thinking perhaps flows from an attachment to the medical model. She is surely not against policy interventions like raising taxes on alcohol and reducing salt intake, the “best buys” recommended by WHO.2 Most of the interventions advocated by WHO are nothing to do with doctors and health systems. Most of what needs to be done to counter NCDs lies outside the health system.

We have strong evidence that we can prevent prediabetes and prehypertension progressing to the full blown conditions by helping people change their lifestyles and lose weight.3 4 Again, this is nothing to do with doctors and drugs. The programmes are unaffordable if they use doctors rather than community health workers. Surely Heath is not suggesting that these people should be simply watched as they develop full blown disease.

There are difficult questions about how much countries should invest in policy changes, prevention, and treatment programmes. Heath’s thinking is the opposite of many in low and middle income countries. Our network of researchers from some of these countries thinks that the emphasis must be on prevention—because the Western model of emphasising treatment is unaffordable and unachievable when health workers are in such short supply.5

Cite this as: BMJ 2011;343:d4888

Competing interest: UnitedHealth together with the National Heart, Lung and Blood Institute funds and works with 11 centres in low and middle income countries that are doing research, training people, and developing policy to counter NCDs. Together with the Centers for Disease Control, UnitedHealth has developed a programme for preventing people with prediabetes developing diabetes.

References

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Heath I. Seeming virtuous on chronic diseases. BMJ2011;343:d4239. (8 July.)

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WHO. Global status report on noncommunicable disease 2010. 2011. www.who.int/chp/ncd_global_status_report/en/index.html.

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Knowler W, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med2002;346:393-403.

[CrossRef][Medline][Web of Science]

↵

McGuire HL, Svetkey LP, Harsha DW, Elmer PJ, Appel LJ, Ard JD. Comprehensive lifestyle modification and blood pressure control: a review of the PREMIER trial. J Clin Hypertens2004;6:383-90.

[CrossRef]

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UnitedHealth, National Heart, Lung, and Blood Institute Centers of Excellence. Global response to non-communicable disease. BMJ2011;342:d3823.

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