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Making changes in society that will make it easier to exchange unhealthy habits for more healthy ones will most likely have a large effect on life expectancy. Many focus more on reducing inequalities, both in general and with respect to health in particular.

Making it easy, safe, and pleasant to use the bicycle as a common means of transportation increases the number of people who take physical exercise every day, reduces air pollution, and saves fuel for more useful purposes. Such a focus has long occupied a particularly important place in thinking about international health issues.

However, transmission may occur via genetic factors from parents to offspring, or indirectly via role models, or by manipulating the determinants of the disease. Similarly, health inequalities have played a much more central part than the health of the poor alone in a long European tradition of concern.

This process does not necessarily operate from people with the disease to the non-diseased, and often the mechanism taks place via more distant determinants of the disease. American Journal of Epidemiology, 139, 856 (1994).) Olschwang, S., Hamelin, R., Laurent-Puig, P., et al. Alternative genetic pathways in colorectal carcinogenesis. Proceedings of the National Academy of Sciences of the United States of America, 94, 12122–7. For instance, the well-known 1980 Black Report in the United Kingdom was entitled Inequalities in Health (Department of Health and Social Security 1980), as was the exercise that produced its successor, the 1998 Acheson Report (Department of Health 1998).

12.5 Disease prevention and control of non-communicable diseases Oxford Textbook of Public Health 12.5 Disease prevention and control of non-communicable diseases Jørn Olsen Introduction Types of prevention Screening Causation Health promotion Prevention and care Reducing risk factors Social determinants of health Environmental risk factors Social support A life-course approach to disease prevention Non-communicable diseases in developing countries Changes during the course of life Burden of chronic diseases Health futures The economy of prevention Conclusions Chapter References Introduction In the year 2000 the Executive Board of the World Health Organization (WHO) recommended the 55th World Health Assembly: (1) to formulate a global strategy for the prevention and control of non-communicable diseases. However, they all share a recognition that in health, as in many other fields, societal averages typically disguise as much as they reveal.

(2) to recognize the enormous human suffering caused by cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases, and the threats they pose to the economics of member states. Thus their interest is not in the health conditions that prevail in society as a whole, but in the condition of different socio-economic groups within society—especially the lowest or most disadvantaged groups.

An enormous amount of money is spent on influencing consumer behaviour on the market through advertising. It emerged in the late 1960s and early 1970s in reaction to the then dominant emphasis on overall per capita income growth rates.

Many people want to influence our lifestyle, yet there are few epidemiologists or public health workers and their financial resources are comparatively sparse. At the time, a concern for distribution was thought likely to detract from the overall economic growth that was considered a necessary condition for the long-term alleviation of poverty.

In addition, the incidence of non-communicable diseases will increase with increasing life expectancy. Almost all these people—who constitute just under a quarter of the world’s total population—live in South Asia, sub-Saharan Africa, and China (World Bank 2000).

One could envisage a taxation system where taxes are partly paid according to how much one’s behaviour has negative consequences for the environment and to what extent one expects to need the health-care system to cure self-inflicted health problems. For example, at the same time as the Alma-Ata Declaration professed its concern for the unacceptable health conditions found among the hundreds of millions among the world’s poor, it also advocated primary health care because of its potential ‘to close the gap between the “haves” and the “have-nots” ‘, i.e. The previously cited World Health Report 1995 (WHO 1995), which had a great deal to say about the health of the poor, was subtitled Bridging the Gaps, referring to the inequalities between poor and rich.

Non-communicable diseases have only one common property —the diseases are non-transmittable directly from one person to another via a single external agent. A recent major WHO publication in this area emphasizes the importance of being concerned with poor–rich health inequalities, rather than simply focusing on the health of the poor alone (WHO 1996).

Non-communicable diseases include arteriosclerosis, psychosocial diseases, low back pain, infertility, congenital malformations, poor visual acuity, hypertension, psoriasis, diabetes, etc. Marine n-3 fatty acids ingested in pregnancy as a possible determinant of birth weight: a review of the current epidemiologic evidence. In the same vein, the 1984 targets of the WHO Regional Office for Europe (EURO) were expressed in terms of reducing poor–rich disparities.

Some of these diseases may be caused by infection, but most are probably not. ‘By the year 2000’, said the WHO document in which these targets were presented, ‘the actual differences in health status between countries and between groups within countries should be reduced by at least 25 per cent, by improving the health of disadvantaged nations and groups’ (Whitehead 1990).

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