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.
Prevention has to do with avoiding diseases at a premature stage, not necessarily preventing the diseases from occurring at any stage in life. The consumption level of about 1200 million of the world’s population lies below this line.
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).
Many of the proximal determinants of these diseases are known, and as the most important health determinants operate within the domain of lifestyle factors, behavioural changes will be needed (Roemer 1984; Koplan and Livengood 1994; Wynder and Andres 1994). Proceedings of the National Academy of Sciences of the United States of America, 91, 3662–5. For those oriented towards equality, the principal objective is the reduction of poor–rich health differences.
Of course, these changes should be implemented without violating people’s right to choose their own way of living. Those concerned with health inequities are concerned with righting the injustice represented by inequalities or poor health conditions among the disadvantaged.
All of this is intended and desirable, but unfortunately this epidemiological transition is often followed by undesirable epidemics of chronic diseases. Poverty lines of this sort are used in the developed as well as the developing world.
If elimination of environmental hazards is followed by physical inactivity, a high-fat diet, and increased smoking, the incidence of other diseases increases. In the United States, for example, the Census Bureau estimates that a family of four requires US 000 annually to purchase a minimally adequate diet and meet other basic needs, and that 12.7 per cent of the population falls below this level (Uchitelle 1999).
The problem in passing on the information is that when health consequences are addressed they are placed in a distant future—people are asked to give up habits that give them pleasure at present and no any guarantees are given that these changes will actually prevent the diseases in question. The ‘trickle-up’ and ‘basic human needs’ schools of thought, which emerged to counter the view just presented, advocated dealing directly with the poor as the best means of producing sustainable growth.
The concept of disease causation is used, which apparently is far away from a common-sense concept and therefore has low credibility (J. Rose’s paradox of prevention (Rose 1992) is well documented. The many discussions about how best to define the poor population groups of concern produced two approaches.
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.
The shift from communicable to non-communicable diseases in many developing countries is an achievement that cannot and should not be prevented as it is largely driven by forces that prevent premature death. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. The second approach is simply to define the national poverty line as some proportion—often arbitrarily determined—of a society’s average per capita income or expenditure.