Top 20 Global Health Priorities

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Eliminating key factors like smoking and drinking could significantly reduce heart disease and cancer risk.

In one of the world's largest public-health collaborations, 155 experts from 50 countries have a plan to tackle the world's deadliest diseases. The result is a list, published this week in the journal Nature, of the top 20 research and policy priorities in chronic non-communicable diseases —things like heart disease, stroke, diabetes, and most cancers — which account for 60% of all deaths worldwide. It's "a road-map" for action, says lead researcher Abdallah Daar at the McLaughlin-Rotman Centre for Global Health in Toronto. It's also the first systematic attempt to prioritize these diseases globally. "With concerted action, we can avert at least 36 million premature deaths by 2015," the paper reports. Without, these largely lifestyle-driven diseases will kill some 388 million people in the next ten years, 80% of them in the developing world.

The experts' 20 "grand challenges" to address are sweeping — and not a little daunting. They include things like "Increase the availability and consumption of healthy food"; "Study and address how poverty increases risk factors"; and "Move health professional training and practice towards prevention." (See the full list below.) None of these challenges is new, and none will be solved without considerable commitment.

Still, the authors say, the key to success will lie in relatively minor interventions. "It may look very comprehensive and complicated, but very small changes, if you apply them on a population scale, will have really huge effects," says Stig Pramming, a U.K.-based co-author and executive director of the Oxford Health Alliance. An obese person can cut the risk of diabetes dramatically by losing just 10 lbs (5 kg). The problem is getting more people involved in health decisions. Tackling obesity, for example, will take more than telling people to eat less. "We all want to lose weight and exercise more," he says. "The environment needs to help." People who want to exercise need safe streets to walk on. People who want fresh fruits and vegetables need somewhere to buy them.

That's why the authors consider their top-20 list a call to arms for just about everyone in the world. They hope that policy makers will consider the experts1 priorities when allocating health-care resources and when setting tax rates and laws concerning smoking, drinking and unhealthy eating. They hope scientific researchers, businesses, and NGOs will conduct research, design products, and raise funds with the global priorities in mind. And they hope that voters all over the world will learn more about the threat of chronic non-communicable diseases, change their behavior to prolong healthy life, and then pressure their governments to act against the biggest killers. With the burden of chronic disease shifting to poorer nations, that1s a global challenge in its own right. "For the developing world we can call attention to the fact [disease] is not just infectious disease," says Daar. "For the developed world, I hope this will help change the delivery of health care from treatment to prevention."

The Top 20, as printed in Nature, have been grouped into six clusters:


1 Raise the political priority of non-communicable disease

2 Promote healthy lifestyle and consumption choices through effective education and public engagement

3 Package compelling and valid information to foster widespread, sustained and accurate media coverage and thereby improve awareness of economic, social and public health impacts


4 Study and address the impact of government spending and taxation on health

5 Develop and implement local, national and international policies and trade agreements, including regulatory restraints, to discourage the consumption of alcohol, tobacco and unhealthy foods

6 Study and address the impacts of poor health on economic output and productivity


7 Deploy universally measures proven to reduce tobacco use and boost resources to implement the WHO Framework Convention on Tobacco Control

8 Increase the availability and consumption of healthy food

9 Promote lifelong physical activity

10 Better understand environmental and cultural factors that change behavior


11 Make business a key partner in promoting health and preventing disease

12 Develop and monitor codes of responsible conduct with the food, beverage and restaurant industries

13 Empower community resources such as voluntary and faith-based organizations


14 Study and address how poverty increases risk factors

15 Study and address the links between the built environment, urbanization and chronic non-communicable disease


16 Allocate resources within health systems based on burden of disease

17 Move health professional training and practice towards prevention

18 Increase number and skills of professionals who prevent, treat and manage chronic non-communicable diseases, especially in developing countries

19 Build health systems that integrate screening and prevention within health delivery

20 Increase access to medications to prevent complications of chronic non-communicable disease