The World Health Organization and the Globalization of Chronic Noncommunicable Disease

Abstract

Chronic noncommunicable diseases (NCDs) in low‐ and middle‐income countries have recently provoked a surge of public interest. This article examines the policy literature—notably the archives and publications of the World Health Organization (WHO), which has dominated this field—to analyze the emergence and consolidation of this new agenda. Starting with programs to control cardiovascular disease in the 1970s, experts from Eastern and Western Europe had by the late 1980s consolidated a program for the prevention of NCD risk factors at the WHO. NCDs remained a relatively minor concern until the collaboration of World Bank health economists with WHO epidemiologists led to the Global Burden of Disease study that provided an “evidentiary breakthrough” for NCD activism by quantifying the extent of the problem. Soon after, WHO itself, facing severe criticism, underwent major reform. NCD advocacy contributed to revitalizing WHO's normative and coordinative functions. By leading a growing advocacy coalition, within which The Lancet played a key role, WHO established itself as a leading institution in this domain. However, ever‐widening concern with NCDs has not yet led to major reallocation of funding in favor of NCD programs in the developing world.

Reframing NCDs? An analysis of current debates

“…In the post-World-War-II era, British epidemiologists such as Bradford Hill, Doll and McKeown also advanced the study of chronic disease with their research on smoking, cardiovascular disease and cancer [4]. The study and control of chronic disease in the last century greatly influenced the fields of epidemiology and public health, simultaneously advancing the more individualistic biomedical and lifestyle models of disease [2,[5][6][7]. For example, it was from the Framingham Heart Study, that the phrase 'risk factor' was coined in 1961 [6].…”

Introduction

“…cesse de progresser dans les pays en développement depuis les années 1970, la lutte contre les maladies chroniques demeure relativement marginale dans l'agenda de la santé mondiale (Weisz, Vignola-Gagné, 2015).…”

“…De plus, la priorité est donnée à la prévention des facteurs de risque individuels, à l'observance thérapeutique et au « selfcare » des malades (Whitmarsh, 2013). Reproduisant le discours de l'autonomie prédominant au Nord (Fainzang, 2015), ces programmes accordent peu d'importance aux enjeux structurels tels que les inégalités sociales de santé (Weisz, Vignola-Gagné, 2015).…”

The Association of Health Literacy with High-Quality Home Blood Pressure Monitoring for Hypertensive Patients in Outpatient Settings

“…It was defined by the American Medical Association in 1999 as "the constellation of skills, including the ability to perform basic reading and numeral tasks required to function in the healthcare environment" [11]. Underprivileged patients, such as those from lower socioeconomic class, those with lower educational levels, or those with limited health literacy or numeracy, were found to have a poorer outcome in overall noncommunicable diseases [12]. In addition, patients with inadequate health literacy were more likely to have poorer disease knowledge, poorer selfefficacy, and misconception in cardiovascular disease [13].…”