The Global Alliance against Chronic Respiratory Diseases:journey so far and way ahead

The Global Alliance Against Chronic Respiratory Diseases(GARD)is a voluntary alliance of national and international organizations,institutions,and agencies committed to the vision of "a world where all people breathe freely"Its goal is to reduce the global burden of chronic respiratory disease(CRD).The GARD initiative was set up to respond to a resolution of the World Health Assembly in May 2000(Resolution WHA53.17)that emphasized the need to increase awareness of the growing epidemic of CRDs worldwide.A program was begun to design a comprehensive approach to the prevention and control of CRDs.11,21 The resolution was approved by the General Assembly of World Health Organization(WHO)in 2004.

Global lung cancer mortality trends and lifestyle modifications:preliminary analysis

Background:According to the Independent High-level Commission on Non-communicable Diseases(NCD)of the World Health Organization(WHO),global reduction in lung cancer mortality has been achieved since the year 2000,although this effect is not sufficient to reach the 30%reduction of mortality from NCDs by the year 2030,as stipulated by the United Nations Sustainable Development Goal 3.4.The objective of this study was to analyze whether the lifestyle changes implemented by the WHO at country level could have an impact on mortality from this form of cancer.Methods:WHO statistics,based on the unified mortality and causes-of-death reports of Member-State countries,were used to evaluate global lung cancer mortality trends and make comparisons and assessments of different types of community-based,country-wide interventions.Results:The lung cancer mortality decline was associated with the anti-tobacco campaign initiated by the WHO in the last 15 to 20 years.Comprehensive tobacco control remained the major and most successful lifestyle modification measure.In countries with declining lung cancer mortality,91%of countries had decreasing tobacco prevalence in males and 82%in females.Country-wide measures to increase physical activity had a strong tendency to be better implemented in countries with declining lung cancer mortality(t=1.79,P>0.05).Other WHO"best-buy"lifestyle modification campaigns(diet and alcohol)had been carried out for shorter periods,and their associations with lung cancer were less strong than tobacco.There was no significant difference between countries with declining and increasing lung cancer mortality in the measures for reduction of harmful alcohol use(t=0.92,P>0.05)and unhealthy diet reduction measures(t=0.84,P>0.05).Conclusion:Following WHO"best-buys"should facilitate to move countries towards the NCD including lung cancer mortality reduction targets.Governments and communities must embrace these targets with coordinated effective action for better health.

Countrywide“best buy”interventions for noncommunicable diseases prevention and control in countries with different level of socioeconomic development

Background:Noncommunicable diseases(NCDs)place a heavy burden on populations globally and in particular,on lower-income countries(LIC).WHO identified a package of 16“best buy”lifestyle and management interventions that are cost-effective and applicable in all settings.The purpose of this study was to evaluate and compare NCD risk factors in all WHO countries and make preliminary assessment of“best buy”interventions.Methods:Risk factors estimation was made in 188 countries.NCD attributable“best buys”concern tobacco use,unhealthy diet,physical inactivity,and harmful use of alcohol.Management issues are based on the availability of the national NCD guidelines and provision of drug therapy.Results:Every fourth adult in high-income countries(HIC)has raised blood pressure(RBP).Prevalence of RBP in lower-middle-income countries(LMIC)and LIC is 22%–23%(HIC/LMIC:t=3.12,p<0.01).Prevalence of diabetes in LIC is less than half of that in HIC and upper-middle-income countries(UMIC)UMIC/LIC:t=8.37,p<0.001.Obesity prevalence is gradually decreasing from HIC to LIC(HIC/LIC:t=11.48,p<0.001).Highest level of physical inactivity is seen in HIC,which then gradually declines to LIC(17%).Tobacco prevalence in LIC is almost less than half of that in HIC and UMIC(HIC/LIC:t=7.2,p<0.0001).There is a gradual decline in the implementation of“best buys”from HIC to LIC.Conclusion:Wealthier countries have better implementation of the WHO NCD prevention strategy.

Cardiovascular disease mortality and air pollution in countries with different socioeconomic status

Background Cardiovascular diseases(CVDs)account for 17.9 million deaths annually.Behavioral risk factors increase the risk of dying from CVD.Air pollution is not included in this risk calculation since the appreciation of air pollution as a modifiable risk factor is still limited.The purpose of this study was to analyze CVD mortality attributed to air pollution in all World Health Organization WHO member states and demonstrate the association of CVD mortality with air pollution depending on countries'income level.Methods The CVD death rate was calculated by dividing the number of deaths by the total population.The proportion of the population with primary reliance on clean fuels and technologies for cooking was calculated as an indicator of household air pollution.The annual mean concentration of fine particulate matter≤2.5µg/m^(3) and≤10.0µg/m^(3) to which the population is exposed was used as an indicator of ambient air pollution.Results There is a gradual increase in CVD mortality attributed to air pollution from high-income countries(HICs)to low-income countries(LICs).Household air pollution is the major cause of CVD mortality in LICs.Ischemic heart disease mortality attributed to ambient air pollution in all countries is higher than stroke mortality attributed to ambient air pollution.In LIC,mortality from stroke is attributed to household air pollution of 39.27±14.47,which is more than twice the stroke mortality attributed to ambient air pollution at 18.60±5.64,t=7.17,p<0.01.Conclusion Air pollution control should be an essential component of the CVD preventive strategy,along with lifestyle modifications and effective disease management.

Countrywide cardiovascular disease prevention and control in 49 countries with different socio-economic status

Background: Cardiovascular disease (CVD) is the major noncommunicable disease (NCD) accounting for 17.9 million deaths. If current trends continue, the annual number of deaths from CVD will rise to 22.2 million by 2030. The United Nations General Assembly adopted a sustainable development goal (SDG) by 2030 to reduce NCD mortality by one-third. The purpose of this study was to analyze the CVD mortality trends in different countries implementing World Health Organization (WHO) NCD Action Plan and emphasize effective ways to achieve SDG.Methods: WHO statistics, based on the Member-States unified mortality and causes-of-death reports were used for analyzing trends and different interventions.Results: Reduction of CVD mortality from 2000 to 2016 in 49 countries was achieved for stroke at 43% and ischemic heart disease at 30%. Smoking prevalence and raised blood pressure (RBP) decreased in 84% and 55% of the countries. Eighty-nine percent of high-income countries (HIC) demonstrated a decline in tobacco smoking against 67% in middle-income countries (MIC). Sixty-nine percent of HIC demonstrated a decline in RBP against 15% in MIC. CVD management, tobacco, and unhealthy diet reduction measures are significantly better in HIC. The air pollution level was higher in MIC.Conclusion: Building partnerships between countries could enhance their efforts for CVD prevention and successful achievement of SDG.