NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL

Introduction This chapter discusses programs aimed at Preventing non-communicable disease (as
distinguished from infectious or communicable disease).

●The first part discusses the integrated community based non-communicable disease prevention and
control program aimed at preventing the four non communicable/chronic/lifestyle related diseases,
cancer, chronic obstructive pulmonary disease and diabetes mellitus, through the promotion of
healthy lifestyle aimed at preventing the three commonly shared major risk factor; unhealthy diet,
physical inactivity and smoking.

●The second part discusses the various programs aimed at preventing other non communicable
diseases particularly mental disorders, blindness, renal disease and programs for persons with
disabilities.

I. INTEGRATED COMMUNITY BASED NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL

PROGRAM INTRODUCTION 
There are four major non-communicable diseases (also known as chronic diseases or lifestyle related
diseases): cardiovascular diseases, cancer, chronic obstructive pulmonary diseases, and diabetes mellitus.
The rapid rise in the prevalence of these diseases represents one of the major health challenges to global
development in the coming century.
This growing challenge threatens economic and social development as well as the lives and health of
millions of people.

In 2005, it was estimated that 35 million deaths would have occurred due to these diseases, contributing
60% of deaths worldwide. As well as a high death toll, chronic diseases also cause disability, often for
decades of a person’s life.
The most widely used summary measure of the burden of the disease is the disability adjusted life year of
life. The projected burden of the diseases is the disability adjusted life year or DALY, which combines the
number of years of healthy life lost to premature death with time spent in less than full health. One DALY
can be thought of as one lost healthy year of life. The projected burden of disease of these diseases is
approximately half or 48% of the global burden of diseases. Based on current trends, by the year 2020
these diseases are expected to account for 73% of deaths and 60% of the disease burden.

In the Philippines, increasing life expectancy, urbanization and lifestyle changes have brought about a
considerable change on the health status of the country. Globalization and social changes has influenced
the spread of non-communicable or lifestyle/degenerative diseases by increasing exposure to risk.

The life expectancy of Filipinos in 2002 has gone up to 69.6 years. The process of aging brings out myriad
health problems that are degenerative by nature. Mortality statistics in 2002 showed that 7 out of 10
leading causes of deaths in the country are diseases which are lifestyle related: diseases of the heart,
accidents, diabetes, kidney problems.
Morbidity statistics in 2002 also showed that hypertension and diseases of the heart are among the top
ten leading causes of illness in the country.

These diseases are linked by three major risk factors:

tobacco smoking, physical inactivity and an unhealthy diet.
The result of the National Nutrition and Health Survey conducted in 2003 concluded that presently 90%
of Filipinos has one or more risk factors associated with chronic, non-communicable diseases.
Below are the risk factors with the corresponding prevalence rates:
a. physical inactivity. . . . . . . . .60.5%
b. smoking. . . . . . . . . . . . . . . . 34.8%
c. hypertension. . . . . . . . . . . .22.5% (SBP>140 or DBP)
d. hypercholesterolemia. . . . .8.5% (TC>240)
e. obesity. . . . . . . . . . . . . . . . . .4.9% (BMI>30)
f. diabetes. . . . . . . . . . . . . . . . .4.6%

Action to prevent these diseases should therefore focus on controlling risk factors in an integrated
manner. A major strategy is health promotion across the life course and prevention of the emergence of
the risk factors in the first place. Intervention at the level of family and community is essential for
prevention because the causal risk factors are deeply entrenched in the social and cultural framework of
the society. Addressing the major risk factors should be given the highest priority in the prevention and
control of lifestyle related diseases.

Promotion of healthy lifestyle then becomes an imperative. For common understanding, healthy lifestyle
is operationally defined as a way of life that promotes and protects health and well- being. This would
include practice s that promote health such as healthy diet and nutrition, regular and adequate physical
activity and leisure, avoidance of substances that can be abused such as tobacco, alcohol, and other
addicting substances, adequate stress management and relaxation; and practices that offer protection
from health risks such as safe sex and immunization.

Thus, in response to the increasing prevalence of chronic, non- communicable lifestyle related diseases, a
comprehensive integrated community based non- communicable disease prevention and control
program should be put in place by local government units, workplaces and various stakeholders wherever
they are.

Goal:

Reduce the toll of morbidity, disability and premature deaths due to chronic, non- communicable lifestyle
related disease.

Objectives:

1. Analyze the social economic, political and behavioral determinants of NCD that will serve bases
for:
a. Developing policy guidelines;
b. Setting legislative and political directions, and
c. Providing financial measures to support NCD prevention and control.

The initial step in developing a plan for NCD prevention and control is the assessment of disease burden
in a locality. It consists of NCD surveillance to identify vulnerable population groups along with the
social, political, economic, and cultural factors that predispose population to NCD.

2. Reduce exposure of individuals and population to major determinants of NCD while preventing
emergence of preventable common risk factors. The NCD prevention and control program must
focus on modification of unhealthy lifestyles and behaviors that predispose populations to NCD.
To hasten this, the health sector should lobby for a health protective environment by:
 a. Proposing healthy public policies that encourage health- promoting settings in school,
workplaces, and communities.
b. Encouraging governments to provide protection against activities by industry and commerce
that promote unhealthy products and lifestyles.
c. Communicating the consequences of major risk factors of NCD, paying particular attention
to the most vulnerable population.
3. Strengthen health care for people with NCD through health sector reforms and cost-effective
interventions. In order to contribute to the improved health status of individuals and respond to
the community’s basic health care needs, there must be enhanced capability to take action to
address these major NCD risk factors. Enhanced capability reiterates the value of strong
community participation combined with institution- building and appropriate, cost- effective
health interventions.

To achieve significant reduction in morbidity and mortality from major NCDs, the following approaches
should characterize the program:

1. Comprehensive Approach Focused on Primary Prevention

A comprehensive long- term strategy for control of NCDs must focus on primary prevention. It must
include:

a. Prevention of emergence of risk factors referred to as primordial prevention;

b. Specific protection from NCD by removal of the risk factors or reduction in their levels.

The objectives of primary prevention can be achieved by implementing strategies aimed at reducing
risk factor levels utilizing a combination of the population approach and one that is directed towards
the high-risk individual. Interventions aimed at primordial intervention are best achieved by influencing
public policies such as those in trade, food and pharmaceuticals, agriculture, urban development, and
the like.

The presence of large number of people who are already suffering from NCD necessitates the inclusion
of secondary and tertiary prevention and curative components into the program.

Secondary prevention activities are directed towards prompt diagnosis and treatment of NCD. T

Tertiary prevention and curative activities include rehabilitative services for stroke and CHD patients,
foot care for diabetes patients, pain relief for cancer patients and other similar activities.

The decision to extend the primary prevention framework and include secondary and tertiary
prevention and curative activities depends much on the availability of resources. Should these activities
be included in the program, they should not be done at the expense of primary prevention, which
almost always happens in a cure- oriented health care delivery system.

2. Community- based Approach

A community- based NCD prevention and control program recognizes people as the center of any health
and development effort. The community is given the right, responsibility, and capability to identify and
address its own health problems and needs. Given their limitations and constraints, the program is
expected to provide a mechanism for people to participate in activities that have the potential to impact
positively on health.

The program provides the means to respond to their needs and the basic tools for mobilizing the people.
The key ingredients to successful and sustainable- community- based health initiatives are:

• Active participation;
• Involvement of community leaders, community committees and other community groups;
• Strong support and guidance from local governments and technical experts and
• Multi- sectoral collaboration

3. Integrated Approach

A healthy community contributes to the socio- economic development of the community. In the same
manner, improved economic and social status will enable the population to attain healthy condition. It is
from this perspective that an integrated NCD prevention and control program will take off. An
integrated approach is viewed in the following context:

NCD and its major risk factors are not to be regarded solely as health issues.

Since the risk factors are rooted on the people’s way and quality of life, it becomes inherent that the
NCD program be part of the overall development program of the locality. Policy decisions and
appropriate legislations towards a health protective environment will be a major influencing factor in
the reduction or removal of these risk factors.

Interventions for NCD and its major risk factors encompass the three levels of disease prevention.
Intervention aimed at primary prevention can be integrated with the health services and activities that
the community level utilizing the primary health care approach while the secondary and tertiary
prevention activities can be readily made available and accessible through a referral pathway. Health
initiatives of private sector to develop community health services and facilities must be supported and
integrated into the overall scheme of NCD prevention and control program.

Key Intervention Strategies

1. Establishing program direction and infrastructure. A community diagnosis gives good

information on risk factors and prevalence of NCD, in the community.
This becomes the basis for program plan and action and provides for rational resourcing.
Establishing a team to manage the program is a must.
2. Changing environments. Establishing partnership and intercoastal coordinating mechanism in
order to develop policies and programs that ensure health and environment are not
compromised by economic progress.
For example, in order to encourage physical activity and exercise, make facilities like walking
lanes, biking lanes, open spaces, parks, etc. accessible, walkable and attractive to people.
3. Changing lifestyle. Raising public awareness by producing and disseminating information
through mass media, health campaigns, public information systems and school education. At the
community level, mothers’ classes, barangay assemblies, posting in community bulletin boards
 or in places where most people frequent or converge such as sari- sari stores or marketplaces
are examples of activities that can be easily carried out.
4. Reorienting health services. Reorienting focus of health service delivery from cure to health
promotion or wellness.

The Role of Public Health Nurse in NCD Prevention and Control

Health Advocate

Public health nurses promote active community participation in NCD prevention and control through
advocacy work. As a health advocate, the PHN helps the people towards optimal degree of
independence in decision-making and asserting their right to a safer, better community. This involves:

1. Informing the people about the rightness of the cause. It is important to convey the problems,
show how it affects people in the community and describe what possible actions to take.
2. Thoroughly discussing with the people, the nature of the alternatives, their content and
consequences. In this manner, needs and demands of the people are amplified and eventually
become the framework for decision- making. In this exchange process, the advocate and the
people strive to understand meanings in a common way and establish accuracy and reality in
order to select the most effective strategy and tactic in the solution of the problem.
3. Supporting people’s right to make a right choice and to act on the choice. The people must be
assured that they have the right and responsibility to make decisions and that they do not have
to change their decisions because of others’ objections.
4. Influencing public opinion. The advocate affirms the decision made by the people by getting
powerful individuals or groups to listen, support and eventually, make substantial changes to
solve the problem.

Health Educator

Health education is an essential tool to achieve community health. A health educator is concerned with
promoting health as well as reducing behavior- induced disease. In non- communicable disease
prevention and control, health education focuses on establishing or inducing changes in personal and
group attitudes and behavior that promote healthier living. PHNs, as well as educators and media
personnel, should conduct health education in a variety of settings.

The health educator aims to:

1. Inform the people. Health education creates an awareness of health needs and problems which
consequently make the people become conscious of their own responsibilities towards their
own health. Misconceptions and ignorance will be corrected by disseminating scientific
knowledge about causes, factors, prevention and control of non- communicable diseases.
2. Motivate the people. Telling about their health is not enough. They should be motivated to
make own choices and decisions about habits and practices that are detrimental to health, such
as cigarette smoking, indulgence in alcohol, physical activity and fat and sugar- rich diet. In order
to motivate them, health education focuses on providing learning experiences on what health
actions to take, how, when and under what conditions are they going to undertake them.
3. Guide people into action. Oftentimes, people need to be supported in their effort to adopt or
maintain healthy practices and lifestyles. Support comes in the form of making essential health
 services affordable, available and accessible to them. In our society, legislative policies are also
necessary to provide initial push for people to undertake measures to improve their own health
status and the communities they live in.

Health Care Provider

The Public Health Nurse is a care provider to individuals, families and communities rendering primary,
secondary and tertiary health care services in any setting including the community, school and
workplace.

As a care provider, emphasis of health care is on health promotion and disease prevention focusing on
promotion of rational diet and physical activity and cessation of smoking and alcohol drinking. In
addition, action is directed towards the reduction of risk factors of non- communicable diseases. Primary
prevention must be family- oriented because the family members live and eat together and the roots of
chronic diseases are related to personal habits and lifestyle.

Although secondary level of care is the domain of clinical medicine, it seeks to relieve pain, arrest or
cure the disease and prevent disability and death. It also prevents the development of secondary cases
in the community. This is where the guidelines for clinical management of obesity, diabetes,
hypertension, and palliative care for cancer will come in.

Disability limitation and rehabilitation does not refer to prevention of disease per se but rather to
prevention of its potential consequences. The Public Health Nurse provides activities that will permit
clients who have suffered from consequences of non- communicable diseases to lead a socially and
economically productive life.

Community Organizer

• As an organizer, the ultimate goal of the PHN is community health development and
empowerment of the people. This is achieved by:
• Raising the level of awareness of the community regarding noncommunicable diseases, its
causes, prevention and control;
• Organizing and mobilizing the community in taking action for the reduction of risk factors;
• Influencing executive and legislative bodies to create and enforce policies that favor a healthy
environment.

Health Trainer

The PHN provides technical assistance in the assessment of the skills of auxillary health workers in NCD
prevention and control; teaching and supervision on clinical management of non- communicable disease
and other community- based services and recording, reporting and utilization of health information
related to non- communicable diseases.

Researcher

Research is an integral part of a primary health care approach to non- communicable disease prevention
and control program. It is inextricably related to community health practice since it provides the
theoretical bases for developing appropriate and responsive programs and strategies.