Prevention of chronic diseases: a call to action

Chronic (non-communicable) diseases--principally cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes--are leading causes of death and disability but are surprisingly neglected elements of the global-health agenda. They are underappreciated as development issues and underestimated as diseases with profound economic effects. Achievement of the global goal for prevention and control of chronic diseases would avert 36 million deaths by 2015 and would have major economic benefits. The main challenge for achievement of the global goal is to show that it can be reached in a cost-effective manner with existing interventions. This series of papers in The Lancet provides evidence that this goal is not only possible but also realistic with a small set of interventions directed towards whole populations and individuals who are at high risk. The total yearly cost of the interventions in 23 low-income and middle-income countries is about US$5.8 billion (as of 2005). In this final paper in the Series we call for a serious and sustained worldwide effort to prevent and control chronic diseases in the context of a general strengthening of health systems. Urgent action is needed by WHO, the World Bank, regional banks and development agencies, foundations, national governments, civil society, non-governmental organisations, the private sector including the pharmaceutical industry, and academics. We have established the Chronic Disease Action Group to encourage, support, and monitor action on the implementation of evidence-based efforts to promote global, regional, and national action to prevent and control chronic diseases.     

Increased mortality in chronic kidney disease: a call to action

The mortality rate among patients with chronic kidney disease is much higher than among those without. As glomerular filtration rate declines and patients approach end-stage renal disease, the mortality rate increases and patients at this stage are more likely to die than receive renal replacement therapy. The higher mortality and its underlying causes among chronic kidney disease patients is a serious issue. Lack of physician awareness of chronic kidney disease and its association with excess mortality remains a problem. In this review of current literature, we aim to increase this awareness among health care professionals and the general public and to call for action to improve survival in chronic kidney disease patients. The data strongly suggest that advancing kidney dysfunction leads to increased mortality risk. Contributing to the mortality associated with chronic kidney disease are the comorbidities that accompany this disease state. For instance, patients with chronic kidney disease and comorbidities are at 1.3 to 3.6 times more risk than patients without chronic kidney disease. Further, cardiovascular disease is the leading cause of death among chronic kidney disease patients. It appears that both traditional (such as diabetes mellitus, hypertension, and smoking) and nontraditional risk factors (C-reactive protein and interleukin-6 levels) present in the chronic kidney disease population promote the frequent development of cardiovascular disease. Therefore, therapies targeting both progression of chronic kidney disease and comorbidities such as cardiovascular disease are required to reduce mortality among these patients.     

Citizenship ethics: a call to action

Ethics is the philosophical study of mortality--the study of goodness, moral values, and right action. Citizenship ethics is the part of public ethics that is concerned with the right action of citizens in the public arena. This article defines citizenship ethics and examines the ethics of individual citizens or groups as it relates to opportunities for healthcare professionals in their respective communities. The spirit of volunteerism among three professionals is highlighted as they make a positive contribution to their communities, and an appeal is made to healthcare professionals to seek their own opportunities to make a positive impact on their communities.     

Dialing 911: a call to action

Cardiovascular disease and stroke are the nation's leading causes of disability and death. Scientific advances have provided newer treatments that, when applied effectively and in time, save a significant number of lives. Multiple factors in our system of delivery impede our ability to apply effective treatments, but with an analysis of the components of care, each of us can take leadership roles in our communities to improve the chain of survival. These elements and the science supporting each are briefly reviewed.     

Rare disease registries: a call to action

When registries collect accurate clinical data over time, they can act as fundamental support structures for patients and their families and powerful cost‐effective instruments to support clinical trials and translational research to improve quality of care, quality of life and survival. Registries are critical for rare diseases (RD) with low prevalence and propensity for variation in treatment and outcomes. Rare Voices Australia is leading a call for action to the research and clinical community to prioritise RD data collection and develop an integrated RD Registry strategy for Australia. Financial, operational and governance challenges exist for establishing and maintaining RD registries. As a multidisciplinary team whose interests converge on RD, we highlight the need for the establishment of an Australian RD Registry Alliance. This ‘umbrella’ organisation will: (i) bring together existing RD registries across Australia; (ii) establish National RD Registry Standards to support interoperability and cohesion across registries; (iii) develop strategies to attract sustainable funding from government and other sources to maximise the utility of existing RD registries and support the development of new RD registries. The most important role for the Alliance would be to use the RD registries for translational research to address current knowledge gaps about RD and to improve the care for the over 1.4 million Australians estimated to live with RD.     

Conquering heart disease: a call to action

Despite 20th century scientific and technologic advances in the area of cardiovascular medicine and public health and associated benefits in terms of significant declines in mortality, heart disease remains as the dominant cause of death for all Americans. Tremendous geographic variation in age-adjusted coronary heart disease mortality, varying over two-fold between the highest and lowest states, provides troubling evidence that this epidemic is raging unrelentingly in many communities across our country. Also disturbing are signs that the significant decline in coronary heart disease mortality observed since the 1960s may have slowed in recent years. The coronary heart disease epidemic continues to hit hard among certain racial and ethnic minorities, prompting the Healthy People 2010 national call for action to eliminate cardiovascular disease disparity.     

Changing European CKD trends: a call to action

Increasing numbers of patients with chronic kidney disease (CKD) who require renal replacement therapy threaten to overwhelm nephrologists, nephrology nurses, and haemodialysis units in many European countries. Health care costs are increasing more rapidly than corresponding budgets. These changing trends mandate new policies to provide continued quality care for more patients at international, national, and local levels. Although individual countries have different requirements regarding health care systems, approaches must be taken that improve structure, process, and outcome. Common issues include improving professional education, increasing collaboration among health care providers and specialists, and the acquisition and allocation of funds. Solutions identified by some countries provide examples of model programs that could be adapted for others. The impending crisis that more and older patients with serious comorbidities and CKD will impose on health care delivery must be addressed now in a proactive manner by the nephrology health care community.     

Family coronary heart disease: a call to action

A family history of coronary heart disease (CHD) is an accepted risk factor for cardiovascular events and is independent of common CHD risk factors. Advances in the understanding of genetic influences on CHD risk provide the opportunity to apply this knowledge and improve patient care. Utility of inherited cardiovascular risk testing exists by utilizing both phenotypes and genotypes and includes improved CHD risk prediction, selection of the most appropriate treatment, prediction of outcome, and family counseling. The major impediment to widespread clinical adoption of this concept involves un-reimbursed staff time, educational needs, access to a standardized and efficient assessment mechanism, and privacy issues. The link between CHD and inheritance is indisputable and the evidence strong and consistent. For clinicians, the question is how to utilize this information, in an efficient manner, in order to improve patient care and detection of high-risk family members.     

Beta adrenergic blockers in chronic congestive cardiac failure: a call for action

Antagonism of adverse neuro-endocrine responses is the current paradigm by which chronic congestive cardiac failure is treated. Several recent large-scale randomized, controlled trials have confirmed the benefits of beta-adrenergic blocking agents in this regard. In light of the present heart failure 'epidemic', appropriate organization of services is mandatory to ensure that as many patients as possible can benefit from this life-saving therapy.