Redesigning primary care to tackle the global epidemic of noncommunicable disease

• Published in: American journal of public health (1971) Vol. 105; no. 3; pp. 431 - 437
• Main Authors: Kruk, Margaret E, Nigenda, Gustavo, Knaul, Felicia M
• Format: Journal Article
• Language: English
• Published: United States American Public Health Association 01.03.2015
• Subjects: Budgets; Cancer; Cardiovascular disease; Childrens health; Chronic Disease; Chronic Disease - economics; Chronic Disease - epidemiology; Chronic Disease - prevention & control; Chronic Disease - therapy; Chronic illnesses; Commentaries; Community Health Workers - economics; Community Health Workers - standards; Community Health Workers - trends; Comorbidity; Continuity of care; Cross-Cultural Comparison; Delivery of Health Care, Integrated - economics; Delivery of Health Care, Integrated - standards; Delivery of Health Care, Integrated - trends; Developing countries; Developing Countries - economics; Developing Countries - statistics & numerical data; Diabetes; Disease prevention; Family Practice - economics; Family Practice - standards; Family Practice - trends; Global Health; GNI; Gross National Income; Health Service Delivery; HIV; Human immunodeficiency virus; Humans; Hypertension; Infectious diseases; Integrated approach; LDCs; Low income groups; Mass Screening - economics; Mass Screening - methods; Maternal & child health; Nurses; Pain Management - methods; Pain Management - standards; Patient Care Team - economics; Patient Care Team - standards; Patient Care Team - trends; Patients; Per capita; Physicians; Primary care; Primary Health Care - economics; Primary Health Care - standards; Primary Health Care - trends; Public health; Quality of Life; Respiratory diseases; Risk Factors; Smoking; Teams; Technology adoption; Telemedicine - economics; Telemedicine - standards; Telemedicine - trends
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2014.302392

Noncommunicable diseases (NCDs) have become the major contributors to death and disability worldwide. Nearly 80% of the deaths in 2010 occurred in low- and middle-income countries, which have experienced rapid population aging, urbanization, rise in smoking, and changes in diet and activity. Yet the health systems of low- and middle-income countries, historically oriented to infectious disease and often severely underfunded, are poorly prepared for the challenge of caring for people with cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We have discussed how primary care can be redesigned to tackle the challenge of NCDs in resource-constrained countries. We suggest that four changes will be required: integration of services, innovative service delivery, a focus on patients and communities, and adoption of new technologies for communication.