McKee Martin, Haines Andy, Ebrahim Shah, Lamptey Peter, Barreto Mauricio L, Matheson Don, Walls Helen L, Foliaki Sunia, Miranda J Jaime, Chimeddamba Oyun, Garcia-Marcos Luis, Vineis Paolo, Pearce Neil
Global Health. 2014 Oct 28;10:74. doi: 10.1186/s12992-014-0074-8.
The "25×25" strategy to tackle the global challenge of non-communicable diseases takes a traditional approach, concentrating on a few diseases and their immediate risk factors.
We propose elements of a comprehensive strategy to address NCDs that takes account of the evolving social, economic, environmental and health care contexts, while developing mechanisms to respond effectively to local patterns of disease. Principles that underpin the comprehensive strategy include: (a) a balance between measures that address health at the individual and population level; (b) the need to identify evidence-based feasible and effective approaches tailored to low and middle income countries rather than exporting questionable strategies developed in high income countries; (c) developing primary health care as a universal framework to support prevention and treatment; (d) ensuring the ability to respond in real time to the complex adaptive behaviours of the global food, tobacco, alcohol and transport industries; (e) integrating evidence-based, cost-effective, and affordable approaches within the post-2015 sustainable development agenda; (f) determination of a set of priorities based on the NCD burden within each country, taking account of what it can afford, including the level of available development assistance; and (g) change from a universal "one-size fits all" approach of relatively simple prevention oriented approaches to more comprehensive multi-sectoral and development-oriented approaches which address both health systems and the determinants of NCD risk factors.
The 25×25 is approach is absolutely necessary but insufficient to tackle the the NCD disease burden of mortality and morbidity. A more comprehensive approach is recommended.
应对全球非传染性疾病挑战的“25×25”战略采用了传统方法，专注于少数几种疾病及其直接风险因素。
我们提出了一项应对非传染性疾病的综合战略要素，该战略考虑到不断变化的社会、经济、环境和医疗保健背景，同时建立有效应对当地疾病模式的机制。支撑该综合战略的原则包括：（a）在针对个人层面和人群层面健康的措施之间取得平衡；（b）需要确定适合低收入和中等收入国家的基于证据的可行且有效的方法，而不是输出高收入国家制定的可疑战略；（c）将初级卫生保健发展为支持预防和治疗的通用框架；（d）确保能够实时应对全球食品、烟草、酒精和运输行业复杂的适应性行为；（e）在2015年后可持续发展议程中纳入基于证据、具有成本效益且负担得起的方法；（f）根据每个国家的非传染性疾病负担确定一系列优先事项，同时考虑其承受能力，包括可得的发展援助水平；以及（g）从相对简单的以预防为导向的通用“一刀切”方法转变为更全面的多部门和以发展为导向的方法，这些方法既要解决卫生系统问题，也要解决非传染性疾病风险因素的决定因素。
“25×25”方法对于应对非传染性疾病的死亡和发病负担绝对必要，但并不充分。建议采用更全面的方法。
