Brumana Luisa, Arroyo Alvaro, Schwalbe Nina R, Lehtimaki Susanna, Hipgrave David B
UNICEF Regional Office for Latin America and the Caribbean, Panama City, Panama.
UNICEF Country Office, Montevideo, Uruguay.
BMJ Glob Health. 2017 Aug 19;2(3):e000295. doi: 10.1136/bmjgh-2017-000295. eCollection 2017.
Described as the 'invisible epidemic', non-communicable diseases (NCDs) are the world's leading cause of death. Most are caused by preventable factors, including poor diet, tobacco use, harmful use of alcohol and physical inactivity. Diabetes, cancer and cardiovascular and chronic lung diseases were responsible for 38 million (68%) of global deaths in 2012. Since 1990, proportionate NCD mortality has increased substantially as populations have aged and communicable diseases decline. The majority of NCD deaths, especially premature NCD deaths (<70 years, 82%), occur in low-income and middle-income countries, and among poor communities within them. Addressing NCDs is recognised as central to the post-2015 agenda; accordingly, NCDs have a specific objective and target in the Sustainable Development Goals. While deaths from NCDs occur mainly in adulthood, many have their origins in early life, including through epigenetic mechanisms operating before conception. Good nutrition before conception and interventions aimed at preventing NCDs during the first 1000 days (from conception to age 2 years), childhood and adolescence may be more cost-effective than managing established NCDs in later life with costly tests and drugs. Following a life-course approach, maternal and child health interventions, before delivery and during childhood and adolescence, can prevent NCDs and should influence global health and socioeconomic development. This paper describes how such an approach may be pursued, including through the engagement of non-health sectors. It also emphasises evaluating and documenting related initiatives to underwrite systematic and evidence-based cross-sectoral engagement on NCD prevention in the future.
非传染性疾病（NCDs）被称为“隐形流行病”，是全球主要的死亡原因。大多数非传染性疾病是由可预防的因素引起的，包括不良饮食、烟草使用、有害使用酒精和身体活动不足。2012年，糖尿病、癌症以及心血管和慢性肺部疾病导致了全球3800万人死亡（占68%）。自1990年以来，随着人口老龄化和传染病发病率下降，非传染性疾病的相对死亡率大幅上升。大多数非传染性疾病死亡，尤其是过早的非传染性疾病死亡（<70岁，占82%），发生在低收入和中等收入国家以及这些国家内的贫困社区。应对非传染性疾病被认为是2015年后议程的核心；因此，非传染性疾病在可持续发展目标中有具体的目标和指标。虽然非传染性疾病死亡主要发生在成年期，但许多疾病起源于生命早期，包括通过受孕前起作用的表观遗传机制。受孕前的良好营养以及旨在在生命最初1000天（从受孕到2岁）、儿童期和青少年期预防非传染性疾病的干预措施，可能比在晚年用昂贵的检测和药物治疗已确诊的非传染性疾病更具成本效益。遵循生命历程方法，产前以及儿童期和青少年期的母婴健康干预措施可以预防非传染性疾病，并应影响全球健康和社会经济发展。本文描述了如何采用这种方法，包括通过非卫生部门的参与。它还强调评估和记录相关举措，以便为未来基于系统和证据的跨部门参与非传染性疾病预防工作提供支持。
