Department of Health Science, California State University, Fullerton, KHS 161A, 800 N. State College Blvd., Fullerton, CA, 92834, USA.
College of Public Health, East Tennessee State University, Room G42-D, Lamb Hall, Johnson City, TN, 37614, USA.
Global Health. 2018 Jul 6;14(1):66. doi: 10.1186/s12992-018-0380-7.
Non-communicable diseases (NCDs) account for over two-thirds of deaths worldwide, and global efforts to address NCDs have accelerated. Current prevention and control efforts rely primarily on individual behavior/lifestyle approaches that place the onus of responsibility for health on the individual. These approaches, however, have not stopped the increasing trend of NCDs worldwide. Thus, there is urgent need for exploring alternative approaches in order to attain the aim of reducing global premature NCDs mortality by 25% by 2025, and meeting the NCD reduction objective in the Sustainable Development Goals.
We suggest the need for a structural approach to addressing the NCDs epidemic that integrates social science and public health theories. We evaluate two overarching principles (empowerment and human rights) and three social determinants of health (labor and employment, trade and industry, and macroeconomics) addressed in the 2013 Global Action Plan for the Prevention and Control of NCDs to demonstrate how a structural approach to NCDs can be incorporated into existing NCD interventions. For each area considered, theoretical considerations for structural thinking are provided and conclude with recommended actions.
Achieving the global health agenda goals of reducing NCDs mortality will require a shift to a paradigm that embraces concerted efforts to address both behavioral/lifestyle factors and structural dimensions of NCDs.
非传染性疾病（NCDs）在全球死亡人数中占比超过三分之二，全球应对 NCDs 的努力已经加速。目前的预防和控制工作主要依赖于个人行为/生活方式的方法，将健康责任归咎于个人。然而，这些方法并没有阻止全球 NCDs 发病率的上升趋势。因此，迫切需要探索替代方法，以实现到 2025 年将全球过早 NCDs 死亡率降低 25%的目标，并实现可持续发展目标中的 NCDs 减少目标。
我们建议需要采取一种结构性方法来应对 NCDs 流行，该方法将社会科学和公共卫生理论结合起来。我们评估了 2013 年全球预防和控制 NCDs 行动计划中涉及的两个总体原则（赋权和人权）和三个健康社会决定因素（劳动和就业、贸易和工业以及宏观经济学），以展示如何将结构性方法纳入现有的 NCD 干预措施中。对于每个考虑的领域，都提供了结构性思维的理论考虑，并以建议的行动结束。
要实现降低 NCDs 死亡率的全球卫生议程目标，就需要转变思维模式，共同努力解决 NCDs 的行为/生活方式因素和结构性维度。
