Chronic Disease Prevention and the New Public Health

Chronic diseases are the major causes of morbidity and mortality across the globe in developed and developing countries, and in countries transitioning from former socialist status. Chronic diseases — including heart disease, cancer, stroke, diabetes, and respiratory diseases — share major risk factors beyond genetics and social inequalities including tobacco use, unhealthy diet, physical inactivity, and lack of access to preventive care. There are evidence-based interventions that are effective in modifying these risks and subsequently preventing disease. Evidence for prevention is strongest for measures aimed at reducing tobacco use and increasing physical activity, while large gaps remain in our knowledge about how to effectively change eating habits and achieve healthy weights in a population. The New Public Health addresses interventions delivered at three levels: 1) at the level of society, where public policy and governmental interventions can change the environment, as well as individual behavior (e.g., regulation of tobacco products and food composition, taxation, redesigning the built environment, banning advertising); 2) at the level of the community, through the activities of local institutions delivered at the population level (e.g., school-based and workplace health promotion, community education, training, and public awareness campaigns); and 3) at the level of the individual, through the provision of clinical preventive services including screening, counselling, chemoprophylaxis, and immunizations (in recognition of the growing evidence that infections cause important chronic diseases). We conclude with a discussion of comprehensive national and international efforts needed to stem the tide of the growing global burden of chronic disease.