- Open Access
Chronic Disease Prevention and the New Public Health
Public Health Reviewsvolume 32, pages120–154 (2010)
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.
Beaglehole R, Ebrahim S, Reddy S, Voûte J, Leeder S, on behalf of the Chronic Disease Action Group. Prevention of chronic diseases: a call to action. Lancet. 2007;370:2152–7.
Nugent R. Chronic diseases in developing countries. Health and economic burdens. Ann NY Acad Sci. 2008;1136:70–9.
Lopez AL, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367:1747–57.
Strong K, Mathers C, Leeder S, Beaglehole R. Preventing chronic diseases: how many lives can we save? Lancet. 2005;366:1578–82.
Centers for Disease Control. Achievements in public health, 1900–1999. Decline in deaths from heart disease and stroke, 1900–1999. MMWR Morb Mortal Wkly Rep. 1999;48:649–56.
Mackay J, Mensah G. The atlas of heart disease and stroke. World Health Organization, Geneva: World Health Organization; 2004.
Rodriguez-Artalejo F, Guallar-Castillón P, Villar Alvarez F, Banegas JR. Critical review and proposals for improvement of the health information systems on cardiovascular diseases in Spain. Med Clin (Barc). 2008;131:302–11.[article in Spanish].
World Health Organization. Cardiovascular diseases (CVDs) fact sheet 317. [online]. Available from URL: http://www.who.int/mediacentre/factsheets/fs317/ en/index.html (Updated September, 2009 and accessed 30 October, 2009).
Allender S, Scarborough P, Peto V, Rayner M, Leal L, Luengo-Fernandez R, Gray A. European cardiovascular disease statistics 2008. Brussels: European Heart Network: 2008. Available form: URL: http://www.ehnheart.org/content/ SectionIntro.asp?level0=1457&docid=4345 (Accessed 1 November, 2009).
Appelros P, Stegmayr B, Terént A. Sex differences in stroke epidemiology: a systematic review. Stroke. 2009;40:1082–90.
Turk WM, Tuite PK, Burke LE. Cardiac health: primary prevention of heart disease in women. Nurs Clin N Am. 2009;44:315–25.
Kark M, Rasmussen F. High systolic blood pressure increases the risk of obtaining a disability pension because of cardiovascular disease: a cohort study of 903 174 Swedish men. Eur J Cardiovasc Prev Rehabil. 2009;16:597–602.
Franco OH, Peeters A, Bonneux L, de Laet C. Blood pressure in adulthood and life expectancy with cardiovascular disease in men and women. Hypertension. 2005;46:280–6.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23.
Chobanian AV. The hypertension paradox — more uncontrolled disease despite improved therapy. N Engl J Med. 2009;361:878–87.
Tesfaye F, Byass P, Wall S. Population based prevalence of high blood pressure among adults in Addis Ababa: uncovering a silent epidemic. BMC Cardiovasc Disord. 2009;9:39.
Rodgers A, Ezzati M, Vander Hoorn S, Lopez AD, Lin RB, Murray CJ; Comparative Risk Assessment Collaborating Group. Distribution of major health risks: findings from the Global Burden of Disease study. PLoS Med. 2004 Oct; 1(1):e27. [Epub 2004 Oct 19].
Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M; Comparative risk assessment collaborating group (Cancers). Causes of cancer in the world: comparative risk assessment of nine behavioral and environmental risk factors. Lancet. 2005;366:1784–93.
Soerjomataram I, de Vries E, Pukkala E, Coebergh JW. Excess of cancers in Europe: a study of eleven major cancers amenable to lifestyle change. Int J Cancer. 2007;120:1336–43.
Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002; Cancer incidence, mortality and prevalence worldwide IARC CancerBase No. 5, version 2.0 Lyon (France): IARC Press; 2004.
Gracia M, Jemal A, Ward EM, Center MM, Hao Y, Siegel RL, et al. Global cancer facts & figures 2007. Atlanta, (GA): American Cancer Society; 2007. Available from URL: http://www.cancer.org/downloads/STT/Global_Cancer_ Facts_and_Figures_2007_rev.pdf (Accessed 31 March, 2010).
World Health Organization. Factsheet No. 297: Cancer. Available from URL: http://www.who.int/mediacentre/factsheets/fs297/en/ (Posted February, 2009, Accessed 31 March, 2010).
Hakama M, Coleman MP, Alexe DM, Auvinen A. Cancer screening: evidence and practice in Europe 2008. Eur J Cancer. 2008;44:1404–13.
Harper DM, Franco EL, Wheeler CM, Moscicki AB, Romanowski B, Roteli-Martins CM, et al. Sustained efficacy up to 4.5 years of a bivalent L1 viruslike particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet. 2006;367:1247–55.
Castellsagué X, Díaz M, de Sanjosé S, Muñoz N, Herrero R, Franceschi S, et al. Worldwide human papillomavirus etiology of cervical adenocarcinoma and its cofactors: implications for screening and prevention. J Natl Cancer Inst. 2006;98:303–15.
Martinez-Hervas S, Romero P, Hevilla EB, Real JT, Priego A, Martin-Moreno JM, et al. Classical cardiovascular risk factors according to fasting plasma glucose levels. Eur J Intern Med. 2008;19:209–13.
Tuomilehto J, Rastenyte D, Qiao Q, Jakovljevic D. Epidemiology of macrovascular disease and hypertension in diabetes mellitus. In: De Fronso RA, Ferrannini E, Keen H, Zimmet P, editors. International Textbook of Diabetes Mellitus, 3rd ed. Milan: John Wiley & Sons; 2004. p 1345–70.
Australian Institute of Health and Welfare: Diabetes: Australian facts 2008. Diabetes series no. 8. Cat. No. CVD 40. Canberra: Australian Institute of Health and Welfare; 2008.
Unwin N, Whiting D, Gan D, Jacqmain O, Ghyoot G. Eds. IDF Diabetes Atlas, 4th Ed. International Diabetes Federation, 2009. Available from http://www.diabetesatlas.org/ (Accessed 31 March, 2010).
Zimmet P. Preventing diabetic complications: a primary care perspective. Diabetes Res Clin Pract. 2009;84:107–16.
Lieberman LS. Dietary, evolutionary, and modernizing influences on the prevalence of type 2 diabetes. Annu Rev Nutr. 2003;23:345–77.
Stuckler D. Population causes and consequences of leading chronic diseases: a comparative analysis of prevailing explanations. Milbank Q. 2008;86:273–326.
Ezzati M, Hoorn SV, Rodgers A, Lopez AD, Mathers CD, Murray CJ; Comparative Risk Assessment Collaborating Group. Estimates of global and regional potential health gains from reducing multiple major risk factors. Lancet. 2003;362:271–80. Erratum in: Lancet. 2005;365:28.
Ahluwalia IB, Mack KA, Murphy W, Mokdad AH, Bales VS. State-specific prevalence of selected chronic disease-related characteristics — behavioral risk factor surveillance system, 2001. MMWR Morb Mortal Wkly Rep. 2003;52(SS08);1–80.
Report of the Advisory Committee to the Surgeon General of the Public Health Service. Smoking and health. Public Health Service Publication. No. 1103. Washington (DC): U.S. Government Printing Office; 1964.
Corrêa PC, Barreto SM, Passos VM. Smoking-attributable mortality and years of potential life lost in 16 Brazilian capitals, 2003: a prevalence-based study. BMC Public Health. 2009;9:206.
Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ; Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347–60.
Ezzati M, Lopez AD. Regional, disease specific patterns of smoking-attributable mortality in 2000. Tob Control. 2004; 13:388–95.
International Agency for Research on Cancer. Tobacco smoke and involuntary smoking. IARC Monogr Evaluat Carcinog Risks Hum.Vol. 83. Lyon (France): IARC; 2004; 83:1–1438.
Dreyer L, Winther JF, Pukkala E, Andersen A. Avoidable cancers in the Nordic countries. Tobacco smoking. APMIS Suppl. 1997;76:9–47.
Glantz SA, Parmley WW. Passive smoking and heart disease: mechanisms and risk. JAMA. 1995; 273:1047–1053.
Ockene IS, Miller NH., for the American Heart Association Task Force on Risk Reduction. Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals. Circulation. 1997;96:3243–7.
Bonita R. Epidemiology of stroke. Lancet. 1992;339:342–4.
Burke AP, Farb A, Malcom GT, Liang YH, Smialek J, Virmani R. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med. 1997;336:1276–82.
Wells AJ. Passive smoking as a cause of heart disease. J Am Coll Cardiol. 1994;24:546–54.
Will JC, Galuska DA, Ford ES, Mokdad A, Calle EF. Cigarette smoking and diabetes mellitus: Evidence of a positive association from a large prospective cohort study. Int J Epidemiol. 2001;30:540–6.
Bott U, Jörgens V, Grüsser M, Bender R, Mühlauser I, Berger M. Predictors of glycaemic control in type 1 diabetic patients after participation in an intensified treatment and teaching program. Diabet Med. 1994;11:362–71.
Chase HP, Garg SK, Marshall G, Berg CL, Harris S, Jackson WE. Cigarette smoking increases the risk of albuminuria among subjects with type I diabetes. JAMA. 1991;265:614–7.
Morrish NJ, Stevens LK, Fuller JH, Jarrett RJ, Keen H. Risk factors for macrovascular disease in diabetes mellitus: the London follow-up to the WHO Multinational Study of Vascular Disease in Diabetics. Diabetologia. 1991;34:590–4.
World Health Organization. Overweight and obesity (BMI). Health topic page. [Online]. Available from URL: http://www.apps.who.int/infobase/report.aspx?rid =112&ind=BMI&goButton=Go (Accessed 27 October, 2009).
Popkin BM. Global changes in diet and activity patterns as drivers of the nutrition transition. Nestle Nutr Workshop Ser Pediatr Program. 2009;63:1–10, 10–4, 259–68.
Macfarlane DJ, Thomas N. Exercise and diet in weight management: updating what works. Br J Sports Med. 2009; Oct 20. [Epub ahead of print].
Martínez-González MA, Fernández-Jarne E, Serrano-Martínez M, Marti A, Martinez JA, Martín-Moreno JM. Mediterranean diet and reduction in the risk of a first acute myocardial infarction: an operational healthy dietary score. Eur J Nutr. 2002;41:153–60.
Guallar E, Aro A, Jiménez FJ, Martín-Moreno JM, Salminen I, van’t Veer P, et al. Omega-3 fatty acids in adipose tissue and risk of myocardial infarction: the EURAMIC study. Arterioscler Thromb Vasc Biol 1999;19:1111–8.
Sui X, LaMonte MJ, Blair SN. Cardiorespiratory fitness and risk of nonfatal cardiovascular disease in women and men with hypertension. Am J Hypertens. 2007;20:608–15.
Sieverdes JC, Sui X, Lee DC, Church TS, McClain A, Hand GA, et al. Physical activity, cardiorespiratory fitness, and the incidence of type 2 diabetes in a prospective study of men. Br J Sports Med. 2009; July 26; [Epub ahead of print].
Melzer K, Kayser B, Pichard C. Physical activity: the health benefits outweigh the risks. Curr Opin Clin Nutr Metab Care. 2004;7:641–7.
Woodcock J, Edwards P, Tonne C, Armstrong BG, Ashiru O, Banister D, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport. Lancet. 2009;374:1930–43.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.
Qin L, Knol MJ, Corpeleijn E, Stolk RP. Does physical activity modify the risk of obesity for type 2 diabetes? A review of epidemiological data. Eur J Epidemiol. 2009;25:5–12.
Tulchinsky TH. Micronutrient deficiency conditions: global health issues. Public Health Reviews 2010;32:243–255.
Schlipköter U, Flahault A. Communicable diseases: achievements and challenges for public health, Public Health Reviews 2010;32:90–119.
Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118:3030–44.
Goedert J, Coté T, Virgo P, Scoppa S, Kingma D, Gail M, et al., AIDS-Cancer Match Study Group. Spectrum of AIDS-associated malignant disorders. Lancet. 1998;351:1833–39.
World Health Organization Europe, Regional Committee for Europe. Gaining health: The European strategy for the prevention and control of noncommunicable diseases. EUR/RC56/Conf.Doc./3._30 June 2006. Fifty-sixth session. Copenhagen, 11–14 September 2006.
Franco M, Orduñez P, Caballero B, Tapia Granados JA, Lazo M, Bernal JL, et al. Impact of energy intake, physical activity, and population-wide weight loss on cardiovascular disease and diabetes mortality in Cuba, 1980–2005. Am J Epidemiol. 2007;166:1374–80.
Schauffler HH, Faer M, Faulkner L, Shore K. Health promotion and disease prevention in health care reform. Am J Prev Med. 1994;10 (5 Suppl)1–31.
Lalonde M. A new perspective on the health of Canadians. A working document. Ottawa: Government of Canada; 1974. Available from http://www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/1974-lalonde/lalonde-eng.pdf (Accessed 31 March, 2010).
US Department of Health and Human Services. Centers for Disease Control and Prevention. Guide to Community Preventive Services. (Updated 10 February, 2009).
U.S. Department of Health and Human Services, Agency for Health Care Research and Quality, U.S. Preventive Services Task Force, Guide to clinical preventive services. 2009. (Updated 18 January, 2010).
Maciosek MV, Coffield AB, Edwards NM, Flottemesch TJ, Goodman MJ, Solberg LI. Priorities among effective clinical preventive services: results of a systematic review and analysis. Am J Prev Med. 2006:31:52–61.
World Health Organization. WHO Framework Convention on Tobacco Control. Geneva: WHO; 2003.
Fiore MC, Jaén CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service; 2008.
de Beber J, Waverly Brigden L. Tobacco control policy: strategies, succeses and setbacks. Washington, DC: World Bank and Research for International Tobacco Control; 2003.
Cahill K, Moher M, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2008; Issue 4.Art. No.: CD003440.
Stead LF, Perera R, Lancaster T. Telephone counseling for smoking cessation. Cochrane Database of Systematic Reviews. 2006; Issue 3. Art No.:CD002850.
Perdue WC, Stone LA, Goslin LO. The built environment and its relationship to the public’s health: the legal framework. Am J Public Health. 2003;93:1390–94.
U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. Physical activity for everyone: guidelines. November 5, 2008.
Gostin LO. Law as a tool to facilitate healthier lifestyles and prevent obesity. JAMA. 2007;297:87–90.
U.S. GAO. School lunch program: efforts needed to improve nutrition and encourage healthy eating. GAO-03-506. Washington, DC. U.S. Government Accounting Office; 2003.
Institute of Medicine. Food marketing to children and youth: threat or opportunity? Washington, D.C.: National Academies Press; 2006.
Jacobson MF, Brownell KD. Small taxes on soft drinks and snack foods to promote health. Am J Public Health. 2000;90:854–7.
Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, et al. Projected effect of dietary salt reductions on future cardiovascular disease. New Engl J Med. 2010 Jan 20. [Epub ahead of print].
Asaria P, Chisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. Lancet. 2007;370:2044–53.
Mair JS, Pierce MW, Teret SP. The use of zoning to restrict fast food outlets: a potencial strategy to combat obesity. The Center for the Law and Public Health. October 2005.
Health policy priorities. Washington, DC: Partnership for Prevention; 2005. Available from URL: http://www.prevent.org/images/stories/health_policy. pdf (Accessed 31 March, 2010).
PAHO/WHO Task Force. Trans fats free Americas: conclusions and recommendations. April 26-27 2007.
World Health Organization, the World Food Program and the United Nations Childrens Fund. Joint statement: Preventing and controlling micronutrient deficiencias in populations affected by an emergency. Geneva: World Health Organization; 2007.
Tyrovolas S, Panagiotakos DB. The role of Mediterranean type of diet on the development of cancer and cardiovascular disease, in the elderly: A systematic review. Maturitas. 2010;65:122–30.
Martinez-Gonzalez MA, Bes-Rastrollo M, Serra-Majem L, Lairon D, Estruch R, Trichopoulou A. Mediterranean food pattern and the primary prevention of chronic disease: recent developments. Nutr Rev. 2009;67:S111–6.
Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al. PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006;145:1–11.
Martínez-González MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vazquez Z, et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ. 2008;336:1348–51.
Barton RL, Whitehead K. A review of community based healthy eating interventions. J Hum Nutr Diet. August 2008;21:378–9.
Rolls B, Ello-Martin JA, Tohill BC. What can intervention studies tell us about the relationship between fruit and vegetable consumption and weight management? Nutrition Reviews. 2008;62:1–17.
World Cancer Research Fund & American Institute of Cancer Research. The second expert report: Food, nutrition, physical activity and the prevention of cancer — a global perspective. Part 2, Evidence and Judgements; Chapter 4. Foods and Drinks. Washington (DC): American Institute for Cancer Research; 2007. Available from URL: http://www.dietandcancerreport.org/downloads/ chapters/chapter_04.pdf (Accessed 19 August, 2009).
World Health Organization. Food and Agriculture Organization of the United Nations. Diet, nutrition and the prevention of chronic diseases. Report of a joint WHO/FAO expert consultation, Geneva, 28 January — 1 February 2002. WHO Technical Report Series 916. Geneva: World Health Organization; 2003. Available from http://whqlibdoc.who.int/trs/WHO_trs_916.pdf (Accessed 31 March, 2010).
Woodside JV, McCall D, McGartland C, Young IS. Dietary intake vs. supplement use. Proceedings of the Nutrition Society. 2005;64:543–53.
Dangour AD, Sibson VL, Fletcher AE. Hormones and supplements: do they work? micronutrient supplementation in later life: limited evidence for benefit. The J Gerontol A Biol Sci Med Sci. 2004;59:B659–73.
Yach D, Kellogg M, Voute J. Chronic diseases: an increasing challenge in developing countries. Trans R Soc Trop Med Hyg. 2005;99:321–4.
European code against cancer and scientific justification: third version (2003). Europe Against Cancer. 2003. Available from URL: http://www.cancercode.org/code.htm (Accessed 31 March, 2010).
Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice. European guidelines on cardiovascular disease prevention in clinical practice: full text. Eur J Cardiovasc Prev Rehabil. 2007;14 Suppl 2:S1–113.
U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute. JNC 7 Express. The seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure. NIH Publication No. 03-5233. Bethesda, MD: National heart Lung and Blood Institute: 2003.
Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009; Oct 15. [Epub ahead of print].
National Heart, Lung and Blood Institute, National Institutes of Health, US Department of Health and Human Services. Third report of the national cholesterol education program expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult treatment panel III). NIH Publication No. 01-3670. Washington DC: U.S. Department of Health and Human Services; 2001.
Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER. Quadrivalent Human Papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007;56 (RR-01):1–24.
Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, et al. Comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. Recommendations of the Advisory Committee on Immunization Practices (ACIP) part two: immunization of adults. MMWR Morb Mort Wkly Rep. 2006;55(RR-16):1–33.
WHO. 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases. Geneva: World Health Organization, 2008.
Nabel EG, Stevens S, Smith R. Combating chronic disease in developing countries — partners in progress. Lancet. 2009; 373:2004–6.
Van der Heyden JH, Schaap MM, Kunst AE, Esnaola S, Borrell C, Cox B, et al. Socioeconomic inequalities in lung cancer mortality in 16 European populations. Lung Cancer. 2009;63:322–30.
Sentell T, Halpin HA. The importance of adult literacy in understanding health disparities. J Gen Intern Med. 2006;21:862–6.
Messinger-Rapport B. Disparities in long-term health care. Nurs Clin North Am. 2009; 44:179–85.
Stuckler D, King L, Robinson H, McKee M. WHO’s budgetary allocations and burden of disease: a comparative analysis. Lancet. 2008;372:1563–9.
Taylor S. Wealth, health and equity: convergence to divergence in late 20th century globalization. Br Med Bull. 2009;91:29–48.
Eurocan Plus. Feasibility study for coordination of national cancer research activities. Summary Report of the Eurocan+Plus Project. Lyon: International Agency for Research on Cancer; 2008.
Cassels A. Guide to sector-wide approaches for health development: Concepts, issues and working arrangements (WHO/ARA/97.12). Geneva: Division of Analysis Research and Assessment, World Health Organization; 1997.
Swiss Agency for Development and Cooperation. The Kyrgyz-Swiss-Swedish Health Project (KYSS). Project description. 2009; Available from URL: http://www.swiss-cooperation.admin.ch/central/index.php?&nsvID= 220858&IanglD=1 (Updated June, 2009 and accessed 31 March, 2010).
World Health Organization. The Bangkok charter: health promotion in a globalized world. Geneva: WHO; 2006. A59/21 4 May 2006.
About this article
- chronic diseases
- European health
- New Public Health
- health promotion
- public policy
- preventive care
- risk factors
- physical activity
- heart disease