A review of the evidence for the effectiveness and costs of interventions preventing the burden of non- communicable diseases: How can health systems respond?

Non-communicable diseases (NCD) are becoming an increasingly important health problem in Latin America and the Caribbean (LAC). This region is in the unique position of experiencing the epidemiological polarity of increasing NCDs, as well as a resurgence of many communicable diseases – a situation which is straining the resources of many countries in the area. The purpose of this review is to present an overview of effective and cost-effective interventions for the primary prevention of non-communicable diseases which have the potential to be successfully implemented in LAC. This review relied mostly on compiling information from systematic and expert reviews of the various NCDs and risk factors. These were based primarily on research conducted in North America and Europe. Very little published information was found relating to primary prevention of NCDs in LAC. In attempting to generalize the results to LAC caution must be exercised because of the considerable differences in socio-cultural factors, economic factors, and health/education/municipal infrastructure between North America/Europe and LAC, as well as between and within the countries of Latin America and the Caribbean. Effective and cost-effective community interventions for primary prevention of NCDs shared the following characteristics: • a combination of community-wide strategies that include education and skill-building components in multiple settings, combined with social and environmental supports (e.g. policy development, legislation, taxation, access to food, increased access to opportunities for physical activity). This combination of interventions was shown to be effective for reducing tobacco use, increasing physical activity, preventing cardiovascular disease, and increasing food security; • the cost-effec tiveness information emphasizes the importance of interventions in the socio-environmental conditions in which we live rather than individual, lifestyle-oriented strategies. For example, taxation 4 was most cost-effective for reducing smoking, increased access to stoves was cost-effective to improve indoor air quality, and improvement in basic living needs was required for low income populations to improve their heart health; • Low socioeconomic status communities do not participate in " lifestyle " interventions. Those interventions that have the greatest chance of attracting community interest are those that will produce a noticeable improvement in the quality of life of the participants over the short-term. Specifically, interventions to improve indoor air quality in homes, and to address food security and quality are recommended for consideration; • Schools, workplaces and municipalities are recommended as key foci for action because they provide the opportunity to effectively reach large numbers of people with sustained interventions. …