Community Interventions for Health (CIH): A monograph

Non-communicable disease (NCD), including cardiovascular disease, cancer, diabetes and chronic respiratory diseases, accounted for over 65.5% of deaths in 2010, with more than 80% of these occurring in low and middle-income countries (LMIC). Approximately 30% of the deaths in LMIC occur prematurely and are largely preventable. NCD is also associated with increased morbidity and reduced quality of life, and it has been estimated that the global economic impact of NCD could total US$47 trillion over the next twenty years, equivalent to 5% of GDP. The causes of NCD have their roots in three major modifiable risk factors; tobacco use, physical inactivity and unhealthy diet and prevention of NCD by addressing these factors at the community level is fast becoming an area of interest. Most authorities, including the United Nations (UN), the World Health Organisation (WHO) and the US Center for Disease Control and Prevention (CDC) recommend evidence-based strategies for lifestyle interventions, but there is limited high-grade evidence for population or community-based approaches and most of the available evidence is derived from studies conducted in high-risk individuals in high-income countries. The population approach is inclusive and addresses many factors including health education, structural environmental change, engagement of health providers, transport and education ministries, policy and legislative initiatives and partnerships and coalitions with community organisations. In 2008, the Oxford Health Alliance, a UK registered health charity (No 1117580), began its Community Interventions for Health (CIH) program which was designed to utilise this population approach and which adopted multi-factorial, comprehensive strategies for prevention of NCD by addressing modifiable lifestyle risk factor reduction. CIH is an international collaborative study that took place between 2008-2011 in communities in China, India and Mexico and was designed to reduce the risk of NCD by targeting the three main risk factors of tobacco use, physical inactivity and unhealthy diet. The aim of CIH was to evaluate culturally-specific strategies to (i) decrease the prevalence of smoking and smokeless tobacco use, (ii) improve diet by increasing intake of fruit and vegetables and reducing use of salt and (iii) increase levels of physical activity in local communities in India, China and Mexico. CIH was conducted over 5 years, and showed that population-based strategies to improve health were effective in adults, and had a positive impact on risk factors for NCD by improving dietary intake and ameliorating secular trends for reduced physical activity and increases in overweight and obesity.