Prevention and Management of Noncommunicable Disease

Morbidity and mortality from preventable, noncommunicable chronic disease (NCD) threatens the health of our populations and our economies. The accumulation of vast amounts of scientific knowledge has done little to change this. New and innovative thinking is essential to foster new creative approaches that leverage and integrate evidence through the support of big data, technology, and design thinking. The purpose of this paper is to summarize the results of a consensus meeting on NCD prevention sponsored by the International Olympic Committee (IOC) in April 2013. Within the context of advocacy for multifaceted systems change, the IOC's focus is to create solutions that gain traction within health care systems. The group of participants attending the meeting achieved consensus on a strategy for the prevention and management of chronic disease that includes the following: Focus on behavioral change as the core component of all clinical programs for the prevention and management of chronic disease. Establish actual centers to design, implement, study, and improve preventive programs for chronic disease. Use human-centered design (HCD) in the creation of prevention programs with an inclination to action, rapid prototyping and multiple iterations. Extend the knowledge and skills of Sports and Exercise Medicine (SEM) professionals to build new programs for the prevention and treatment of chronic disease focused on physical activity, diet, and lifestyle. Mobilize resources and leverage networks to scale and distribute programs of prevention. True innovation lies in the ability to align thinking around these core strategies to ensure successful implementation of NCD prevention and management programs within health care. The IOC and SEM community are in an ideal position to lead this disruptive change. The outcome of the consensus meeting was the creation of the IOC Non-Communicable Diseases ad hoc Working Group charged with the responsibility of moving this agenda forward. INTRODUCTION Noncommunicable diseases (NCD, Table 1) account for 60% of all deaths and 44% of premature deaths.1,2 Noncommunicable chronic diseases are now the greatest cause of morbidity and mortality even in developing countries where they account for twice as many deaths as HIV/AIDS, tuberculosis, malaria, and all other infectious diseases combined.1–3 They are a barrier to achieving the United Nations' (UN) Millennium Development Goals4 and are a global threat to our economies in addition to our health. A report by the World Economic Forum and Harvard University estimates that chronic disease, currently costing 2% of the global gross domestic product (GDP), will cost the global economy 30 trillion USD over the next 2 decades, cumulatively 48% of the global GDP in 2010.3 But, chronic diseases are largely preventable. Their main causes are related to lifestyle, that is physical inactivity (recently labeled by The Lancet as being pandemic5), an unhealthy diet, and tobacco and alcohol abuse.TABLE 1: List of Noncommunicable DiseasesIn 2010, the World Health Organization (WHO) and the International Olympic Committee (IOC) signed a memorandum of understanding to jointly promote activities and policy choices designed to reduce the risk of NCD.6 This was followed by a landmark speech given by the IOC President to the plenary session of the Sixty-Sixth General Assembly of the United Nations, September 19, 2011; a “watershed event” to “replace ignorance and inertia with awareness and right actions”.7 IOC President Dr. Jacques Rogge told the Assembly: “The problem is acute, the solution is at hand. It is a grim picture, except for one thing: We can do something about it.” Low cost, highly effective solutions for the prevention and management of NCD are available.5 The IOC President emphasized the WHO recommendations on physical activity as core to NCD prevention.6 He called for safe and accessible public spaces for physical activity and sport, partnerships with transportation and urban planning, increased physical education, and better sport infrastructure and organization, thus building on the comprehensive, broad-based, long-term approaches recommended by International Society for Physical Activity and Health (ISPAH), the Grand Challenges Global Partnership, the WHO, the European Commission (EC), the World Economic Forum (WEF), Active Canada, Exercise is Medicine, the Organization for Economic Co-operation and Development (OECD),1–3,8–13 and many others. To date, efforts to promote a “home” for prevention within health care has largely failed. Waiting for comprehensive, emergent reform of dysfunctional health care systems is unrealistic. Likewise, results from reductionist research studies have not been successfully implemented and scaled in such a way as to create population-wide impact. The current approaches to chronic disease prevention and management involving public health and global health strategy14 may need to be merged with HCD. The latter approach, used as a catalyst for change in other industries, focuses on the importance of the human element in behavioral change.7 Successful implementation of testable, novel approaches will require committed, visionary leadership willing to reframe the problem from a practical, human-design perspective while sticking to a clear strategy to mobilize the resources and capacities needed for change. The objective of this IOC consensus meeting was to achieve alignment on a strategy to design a sustainable plan of action for the prevention and management of NCD, coupling existing scientific evidence with HCD, focusing particularly on physical activity/exercise and behavioral change. In order to accomplish this objective, the SEM community must overcome considerable inertia created by the complexity and magnitude of the NCD problem and its context. The SEM community must bundle its efforts and embrace a new, creative approach aligned with a strategy that is clear, concrete, and human-centered. THE PROBLEM For most of human history, people needed to be physically active to survive. Today, for instance, only 20% of Norwegian,15 8.2% of US,16 and 5% of UK17 adults meet physical activity guidelines. Over a 4-decade period, physical activity in the US has declined 32% and is projected to decline even further to 46% by 2030,18 while from 1991 to 2009, China's physical activity rates dropped by 45%.18 In the Arab World, 8 countries have physical inactivity levels ranging from 33% to 70% of the population.19 Over the past 50 years there has been a marked decline in energy expenditure for household management20 and civilian occupation,21 sufficient to explain the rising prevalence of obesity.22 Worldwide, physical inactivity and smoking are responsible for more deaths than any other modifiable risk factors.5 Clinical scientists are continuing to identify more characteristics that magnify the problem. For example, sitting time has been shown to be associated with increased cardio-metabolic risk independent of levels of physical activity.23–25 Low aerobic fitness is a risk factor for all-cause mortality, cancer, and cardiovascular disease, independent of body fatness.26,27 While the problem of physical inactivity, poor diet, and unhealthy lifestyle behaviors is evident and clear, the real problem is that we have not been able to mitigate the steady rise in NCD. 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