Shanghai declaration on non-communicable diseases

BRITISH MEDICAL JOURNAL VOLUME 306 27 FEBRUARY 1993

EDITOR,-This declaration evolved from a meeting of selected WHO directors of collaborating centres in Shanghai, China, in March 1992. Since the 1940s there has been a global transition in health, with a rapid emergence of non-com-municable diseases.' For developing countries, this has been especially troublesome as we are faced with infectious and nutritional diseases concurrent with a new imposing force of non-communicable diseases. The twentv first century looms with a growing and greying world population; non-communicable diseases will tax the resources of all nations unless actions are taken now. As directors of WHO non-communicable disease collaborating centres and key officials in centres for lion-communiicable diseases we declare that a concerted global action needs to be initiated to develop national and regional infrastructures to alleviate the financial expense and cost in human suffering from non-comniunicable diseases in the next millennium.

Historically, countrywide health improvements have begun with the public health system. Improved sanitation, infection and vector control, betterment of nutrition, vaccinations, and maternal and child health programmes have been under the purview of local health authorities in the ministries of health. In contrast, non-commuiiicable diseases have been virtually, ignored by local health departments. Hence, the prevention and control of non-communicable diseases have been out of the mainstream of public health.

Tragically, there are few local or national data concerning the incidence of non-communicable diseases. The limited monitoring is based on information on death certificates, but this has marginal value for control programmes as the occupational, environmental, and genetic factors that precede death are not documented. Moreover, death is just "the tip of the iceberg," the most severe form of disease but a delayed and infrequent manifestation.

To begin scientifically based national non-communicable disease programmes, standardised integrated disease monitoring systems need to be established. Considerable global assets have been spent to prevent non-communicable example, with major investments to improve the environment. However, as there has been no simultaneous monitoring of incidence, it is extremely difficult to determine the effects of these expensive actions to human health and wellbeing. A global system to monitor disease and risk factors is needed to truly understand the effects of environmental and genetic factors on health in the next century.

We therefore declare that nations begin to consider the development of scientifically based national non-communicable disease plans. A foundation to these programmes shoulld be standardised cost effective integrated disease monitoring systems.'

WHO DIRECTORS OF NON-COMMUNICABLE DISEASE
COLLABORATING CENTRES AND KEY OFFICIALS
Australia: S A Dobson, T Dwyer; China: H Z Chen, Y T Gao, X Q Gu, J H Hu, H Q Yan, Z P Qu, K A Wang; Cuba: 0 Mateo-de Acosta; Czechoslovakia: R Poledine, M Rusnak; Germany: L Kohlmer; Japan: S Baba, N Tajima, Y Yamory, Mauritius: H Gareebo; Saudi Arabia: M El-Hazmi; United States: J S Dorman, R E Laporte

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