WHO Global Forum IV on Chronic Disease Prevention and Control

Part 4: Resources

4.1: Key Terms

General Terms⁷

Accountability: accountability results when decision makers at all levels fulfill their obligations and are made answerable for their actions. Setting explicit objectives and defining how progress towards them will be monitored makes it easier to achieve accountability.

Advocacy: the action taken by health professionals and others with perceived authority to influence the decisions of communities and governments.

Assessment: the obligation of a public health agency to monitor the health status and needs of its community regularly and systematically; one of the three core functions of public health.

Attributable: the quality or characteristic that can be assigned to the element of interest.

Behavioural change: an intervention approach that uses public information and education to promote behavioural patterns favourable to the population as a whole; also includes interventions (e.g., counseling) at the group or individual level for the same purpose.

Behavioural patterns:Behavioural patterns: habits of living that influence health. (e.g., diet, physical activity, smoking).

Burden of disease: the loss of health in populations due to disease and injury. It is measured using the Disability Adjusted Life Year or (DALY) which combines the time lived with disability and the time lost due to premature mortality. One DALY can be thought of as one lost year of 'healthy' life and the burden of disease as a measurement of the gap between current health status and an ideal situation where everyone lives into old age free of disease and disability.

Capacity-building: the development of the technical expertise to plan, implement and evaluate interventions aimed at preventing or controlling non-communicable diseases in a variety of settings. Areas of expertise in capacity-building include problem identification, epidemiological and behavioural risk factor analysis, coalition-building, programme implementation, knowledge of intervention methodologies, process, impact and outcome evaluation, and the ability to obtain ongoing support and funding through administrative and legislative means, beyond the life of any particular source of funding.

Coalition-building: the establishment of a temporary alliance of fractions, parties, individuals or groups for a specific purpose.

Collaboration⁸: is a process through which parties or sectors who see different aspects of a problem can constructively explore their differences and search for solutions that go beyond their own visions of what is possible. Collaboration involves joint problem solving and decision making among key stakeholders in a problem or issue.

Four features are critical to collaboration:

1. the stakeholders are interdependent 2. solutions emerge by dealing constructively with differences 3. decisions are jointly owned 4. stakeholders assume collective responsibility for the future direction of the domain.

In collaboration it is common to have:

- lack of clarity about who is a stakeholder
- disparity of power and/or resources among stakeholders
- complex problems that are not well defined
- scientific uncertainty
- differing perspectives that lead to adversarial relationships
- dissatisfaction with previous and existing approaches and processes.

Community: a specific group of people, often living in a defined geographical area, who share a common culture, values and norms and are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community gain their personal and social identity by sharing common beliefs, values and norms, which have been developed by the community in the past and may be modified in the future. They exhibit some awareness of their identity as a group and share common needs and a commitment to meeting them.

Community mobilization: a process aimed at enabling communities to understand and control the circumstances affecting their lives. It acknowledges that agents of change can be found wherever the decisions that affect people's ability to influence their lives are made and implemented.

Comprehensive public health strategy: an approach to a major health problem in the population that identifies and employs the full array of potential public health interventions, including health promotion and disease prevention.

Disease prevention: disease prevention covers measures not only to prevent the occurrence of disease, such as risk factor reduction, but also to arrest its progress and reduce its consequences, once established.

Effectiveness: a measure of the extent to which a specific intervention, procedure, regimen or service, when deployed in the field in routine circumstances, does what it is intended to do for a specified population.

Efficiency: the capacity to produce the maximum output for a given input.

Endemic: the constant presence of a disease or infectious agent within a given geographical area or the usual prevalence of a given disease within such area.

Epidemiology: the study of the causes and prevention of disease in populations or communities, making it the main source of evidence for public health decision making.

Evaluation framework: a description of how a programme is to be evaluated.

Evidence-based public health: the use of agreedupon standards of evidence in making decisions about public health policies and practices to protect or improve the health of populations.

Fiscal: measures related to tax and tax policies.

Generalizability: the level at which the findings of a result can be attributed to a bigger population or the whole population of concern.

Guidelines: systematically developed statements traditionally used to reinforce best practices.

Health: a state of complete physical, social and mental well-being and not merely the absence of disease or infirmity.

Health disparities: differences in the burden and impact of disease among different populations, defined, for example, by sex, race or ethnicity, education or income, disability, place of residence, or sexual orientation.

Health education: health education comprises consciously constructed opportunities for learning involving some form of communication designed to improve health literacy. It includes improving knowledge and developing life skills that are conducive to individual and community health.

Health promotion: the combination of educational and environmental supports for action and conditions of living conducive to health. The actions may be those of individuals, groups or communities, of policymakers, employers, teachers or others whose actions control or influence the determinants of health. The purpose of health promotion is to enable people to gain greater control over the determinants of their own health. In health promotion, health is seen as a resource for everyday life, not the objective of living. Health is a positive concept, emphasizing social and personal resources, as well as physical capabilities.

High-risk approach: an intervention strategy that targets only people with the highest levels of recognized chronic disease risk for the purpose of reducing their level of risk to that of the most favourable level in the population; distinct from and complementary to the population-wide approach.

Impact: the total, direct and indirect effects of a programme, service or institution on the health status and overall health and socio-economic development.

Implementation plan: a list of activities to be organized or carried out, in a set order and according to a schedule, to accomplish a certain goal. The plan stipulates who does what and when, and may include information on the costs associated with each phase of the work. Implementation is also the act of converting programme objectives into actions, such as through policy changes, regulation and organization.

Incidence: the number of new cases of disease occurring in a population of a given size within a specified time interval.

Indicator: a variable with characteristics of quality, quantity and time. It is used to measure, directly or indirectly, changes in a situation and to appreciate the progress made in addressing it. It also provides a basis for developing adequate plans for improvement.

Individual approach: see high-risk approach. Integrated chronic disease prevention:9 although a marked elevation of a single risk factor significantly predicts an individual's ill health, the societal burden from chronic disease results from the high prevalence of multiple risk factors related to general life-styles. Therefore, community-based activities are required with an integrated public health approach that is targeted to populations, in addition to those at high risk.

"No longer can chronic illness be considered in isolation. Awareness is increasing that they share common, usually related risk factors, and that integrated strategies can be effective for many different conditions."

• Within the context of chronic disease prevention and control, the term integration has several meanings. The classical definition involves determination and confrontation of common risk factors, rather than the process of attacking many individual diseases separately.
• Integrated chronic disease prevention programmes aim at interventions that address common risk factors through the health system and other existing community structures, rather than an outside prevention programme.
• Another meaning of the term integration for chronic disease prevention and control denotes a comprehensive approach which combines varying strategies for implementation. These include policy development, capacity building, partnerships, and informational support at all levels.
• Integration calls for intersectoral action to implement health policies - another aspect of integration needed to address the major determinants of health that fall outside the remit of the health system.
• Integration also refers to efforts to combine population and high risk approaches by linking prevention actions of various components of the health system, including health promotion, public health services, primary care and hospital care.
• Integration does not preclude meeting the unique needs of particular populations. However, when chronic disease prevention and control programmes have been established by addressing different diseases, eventually a balance among them should be achieved.

Intersectoral action: when the health sector and other relevant sectors collaborate to achieve a common goal. For practical purposes, intersectoral and multisectoral actions are synonymous.

Intervention: an activity or set of activities aimed at modifying a process, course of action or sequence of events, in order to change one or several of its characteristics such as performance or expected outcome.

Life expectancy: the number of years of life that can be expected on average in a given population.

Lifestyle: a way of living based on identifiable patterns of behaviour which are determined by the interplay between an individual's personal characteristics, social interactions, and socioeconomic and environmental living conditions.

Living conditions: the everyday environment of people, where they live, play and work. These living conditions are a product of social and economic circumstances and the physical environment – all of which are largely outside the immediate control of the individual.

Malnutrition: any disorder of nutrition. It may be due to unbalanced or insufficient diet or defective assimilation or utilization of food.

Modifiable characteristics: factors that are amenable to change (e.g., diet, physical activity, and smoking), in contrast to those that are intrinsic to the individual (e.g., age, sex, race, genetic traits).

Monitoring: regular observation of changes in some condition, either in a population or an individual, such as health status, or in an environment, such as levels of pollution, in order to determine whether an initiative is proceeding according to plan. Monitoring includes keeping track of achievements, staff movements and deployment, supplies, equipment, and money spent. The information gained from monitoring is used in evaluating the initiative.

Morbidity: knowledge of the illness or diseased condition in a population. Various ratios are calculated to ascertain the morbidity level.

Mortality: rate of death expressed as the number of deaths occurring in a population of a given size within a specified time interval.

Network: the number and types of social relations and links between individuals and/or institutions that may provide access to or mobilize social support.

Obesity: usually defined in terms of body mass index (BMI), which is calculated as body weight in kilograms (1 kg = 2.2 lbs) divided by height in meters (1 m = 39.37 in) squared; definitions of obesity may differ by region and specific groups.

Opportunistic screening: the presumptive identification of unrecognized disease or defect by tests, examinations or other procedures which can be applied rapidly to sort out apparently well persons who probably have a disease from those who probably do not. This is done in a passive way in a health setting without having to go out to look for cases.

Outcome: a change in current or future health status or health-related behaviour that can be attributed to an intervention. In the field of health, the desired result or impact of a policy measure or other health intervention would be a positive change in health status or health behaviour.

Outcome assessment: an outcome assessment is used to determine the short-term effects of an intervention on an identified population.

Output: the products, services and other items, such as clinical preventive guidelines, regulations, tax law provisions, directly produced by a programme or organization.

Overweight: see obesity.

Passive smoking: inhaling cigarette, cigar, or pipe smoke produced by another individual. It is composed of second-hand smoke (exhaled by the smoker), and side stream smoke (which drifts off the tip of cigarette or cigar or pipe bowl).

Physical inactivity: lack of habitual activity sufficient to maintain good health, resulting in an unfavourable balance between energy intake and expenditure and fostering the development of overweight or obesity and other risk factors for chronic diseases.

Policy: an agreement or consensus among relevant partners on the issues to be addressed and on the approaches or strategies needed to deal with the issues.

Policy and environmental change: an intervention approach to reducing the burden of chronic diseases that focuses on enacting effective policies (e.g., laws, regulations, formal and informal rules) or promoting environmental change (e.g., changes to economic, social, or physical environments).

Policy framework: a conceptual structure based on consensus among major stakeholders that shows the relationship.

Population-based data: health data that pertain to a defined, usually large, population (e.g., vital statistics, surveillance, results of population surveys).

Population-wide approach: an intervention strategy that targets the population as a whole with regard to the risk levels of various subgroups; distinguished from and complementary to the high-risk approach.

Prevalence: the frequency of a particular condition within a defined population at a designated time (e.g., 5.5 million men living with hypertension in 1994 or 34% of the population found to use tobacco in a survey conducted in Pakistan).

Prevention: approaches and activities aimed at reducing the likelihood that a disease or disorder will affect an individual, interrupting or slowing the progress of the disorder or reducing disability. Primary prevention reduces the likelihood of the development of a disease or disorder. Secondary prevention interrupts, prevents or minimizes the progress of a disease or disorder at an early stage. Tertiary prevention focuses on halting the progression of damage already done.

Preventive dose: the intensity and duration of appropriate public health interventions needed to achieve goals; similar to the dose and duration of medical treatment sufficient to control or cure an illness.

Primary health care: essential health care made accessible at a cost a country and community can afford, with methods that are practical, scientifically sound and socially acceptable.

Primary prevention: a set of interventions, including the detection and control of risk factors, designed to prevent the first occurrence of noncommunicable diseases among people with identifiable risk factors.

Priority populations: groups at especially high risk of chronic diseases (e.g., those identified by sex, race or ethnicity, education, income, disability, place of residence, or sexual orientation).

Process evaluation: an assessment of how a programme achieves its effects. This includes evaluation of the amount of resource inputs used, as well as a description of activities implemented and of outputs (intermediate outcomes, proximal impacts) of the programme.

Programme: a set of projects designed to achieve common, long-term goals.

Programme evaluation: a periodic review and assessment of a programme to determine, in light of current circumstances, the adequacy of its objectives and its design, as well as its intended and unintended results. This assessment addresses how a programme achieves its effects, including evaluation of the amount of resource inputs used, as well as a description of activities implemented and of outputs (intermediate outcomes, proximal impacts) of the programme.

Project: a group of planned activities linked by common short- to long-term objectives and managed by a single centre of responsibility.

Qualitative data: qualitative data are categorical rather than quantifiable observations, and often involve descriptions of attitudes, perceptions, intentions and activity.

Quality of life:Quality of life: individuals' perceptions of their positions in life in the context of the culture and value system where they live, and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept.

Risk: the likelihood of incurring a particular event or circumstance.

Risk assessment: a measure to determine the chance or probability of acquiring a disease. The excess risk caused by exposure to a given factor is calculated by incidence rates of disease in exposed and non-exposed populations.

Risk behaviour: a behavioural pattern associated with increased frequency of specified health problems; for example, high salt intake, smoking, and binge drinking are all associated with CVD.

Risk factor: an individual characteristic associated with increased frequency for specified health problems; for example, high LDL cholesterol, high blood pressure, and diabetes are all associated with CVD.

Risk factor detection and control: an intervention approach that targets people with identifiable risk factors; includes both screening or other methods of detection and long-term disease management through changes in lifestyle, behaviour and medication, when necessary.

Screening: the identification of unrecognized disease or defect by the application of tests, examinations, or other procedures which can be applied rapidly to sort out apparently well persons who probably have a disease from those who probably do not. A screening test is not intended to be diagnostic.

Secondary prevention: a set of interventions aimed at survivors of acute NCDs events (e.g., heart attack, cancer, diabetes, etc.) or others with known NCDs in which long-term case management is used to reduce disability and risk for subsequent NCDs events.

Social marketing: the development and implementation of programmes aimed at influencing people's ideas through the use of techniques and approaches similar to those employed in the marketing of goods and services, such as market research, product planning, communication and distribution.

Stakeholders: parties who have a common interest in a project and have agreed in principle to support it. Depending on their affiliation, they may provide assistance with conceptual, technical, material, financial or human resources.

Strategy: a plan of action that is designed to achieve long-term goals, taking into account the resources available and barriers anticipated, as well as possibilities for collaboration among relevant stakeholders.

Surveillance: a regular collection, summarization and analysis of data on a continuous basis.

Symptomatic: feeling and showing the discomfort and complaints of disease

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7. Many of these terms are adapted from two sources: (a) WHO document appendices, (b) Ministry of Health, Government of Pakistan; World Health Organization, Pakistan office, and Heartfile. National Action Plan for Prevention and Control of Non-communicable Disease and Health Promotion in Pakistan. Appendices.
8. Barbara Gray. Collaborating: Finding Common Ground for Multiparty Problems. Jossey-Bass Publishers, London, 1989, 5. Adapted.
9. Integrated chronic disease prevention and control (adapted, e.g., with NCD changed to chronic disease)

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