Maternal and child health services and an integrated, life-cycle approach to the prevention of non-communicable diseases
Abstract
Described as the ‘invisible epidemic’, non-communicable diseases (NCDs) are the world’s leading cause of death. Most are caused by preventable factors, including poor diet, tobacco use, harmful use of alcohol and physical inactivity. Diabetes, cancer and cardiovascular and chronic lung diseases were responsible for 38 million (68%) of global deaths in 2012. Since 1990, proportionate NCD mortality has increased substantially as populations have aged and communicable diseases decline. The majority of NCD deaths, especially premature NCD deaths (<70 years, 82%), occur in low-income and middle-income countries, and among poor communities within them.
Addressing NCDs is recognised as central to the post- 2015 agenda; accordingly, NCDs have a specific objective and target in the Sustainable Development Goals. While deaths from NCDs occur mainly in adulthood, many have their origins in early life, including through epigenetic mechanisms operating before conception.
Good nutrition before conception and interventions aimed at preventing NCDs during the first 1000 days (from conception to age 2 years), childhood and adolescence may be more cost- effective than managing established NCDs in later life with costly tests and drugs. Following a life-course approach, maternal and child health interventions, before delivery and during childhood and adolescence, can prevent NCDs and should influence global health and socioeconomic development.
This paper describes how such an approach may be pursued, including through the engagement of non-health sectors. It also emphasises evaluating and documenting related initiatives to underwrite systematic and evidence-based cross-sectoral engagement on NCD prevention in the future.
Key questions
- Non-communicable diseases (NCDs) are the dominant cause of global morbidity and mortality; the risk of some acquired NCDs begins early in life and even before conception.
- New evidence reviews presented here suggest that many NCDs can be prevented with appropriate approaches across the maternal and child health (MCH) life-cycle, throughout the years of reproductive age (especially before conception and continuing through pregnancy), and during infancy, childhood and adolescence.
- The evidence reviewed also suggests that a multisectoral approach to reducing the risk of NCDs is needed, spanning the MCH life-cycle and involving public policy and regulation, improved health literacy and behaviour change interventions.
Summary
As the incidence of NCDs rises, the imperative to act on risk factors becomes more urgent. MCH programmes across the reproductive health life-cycle are strongly positioned to play an important role in NCD prevention given early life influences on NCD risks and outcomes. Such programmes should seek both to incorporate NCD prevention within existing services, while also broadening their scope to include older children and adolescents whose related behaviours set up lifetime patterns of risk.
Many MCH activities readily contribute to NCD prevention, such as promotion of good health before conception and during pregnancy, breast feeding and appropriate early childhood nutrition, and emphasising physical activity during early childhood and at school. Refocusing these activities through an NCD prevention lens is an important public health opportunity. Expanding programmes to include older children and adolescents may reduce risk factors such as tobacco smoking and alcohol abuse.
Cross-sectoral involvement is necessary for making a meaningful impact on reducing NCD risk in early life. Many non-health sectors can impact NCD risk, and the SDG’s emphasis on multisectorality supports the consideration of NCD risk reduction in many different sectoral programmes. A greater NCD prevention focus in schools should impact related behaviours and risk factors at individual and family levels. Policy, advocacy and legislation, particularly involving the food and beverage industry and the media, should also help children and adolescents to make healthy choices. Built environment initiatives can also improve opportunities for safe physical activity, beginning early in life.