Neglected Global Epidemics: three growing threats evidence and provided recommendations for nutrient intake goals for the prevention of CVD and other noncommunicable diseases(7) A coherent policy framework, encompassing legislation, regulation and mass education is critical for CVD prevention and control, since individual behaviour change is difficult in the absence of conducive environmental alterations. A suggested stepwise framework for a com prehensive response to CVD prevention and control is outlined in Table 6. 1 and can be modi- fied according to national needs, goals and targets Table 6.1 A stepwise approach for prevention and control of noncommunicable diseases Individual high-risk approach Resource level National level Community level Step 1 WHO Framework Convention on Local infrastructure plans indude the Context-specific management guide Tobacco Control (FCTC)is ratified in the provision and maintenance of accessible lines for noncommunicable diseases and safe sites for physical activity (such have been adopted and are used at all Tobacco control legislation consistent as parks and pedestrian-only areas). health care levels. with the elements of the FCTC is Health-promoting community projects A sustainable, accessible and affordable enacted and enforced include participatory actions to cope supply of appropriate medication is Anational nutrition and physical activity, predispose to risk of noncommunicable asele for priority noncommunicable with the environmental factors that policy consistent with the Globa trategy is developed and endorsed at diseases: inactivity, unhealthy diet, A system exists for the consi Cabinet level: sustained multisectoral tobacco use, alcohol use, etc. uality application of clinica action is evident to reduce fat intake, Active health promotion programmes and for the clinical audit reduce salt (with attention to iodized focusing on noncommunicable diseases offered salt where appropriate), and promote are implemented in different settings fruit and vegetable consumption. villages, schools and workplaces. for recall of patients with hypertension is Health impact assessment of publi y is carried out(for example ort, urban planning, taxation, and Tobacco legislation provides for Sustained, well-designed programmes ms are in place for selective and Expanded incremental increases in tax on tobacco, are in place to promote ted prevention aimed at high-risk and a proportion of the revenue is tobacco-free lifestyles, e.g. smoke. lations, based on absolute levels earmarked for health promotion ee public places, smoke-free sports; Food standards legislation is enacted and enforced: it includes nutrition healthy diets, e.g. low-cost, low-fat lab foods, fresh fruit and vegetables; Sustained, well-designed, national hysical activity, e.g. "movement"in fferent domains occupational and programmes (counter-advertising) are in place to promote non-smoking Step 3: Country standards are established that Recreational and fitness centres are Opportunistic screening, case-finding Optimal regulate marketing of unhealthy food available for community use. and management programmes are to children Capacity for health research is built Support groups are fostered for tobacco within countries by encouraging studies cessation and overweight reduction on noncommunicable diseases Appropriate diagnostic and therapeutic interventions are implemented Adapted from: (8)Neglected Global Epidemics: three growing threats 89 evidence and provided recommendations for nutrient intake goals for the prevention of CVD and other noncommunicable diseases (7). A coherent policy framework, encompassing legislation, regulation and mass education is critical for CVD prevention and control, since individual behaviour change is difficult in the absence of conducive environmental alterations. A suggested stepwise framework for a com￾prehensive response to CVD prevention and control is outlined in Table 6.1 and can be modi￾fied according to national needs, goals and targets. Table 6.1 A stepwise approach for prevention and control of noncommunicable diseases Resource level Step 1: Core Step 2: Expanded Step 3: Optimal Context-specific management guide￾lines for noncommunicable diseases have been adopted and are used at all health care levels. A sustainable, accessible and affordable supply of appropriate medication is assured for priority noncommunicable diseases. A system exists for the consistent, high￾quality application of clinical guidelines and for the clinical audit of services offered. A system for recall of patients with diabetes and hypertension is in operation. Systems are in place for selective and targeted prevention aimed at high-risk populations, based on absolute levels of risk. Opportunistic screening, case-finding and management programmes are implemented. Support groups are fostered for tobacco cessation and overweight reduction. Appropriate diagnostic and therapeutic interventions are implemented. Population approaches Individual high-risk approach Adapted from: (8). National level WHO Framework Convention on Tobacco Control (FCTC) is ratified in the country. Tobacco control legislation consistent with the elements of the FCTC is enacted and enforced. A national nutrition and physical activity policy consistent with the Global Strategy is developed and endorsed at Cabinet level; sustained multisectoral action is evident to reduce fat intake, reduce salt (with attention to iodized salt where appropriate), and promote fruit and vegetable consumption. Health impact assessment of public policy is carried out (for example: transport, urban planning, taxation, and pollution). Tobacco legislation provides for incremental increases in tax on tobacco, and a proportion of the revenue is earmarked for health promotion. Food standards legislation is enacted and enforced; it includes nutrition labelling. Sustained, well-designed, national programmes (counter-advertising) are in place to promote non-smoking lifestyles. Country standards are established that regulate marketing of unhealthy food to children. Capacity for health research is built within countries by encouraging studies on noncommunicable diseases. Community level Local infrastructure plans include the provision and maintenance of accessible and safe sites for physical activity (such as parks and pedestrian-only areas). Health-promoting community projects include participatory actions to cope with the environmental factors that predispose to risk of noncommunicable diseases: inactivity, unhealthy diet, tobacco use, alcohol use, etc. Active health promotion programmes focusing on noncommunicable diseases are implemented in different settings: villages, schools and workplaces. Sustained, well-designed programmes are in place to promote: • tobacco-free lifestyles, e.g. smoke￾free public places, smoke-free sports; • healthy diets, e.g. low-cost, low-fat foods, fresh fruit and vegetables; • physical activity, e.g. “movement” in different domains (occupational and leisure). Recreational and fitness centres are available for community use