CHAPTER 6 Non-Communicable Diseases This chapter summarizes the Organization's activities in some of the more important chronic non-communicable diseases during its second decade, when, in addition to activities in the fields of mental health, dental health and nutrition, programmes and comparative studies were developed in cancer and cardiovas­ cular diseases. A start was also made in 1966 with respect to rheumatic diseases when a scientific group was convened with a view to establishing internationally agreed diagnostic criteria for the diffuse connective tissue diseases. In almost all these spheres, the main emphasis has been on basic research and relevant co-or­ dinating activities, but the training of personnel and organization of services have not been neglected. Much of the research assisted by WHO has consisted of epidemiological studies on population groups in various countries. These studies, based on the concept of multi-factorial etiology, require the simultaneous measurement and handling of many variables, such as personal characteristics, physiological func­ tions and environmental factors; they call for the development and acceptance by research workers of methods suitable for international comparative studies of population groups, and the application of advanced statistical techniques. To open the way for a more extensive use of the experimental approach in research relating to the degenerative diseases, WHO has sought out and investigated spontaneously occurring conditions in animals, comparable to human non-com­ municable diseases - especially cardiovascular diseases and cancer. CARDIOVASCULAR DISEASES Some cardiovascular diseases -arterial hypertension, rheumatic heart disease, cerebrovascular lesions and certain congenital malformations - are commonly found everywhere, though each may differ in clinical manifestations, etiology and pathogenesis. Others, such as coronary heart disease, the Chagas cardiopathy and cardiopathies of unknown etiology, are found in certain geographical areas or among identifiable groups of people. Indications that ischaemic heart disease is occurring nowadays in younger age groups, and the presence of ischaemic heart -202- NON-COMMUNICABLE DISEASES 203 and brain disease with atherosclerosis as the underlying lesion in certain social sections of the population in developing countries, show that these conditions are becoming a universal health problem. The Organization's programme - which aims to further the prevention and control of the major cardiovascular diseases by applying available knowledge and promoting research on etiology and pathogenic mechanisms through inter­ national co-operation - has been guided by the recommendations of various advisory groups, including two study groups and two expert committees which met towards the end of WHO's first decade. 1 Preventive and Control Measures Preventive measures against rheumatic fever, 2 chronic cor pulmonale,3 arterial hypertension and ischaemic heart disease,4 as well as possibilities for rehabilitation of patients with these diseases,5 have been discussed by WHO expert committees and at various regional meetings, including a symposium on the pathogenesis of essential hypertension jointly organized by WHO and the Czechoslovak Cardio­ logical Society in Prague in 1960,6 and a conference on the prevention and control of cardiovascular diseases held in Bucharest in 1965. Available knowledge permits the control and prevention of rheumatic fever, chronic cor pulmonale and heart diseases connected with infections; it is also pos­ sible to control essential hypertension so as to reduce its serious complications, such as hypertensive heart disease and cerebrovascular disease. Regarding the prevention of rheumatic fever, the expert committee which met in 1966 recommended the establishment of pilot centres to carry out preventive programmes against rheumatic fever and the expansion of such services as rapidly as possible; the validation by scientific methods of the Jones' criteria for the diag­ nosis of rheumatic fever in developing and economically developed countries; and the establishment of a network of WHO reference laboratories for bacterio­ logical and serological diagnosis of group A streptococcal infections. 7 In the Region of the Americas, the Organization co-operated with the Pan American League against Rheumatism and the Chilean Rheumatism Society in convening a meeting in 1963 to consider the problem of rheumatic fever. 1 Wld Hlth Org. techn. Rep. Ser., 1957, 117, 126; 1958, 143; 1959, 168. 2 Wld Hlth Org. techn. Rep. Ser., 1957, 126; 1966, 342. 3 Wld Hlth Org. techn. Rep. Ser., 1961, 213. • Wld Hlth Org. techn. Rep. Ser., 1962, 231. • Wld Hlth Org. techn. Rep. Ser., 1964, 270. 6 Cort, J. H. et al., ed. (1961) The pathogenesis of essential hypertension: proceedings of the Prague symposium, Prague (State Medical Publishing House). 1 Wld Hlth Org. techn. Rep. Ser., 1966, 342. 204 THE SECOND TEN YEARS Although it is not yet possible to prevent the occurrence of ischaemic heart disease of atherosclerotic origin, sufficient evidence has been accumulated to indicate that proper care of subjects with acute myocardial infarction may control or prevent lethal complications during the early stages of the disease. The pro­ vision of proper care for these patients has therefore been considered as a most urgent necessity. WHO-assisted studies have been carried out in different areas to ascertain how many subjects with acute myocardial infarction die outside the hospitals, and the time that elapses between the onset of symptoms and the fatal outcome. The majority of subjects who recover from acute myocardial infarction may be successfully rehabilitated so as to resume their previous activities. Research Two scientific groups were convened by WHO (in 1959 and 1961) to advise on needs for internationally co-ordinated research on cardiovascular diseases. In 1966, following a resolution of the Nineteenth World Health Assembly calling for a study of the modalities for further expansion of the Organization's programme in this field, the Advisory Committee on Medical Research reviewed the first five years of WHO's programme and discussed its future orientation. A total of forty-six collaborating laboratories and cardiovascular research and training centres situated in twenty-four countries have been engaged at one time or another during the decade in carrying out research projects under contractual arrangements with WHO, or with assistance provided to individual research workers. Systematic WHO-assisted epidemiological research on ischaemic heart disease and some other cardiovascular diseases was started in 1959. The programme has included selective population studies, the development of internationally accep­ table nomenclature, classification and diagnostic criteria, standardization of techniques, training and exchange of research workers, and improvement of communications. Methodological investigations carried out as a preliminary to co-operative epidemiological studies included the assessment of electrocardio­ graphic and other objective measurements such as blood pressure, serum lipids or ocular fundi, habitual physical activity or mental stress. 1 WHO also prepared a publication on methods of epidemiological studies of cardiovascular disease.2 The Organization has supported several studies on cardiovascular diseases in various population groups, including longitudinal studies of cardiovascular 1 Burgess, A. M., jr., Fejfar, Z. & Kagan, A. (1963): Arterial hypertension and ischaemic heart disease -comparison in epidemiological studies, Geneva (Reprint of a series of articles appearing in the WHO Chronicle between December 1962 and March 1963). 2 Rose, G.A. & Blackbum, H. (1968) Cardiovascular survey methods, Geneva (World Health Organi­ zation: Monograph Series) (in press). PRESIDENTS OF WORLD HEALTH ASSEMBLIES 1958-1967 Or S. A I-Wahbl, Iraq: President of the Tenth A nniversary Commemorative Session, 1958. Or Leroy E. Bumey, United States of A merica: Sir John Charles, United Kingdom of Great President of the Eleventh World Health Britain and Northern Ireland: President of t he A ssembly, 1958. Twelfth World Health A ssembly, 1959. Also Chairman of the Executive Board, twenty-flrst session, 1958; and recipient of the Uwn Bernard Medal and Prize, 1962. PRESIDENTS OF WORLD Or H. B. T urbott, New Zealand: President of Or A . L. Mudaliar, India: President of the the Thirteenth W orld Health A ssembly, 1960. Fourteenth World Health A ssembly,1961. A lso Chairman of the E)(ecutive Board, thirty- fourth and thirty-fifth sessions, 1964-1965. The late Or S. V. Kurasov, Union of Soviet Or M. A . Ma]ekodunmi, Nigeria: President of Socialist Republics: President of the Fifteenth the Slldeenth W orld Heal1h A ssembly, 1963. W orld Health A ssembly, 1962. HEALTH ASSEMBLIES Or Monawar K. Afrldi, Pakistan: Pre sident of Or V. V. Olgufn, Argentina: President of the the Seventeenth W orld Health Assembly, 1964. Eighteenth W orld Health A ssembly, 1965. Also Chairman of the Executive Board, t hirtieth and thirty-first sessions, 1962-1963; and recip­ Ient of the Darling Foundation Medal and Prize, 1964. Or A . Sauter, Switterland: President of the Or V. T. Herat Gunaratne, Ceylon: President Nineteenth W orld Health A ssembly, 1966. of the Twentieth W orld Health A ssembly, 1967. ADVISORY COMMITTEE ON MEDI CAL RESEARCH The Committee in session, June 1964. CHAIRMEN OF THE ADVISORY COMMITTEE 1959-1963 1964-1967 'I ; Or A. J . Wallgren, Emeritus Professor