Intended for healthcare professionals

Observations Border Crossing

Enlist the patients’ help

BMJ 2011; 343 doi: (Published 14 September 2011) Cite this as: BMJ 2011;343:d5827
  1. Tessa Richards, assistant editor, BMJ
  1. trichards{at}

Supporting people to self manage chronic disease could help reduce its global burden

Next week the United Nations will unveil its blueprint to tackle the global epidemic of chronic non-communicable disease. Its summit meeting will focus attention on rapidly rising rates of disease, which threaten economic and social development in poor countries and are putting unsustainable burdens on all countries’ health systems (BMJ 2011;343:d5762, doi:10.1136/bmj.d5762).

The UN’s initiative has provoked much debate. The decision to confine the focus to cardiovascular disease, diabetes, chronic respiratory disease, and cancer was widely criticised. Mental health should have been on the list, because it’s the coexistence of depression and fatigue that erodes patients’ quality of life and accounts for most of their loss of productivity. Obesity, musculoskeletal disorders, and neurodegenerative disease should have been included too, and more emphasis should have been put on drivers such as population ageing, malnutrition, and the wider determinants of health.

Although there has been broad consensus on the “asks” from the summit (BMJ 2011;342:d3823, doi:10.1136/bmj.d3823) and the need for multisectoral action to tackle shared risk factors, successive “tinkering” to the draft outcomes document has led to accusations that it lacks teeth, that rich countries are unwilling to help poor ones, and that the interests of transnational industries have held sway …

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