《自然》公布第一张致命疾病研究蓝图

　　

生物通报道：来自世界上最杰出的健康科学研究的科学家们和科学组织公布了一项针对人类最致命疾病的20项重要的措施，这一首张慢性、非传染性疾病的研究蓝图将有助于指导慢性致死疾病的研究及治疗，这一“Feature”文章发表在《Nature》杂志上。

这些全球性的慢性、非传染性疾病包括心血管类疾病（主要是心脏疾病及中风），几种癌症，慢性呼吸器官疾病（chronic respiratory conditions），以及II型糖尿病。

在这篇发表《Nature》杂志上的文章，19位作者（见附录）认为慢性、非传染性疾病：

• 造成全球最大份额的死亡和伤残；
• 导致了全球60％的死亡，其中五分之四来自低收入和中等收入国家；
• 是HIV/AIDS，肺结核，疟疾，母体和peri-natal conditions和营养缺乏症死亡总数的两倍。

研究人员利用结构性consensus-building“Delphi”技术创建了“慢性、非传染性疾病的重大挑战（Grand Challenges in Chronic Non-Communicable Diseases，CNCDs）”——一项从候选人中精心挑选出来的，来自50个国家的155名成员的意见汇编而成的建议书。

作者表示，这一结果是包含20项最重要的挑战的一份权威性列表。WHO定义CNCDs为心血管疾病，II型糖尿病，慢性呼吸性疾病和某些癌症，预计消除一些关键因素（不健康饮食，不运动和抽烟）将可以组织80％的心脏病，中风和II型糖尿病，以及40％以上的癌症。这一项目的发起人表示他们的目的是“刺激健康、科学和公共团体关注这些方面”，并引起全球的讨论以及资助。

领衔参与单位包括加拿大多伦多大学和健康网络大学McLaughlin-Rotman中心（McLaughlin-Rotman Center），英国牛津健康联盟（Oxford Health Alliance），美国国立卫生研究院（the National Institutes of Health，NIH）等。

这20项重大挑战（见附录）可以归总为6个主要目的：

• 调整健康体系（比如“Allocate resources within health systems based on burden of disease”）；
• 减少贫穷和城市化带来的健康影响（比如“Study and assess how poverty increases risk factors”）；
• 组织商业行为和社团行为参与（比如“Make business a key partner in promoting health and preventing disease; Develop and monitor codes of responsible conduct with the food, beverage and restaurant industries”）；
• 缓解危险因素（比如“Deploy universally measures proven to reduce tobacco use and boost resources to implement the WHO framework Convention on Tobacco Control”）；
• 增强经济，法律和环境相关政策（比如：“Study and address the impacts of poor health on economic output and productivity”）；
• 增加公众及政治的了解程度（比如“Promote healthy lifestyle and consumption choices through effective education and public engagement”）。

CNCDs重大挑战补充了2003年，由Bill & Melinda Gates基金会等成员公布的“Grand Challenges in Human Health”，后者主要聚焦于传染性疾病，尤其是发展中国家的传染性疾病。

伊朗伊斯法罕大学医学院（Isfahan University of Medical Sciences）的Nizal Sarrafzadegan教授表示，“如果缺乏正确的行为指引，未来10年里，3亿8千8百万的人将死于CNCDs中一项或多项内容”，“通过这一协商行动，到2015年，过早死亡的数量将减少至少3千6百万——这几乎相对于加拿大，阿尔及利亚或肯尼亚的人口总数了”。

前WHO主席（慢性疾病和健康促进部门）Robert Beaglehole则针对CNCDs经济方面的影响提出，除非现在就采取重视认真的行动，否则未来十年里，中国，印度和英国由于心脏病，中风和糖尿病将分别丧失5580亿美元，2370亿美元和330亿美元。

牛津大学，牛津健康联盟主席John Bell教授也表示，“虽然这些挑战是面向所有国家的，但是不同的国家也需要结合当地的情况，这是由疾病来源和模式的不同决定的。”
（生物通：张迪）

原文摘要：
Nature 450, 494-496 (22 November 2007) | doi:10.1038/450494a; Published online 21 November 2007
Grand challenges in chronic non-communicable diseases
[Abstract]

附：
20 Grand Challenges in Chronic Non-Communicable Diseases

Goal: Raise public and political awareness

Grand Challenges

Raise the political priority of non-communicable disease;
Promote healthy lifestyle and consumption choices through effective education and public engagement;
Package compelling and valid information to foster widespread, sustained and accurate media coverage and thereby improve awareness of economic, social and public health impacts.

Research Needed to Address Goals

Study how to engage governments in partnerships for disease prevention;
Develop research activities for health that bridge government departments (e.g. transport, civic planning, health, education and environment);
Identify the reasons for low awareness and advocacy of chronic disease in societies;
Study how to create public forums that sustainably raise awareness of CNCD issues.

Goal: Enhance economic, legal and environmental policies

Grand Challenges

Study and address the impact of government spending and taxation on health;
Develop and implement local, national and international policies and trade agreements, including regulatory restraints, to discourage the consumption of alcohol, tobacco and unhealthy foods;
Study and address the impacts of poor health on economic output and productivity.

Research Needed to Address Goals

Evaluate the health impacts of agricultural policy interventions;
Study the health and economic impacts of comprehensive community-based interventions;
Create general population metrics and outcome indicators for policy and program surveillance;
Quantify impact of CNCDs on domestic economies;
Study the international ramifications of change of food and tobacco consumption;
Probe motivations behind domestic expenditures, and how these affect lifestyle choices;
Investigate the impact and effectiveness of food labeling legislation.

Goal: Modify risk factors

Grand Challenges

Deploy universally measures proven to reduce tobacco use and boost resources to implement the WHO Framework Convention on Tobacco Control;
Increase the availability and consumption of healthy food;
Promote lifelong physical activity;
Better understand environmental and cultural factors that change behaviour.

Research Needed to Address Goals

Do prospective cohort studies to identify risk factors, the magnitude of their effects, and factors that reduce risk of CNCDs;
Evaluate foetal and early life influences on chronic disease risk;
Find and evaluate new or combined medical preparations to prevent cardiovascular disease and diabetes, or reduce their morbidities;
Evaluate behavioural modifications to reduce risks;
Establish metrics, and relationships between metrics, which are culturally and ethnically specific;
Investigate cultural and ethnic variation in risk factors to refine behavioural interventions;
Quantify personal risk related to phenotypes, genotypes and multiplicative risks;
Study the interaction of environment and genes in risk factors and in outcomes;
Develop new biomarkers and diagnostics for risk and for early disease detection.

Goal: Engage businesses and community

Grand Challenges

Make business a key partner in promoting health and preventing disease;
Develop and monitor codes of responsible conduct with the food, beverage and restaurant industries;
Empower community resources such as voluntary and faith-based organizations.

Research Needed to Address Goals

Study marketing techniques and marketing data derived from commercial companies regarding behaviour modification;
Investigate mechanisms for consumers and the public to influence food industry positively;
Research the impact of taste, flavour, packaging, labeling and advertising on choice and health;
Create and evaluate community-based strategies to promote healthy living;
Identify modes of effective public/private partnerships that support health;
Develop better understanding of nutrient benefit in foods.

Goal: Mitigate health impacts of poverty and urbanization

Grand Challenges

Study and address how poverty increases risk factors;
Study and address the links between the built environment, urbanization and chronic non-communicable disease.

Research Needed to Address Goals

Investigate the biological basis of health risks related to poverty;
Examine the influence of poverty on the adoption of high risk behaviour;
Identify negative effects of economic growth on health;
Study how to work with planners, architects and city representatives to enhance the environment for healthier living.

Goal: Reorient health systems

Grand Challenges

Allocate resources within health systems based on burden of disease;
Move health professional training and practice towards prevention;
Increase number and skills of professionals who prevent, treat and manage chronic non-communicable diseases, especially in developing countries;
Build health systems that integrate screening and prevention within health delivery

Research Needed to Address Goals

Develop strategies to integrate health system management of communicable and non-communicable disease;
Form collaborations to find best practices in delivering affordable and equitable health care;
Study how to provide more structured knowledge for health-promotion;
Develop strategies to ensure that medical training and curricula focus on chronic non-communicable diseases;
Develop and provide culturally specific and nationally appropriate resources for training of health-care workers;
Study how best to ensure that disadvantaged communities have adequate resource allocations in health care and in preventative practice;
Optimise use of electronic health records for predicting disease and measuring the effect of health interventions;
Study how best to develop and establish real time surveillance tools;
Discover and develop tools for screening and stratifying populations according to risk;
Increase access to medications to prevent complications of chronic non-communicable disease.

Grand Challenges in Non-Communicable Diseases

Executive Committee

(* Denotes Nature article co-author)


Robert Beaglehole (*), former Director, WHO Department for Health Promotion, Disease Prevention, Management and Surveillance. New Zealand.


John Bell (*), Regius Professor of Medicine, University of Oxford; Chair, Oxford Health Alliance, UK


Alan Bernstein (*), President, Canadian Institutes of Health Research, Canada.


Sir Leszek K Borysiewicz (*), Chief Executive, Medical Research Council, UK


Abdallah S. Daar (*), Senior Scientist and Co-director, Program on Life Sciences, Ethics and Policy, McLaughlin-Rotman Centre for Global Health; Professor of Public Health Sciences and of Surgery, University of Toronto, Canada


Roger I. Glass (*), Director, Fogarty International Center, National Institutes of Health, USA


Jeffrey Koplan (*), Vice President for Academic Health Affairs, Emory University, USA

Scientific Board


Lucas Adetokunbo, Former Director, WB/WHO/UNDP/UNICEF Special Programme on Tropical Diseases Research and Training, Nigeria


Sir George Alleyne, Professor Emeritus, University of the West Indies, Jamaica


Stephen Colagiuri (*), Professor of Metabolic Health, University of Sydney, Australia


Diane T. Finegood (*), Scientific Director, Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes, Canada


Ray Fitzpatrick, Faculty Fellow and Dean, Professor of Public Health and Primary Care, University of Oxford, UK


Julio Frenk, Former Secretary of Health, Mexico; Bill and Melinda Gates Foundation, Mexico


Nirmal Ganguly (*), Director General, Indian Council of Medical Research, India


Harold Jaffe, Professor of Public Health, University of Oxford, UK


Stephen Leeder, Director, Australian Health Policy Institute & University of Sydney, Australia


Alan Lopez, Director, Population Health, University of Queensland, Australia


Adel Mahmoud, Professor and Senior Molecular Biologist, Princeton University, USA


David R. Matthews (*) Chairman, Oxford Centre for Diabetes, Endocrinology and Metabolism, Professor of Diabetic Medicine, University of Oxford, UK


Elizabeth G. Nabel (*) Director, National Heart, Lung, and Blood Institute, National Institutes of Health, USA


Stig K. Pramming (*) Executive Director, The Oxford Health Alliance, UK


George Sarna (*) Associate Director, Research Management Group, Medical Research Council, UK


Nizal Sarrafzadegan (*) Professor of Medicine, Isfahan University of Medical Sciences, Iran


Peter A. Singer (*) Interim Director, McLaughlin-Rotman Centre for Global Health, Toronto, Canada


Lars Rebien Sorensen Chief Executive, Novo Nordisk A/S, Denmark


Derek Yach (*), Director of Global Health Policy, PepsiCo, USA


Lap-Chee Tsui, Vice Chancellor and President, University of Hong Kong, China


Richard Smith (*), Director, Ovations Chronic Disease Initiative, Former Editor, British Medical Journal, UK.