Strengthening primary health care to reduce NCD burden in the Americas

The Pan American Journal of Public Health, the scientific publication of the Pan American Health Organization (PAHO), recently published a special issue dedicated to strengthening primary health care to address noncommunicable diseases (NCDs) in the Americas.

NCDs—including cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases—are the leading cause of death in the Americas, causing 6 million deaths in 2021, nearly four out of ten of which were premature, affecting people under 70 years of age.

In addition, it is estimated that more than 250 million people in the Americas are living with an NCD and require ongoing care to better manage their condition. Evidence shows that NCDs can be effectively controlled and quality of life improved, and that a significant portion of premature deaths could be prevented through more accessible, effective, and higher-quality primary care services.

This special issue documents, through a series of scientific articles, the progress, challenges, and lessons learned from initiatives led by ministries of health, academic institutions, civil society organizations, and PAHO to improve the screening, diagnosis, treatment, and management of NCDs at the primary care level.

A central focus is PAHO's Better Care for NCDs initiative, which includes the HEARTS initiative and has contributed to improved management of hypertension and other NCDs in primary care across multiple countries in the region. The articles show that investing in primary care for NCDs is a feasible, necessary, and cost-effective strategy, and a key component in achieving the Sustainable Development Goal (SDG) of reducing premature NCD mortality by one-third by 2030.

The special issue, supported financially by the Government of Denmark through WHO, brings together studies and experiences from Argentina, Bolivia, Brazil, Chile, Peru, and Trinidad and Tobago. Topics include implementation of clinical guidelines, integrated care models, and the influence of social determinants on treatment adherence, highlighting the importance of a person- and community-centered approach.

Highlighted articles from the special issue

Articles are being published progressively and in the language in which they were submitted (Spanish, English, and/or Portuguese). Some of the contributions include:

• Editorial by the Director of PAHO: Accelerating the integration of noncommunicable diseases into primary health care
• Bolivia: Special report on the status of essential conditions for NCD care in the Bolivian Chaco
• Argentina: Study on the use and knowledge of clinical practice guidelines for NCDs
• Chile: Research on social determinants of treatment adherence among users of the primary care cardiovascular health program
• Peru: Analyses of HEARTS implementation experiences, including the ANDES trial in Puno and studies on cardiometabolic screening in Amazonian populations
• Brazil: Research on the implementation of hypertension and diabetes care pathways and the role of nursing staff in managing chronic NCDs
• Trinidad and Tobago: Cross-sectional study evaluating hypertension control using the HEARTS approach in primary care