human papillomavirus, hepatitis, and helicobacter pylori that contribute to chronic disease.

Global statistics provide a window into the magnitude of the chronic disease burden worldwide, but do not reflect variations that exist across countries—especially low- and middle-income counties. Therefore, the opening session of the workshop provided an opportunity to explore the distinct conditions and capacities of six countries—Grenada, Kenya, Bangladesh, Rwanda, India (from the subnational perspective of the state of Kerala), and Chile. These economically, geographically, and demographically diverse countries illustrated the significant variations that can exist regarding the contributions of particular diseases to national chronic disease burdens, how chronic diseases fit in with other health issues, the challenges that countries face when attempting to address chronic diseases, and the degree to which countries have or are able to address these challenges. The exploration of the progress and challenges in these countries’ chronic disease efforts provided a jumping-off point to discuss the importance of local context when considering tools that might be useful to inform country-level decision making to address chronic diseases.

Dr. Lamptey explained that presenters from each of the countries were asked to describe the current national disease burden along with such relevant factors as policies, the health infrastructure, and information management systems. They were also asked to describe existing chronic disease control programs, the role of civil society, and public–private partnerships, with the goal of helping to highlight gaps in disease control efforts and opportunities for improvement.

Lamptey identified a number of specific questions for discussion:

•   Why has the public health community taken so long to move past the myth that chronic diseases are primarily problems in the industrialized world and how can the community make sure the myth no longer impedes policy or funding for combating these diseases in developing nations?

•   Why has the demand for action on chronic diseases—from donors, international institutions, national governments, and communities—been so muted?

•   How can the public health community better combat the myth that chronic diseases are difficult to prevent and expensive to treat?

•   What has prompted some countries to take significant action on these diseases and what lessons do these countries offer?

•   The WHO has proposed that the state of a country’s health services be used as a gauge of its ability to respond to chronic diseases. In some countries, HIV funding has helped to strengthen health systems in many ways, but it has neglected other elements of it. For



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