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Preventing non-communicable diseases through structural changes in urban environments
  1. Manuel Franco1,2,
  2. Usama Bilal1,2,
  3. Ana V Diez-Roux3
  1. 1Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcala, Madrid, Spain
  2. 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Department of Epidemiology, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Manuel Franco, Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcala, Madrid 28871, Spain; mfranco{at}

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The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart. Rose1To achieve [a reduction in overweight and obesity] is perhaps the major public health and societal challenge of the century. Potential strategies include [….] redesign of built environments to promote physical activity, changes in food systems, restrictions on aggressive promotion of unhealthy drinks and foods to children and economic strategies such as taxation. Willet2

Non-communicable diseases (NCDs)—mainly cancers, cardiovascular diseases (CVDs), diabetes and chronic respiratory diseases—are the main causes of death and morbidity worldwide.3 NCDs are now annually responsible for more than 35 million deaths in the world with more than 80% of this disease burden occurring in low-income and middle-income countries.4 At the same time, NCDs are highly preventable by means of effective preventive interventions tackling shared behavioural risk factors such as unhealthy diets, harmful use of alcohol, tobacco use and physical inactivity.5

Efforts to prevent NCDs have historically included strategies to target high-risk individuals, which have shown, especially in the case of obesity and diabetes, poor results.6 ,7 To advance the prevention of NCDs, population-wide understanding of these shared risk factors and morbidity remains crucial. The population approach to prevent NCDs, articulated by Rose1 in his article Sick individuals and sick populations, aims at shifting the distribution of its risk factors for the whole population, therefore affecting everyone regardless of their risk. Rose highlighted the need to measure and understand factors related to interpopulation differences in the distribution of risk factors (social phenomena and social determinants or environmental factors), instead of focusing on factors related to interindividual differences within a population (classic behavioural risk factors and genetics). The population …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.