Isn’t it the Time for Working on Public Health Guidance in Health System of Iran?

Considering epidemiologic and demographic transition, chronic diseases management approach has been important recently.[1] It is estimated that the aging population in the world would be increased over the next 25 years by more than 80% on which major contribution would be in the developing countries and increasing burden of diseases could be resulted.[2,3]

Nowadays, major causes of death in the world are due to cardiovascular disease, stroke, cancer, and other chronic diseases, of which 80% of the mortalities are due to these diseases occurring in low and middle-income countries.[4] Chronic diseases haven’t been concerned properly in spite of being preventable, As Horton pointed: “Many common conditions remain marginal to the mainstream of global action on health. Chronic diseases are among these neglected conditions.”[5]

The 2002 World Health Organization report titling “Reducing Risks, Promoting Healthy Life,” has stated that it must be more emphasized that prevention of major risk-factors. In order to maintain and improve health in addition to treating diseases; and the best way for this, could be coordinated efforts to identifying, reducing common risks and taking advantage of opportunities that are provided to prevention of this risk-factors.[6]

Since one risk-factor could be involved in several diseases, making intervention on that for reducing the frequency and severity of its impact, the frequency and lethality of many diseases would be reduced. For example, if the prevalence of obesity is decreased to normal level, 439,878 years, i.e., 3.1% of Disability Adjusted Life Years (DALY) s will be decreased, thus burden of ischemic heart disease 147,619 years (17.2%), knee osteoarthritis 130,555 years (44.8%), stroke 112,015 years (32.1%), diabetes 45,507 years (28.8%), colon cancer 1,452 years (6.3%) will be reduced.[7]

There is evidence on the effectiveness of preventive interventions and a significant reduction in mortality.[8–10] Empowerment of risk-factor prevention policies in a community, with emphasize on reducing burden of conditions like overweight, low physical activity, smoking, mental-health, and addiction [4,11] could be effective on community health promotion and reducing health system costs.[12,13]

With regard to increased attention to evidence-based health-care (EBHC), using guidelines for diseases prevention and treatment, which is necessary to have a specific question, critical appraisal of researches and found evidences, using expert opinions and patients’ preferences has been established in developed countries.[14]

Since assessing diseases and injuries risk-factors or interventions for omitting or modifying them must be done considering each three biologic, behavioral, and environmental aspects,[15] and it calls for a community based approach, in some developed countries actions have been started in EBHC, evidence-based public-health and public-health guidance (PHG) patterns.[16] This approach not only covers clinical medicine region but also considers other health-care providers’ performance.[17,18]

PHGs are the same as Clinical Practice Guidelines (CPGs) designed for public-health issues,[19] which includes a set of recommendations for the health-care with the aim of preventing diseases, promoting health and reducing health inequalities in community. Such guidance could affect public-health and risk-factors like smoking, drug abuse, low physical activity, nutrition, and healthy eating, etc. PHGs could be developed for different target populations.[20]

Since these guidance could help in selecting appropriate model for implementing health promotion programs, regardless of health service providers, their users could be policy makers and managers from different levels among health system.

Furthermore, in Iran, epidemiologic transition, from communicable to non-communicable diseases, change in age pyramid (decreased young population and increased middle and old age population) in addition to urbanization patterns, demonstrate that the health system delivery needs to change toward prevention instead of treatment with a community-based approach,[7] so that all sectors and departments of government should be involved to create a healthy living place to make healthy choices as the easiest one for population.[21]

Educational evidence-based medicine courses has been held in health system of Iran for ten years, after that there have been actions on developing evidence-based guidelines but not about PHGs, so there is not any Evidence-based PHGs in Iran yet.[22–24]

According to rising trend of chronic diseases and age in Iran, and possible prevention of many mortalities, morbidities, and decrease the costs due to them, spending time and attention in order to develop national PHGs should be one of the priorities in our country. Actually, if we don’t act evidence-based, what are so many preventive subject studies for?