{"id":48605,"date":"2020-09-20T20:29:46","date_gmt":"2020-09-20T19:29:46","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48605"},"modified":"2020-09-20T20:29:46","modified_gmt":"2020-09-20T19:29:46","slug":"we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/","title":{"rendered":"We should consider prevention burden in our approach to tackling NCDs"},"content":{"rendered":"

Non-communicable diseases (NCDs) and multimorbidity (the presence of two or more chronic conditions) are increasing globally.<\/span>1<\/sup><\/span> While newer lifestyle-related risk factors are emerging,<\/span>2<\/sup><\/span> the prevention of major NCDs often focuses on four modifiable risk factors: smoking, obesity, low physical activity and alcohol.<\/span>3<\/sup><\/span> These cluster within individuals and communities and, like multimorbidity, are concentrated among the most socioeconomically deprived where they exert greater levels of risk.2 <\/sup><\/span>Guidelines focus on lifestyle-related risk factor reduction, encouraging healthcare professionals to promote behaviour change.4<\/sup><\/span> We believe this fails to recognise the burden placed on the people asked to make changes, especially those with multiple risk factors and\/or multimorbidity, and downplays the influence of wider contextual factors. This has become even more pressing during the covid-19 pandemic, with higher risks associated with socioeconomic deprivation, ethnicity and obesity,5<\/sup><\/span> and attempts to suggest that “healthier lifestyles” may offer some protection against covid-19.<\/span><\/p>\n

There are two important considerations. Firstly, individualised approaches to behaviour change rarely address the wider social determinants of people\u2019s health such as poverty, unemployment, stigma and discrimination. Secondly, there is an over-simplified distinction between “upstream” social determinants of health and “downstream” individual characteristics and behaviours.6<\/sup><\/span> Upstream social, cultural, environmental and political factors shape the behaviours and practices of individuals, placing individuals and healthcare professionals in positions of tension between upstream contextual and downstream individual pathways to (ill) health.<\/span><\/p>\n

Acknowledging these tensions, we should consider our approach to tackling risk factors for NCDs. One approach would be to look at <\/span>prevention burden.<\/span><\/i> Prevention burden<\/span><\/i> stems from an understanding of <\/span>treatment burden:<\/span><\/i> the workload and demands experienced by patients, families and carers, when managing NCDs and the role that individual capacity plays in tackling these demands.7,8<\/sup><\/span><\/p>\n

Public health messages, campaigns and interventions aimed at modifying health-related behaviour to prevent NCDs, impose burdens on individuals, who will vary in their capacity to respond. Health promotion, and associated behaviour change, is often framed as an individual responsibility.9<\/sup><\/span> Where approaches do consider wider upstream determinants, these are often seen as simply limiting or determining behaviour, rather than seeking to understand how an individual\u2019s contextual situation shapes their capacity to address behaviour change.10<\/sup><\/span> The long term burden of sustaining behaviour change in the face of difficult life circumstances is also insufficiently acknowledged.<\/span><\/p>\n

Addressing <\/span>prevention burden<\/span><\/i> means acknowledging and dealing with issues at multiple levels.\u00a0<\/span><\/p>\n

Firstly, we need to consider individual factors. We suggest that prevention burden arises when there are multiple potential targets for change, for example, reducing alcohol intake alongside increasing physical activity, interacting with an individual\u2019s personal and social circumstances. For those with limited capacity, having multiple health-related targets may be overwhelming and a barrier to addressing any risk factors.<\/span><\/p>\n

Secondly, we need to consider social practices and cultural norms. Health behaviours are not simply individual decisions, but a complex interplay between individual agency and the context of people\u2019s lives.11,12 <\/sup><\/span>Changing behaviour requires changing established practices and habits, often with social and cultural implications. This exerts an additional burden on individuals, which may be overlooked by a more simplistic focus on individual behaviour.<\/span><\/p>\n

Finally, <\/span>s<\/span>ocietal and structural factors have an impact. Clustering of risk factors and multimorbidity in areas of socioeconomic deprivation means people are also more likely to experience financial and practical barriers to addressing health behaviour change.13<\/sup><\/span> This may be most marked for people experiencing multiple disadvantages, for example, homelessness people or asylum seekers.\u00a0<\/span><\/p>\n

In response to the challenge of prevention burden, we suggest that healthcare professionals should establish individual priorities with patients. Discussion of behaviour change should incorporate the principles of shared decision-making while understanding patient capacity, with recommendations tailored to an individual\u2019s circumstances and priorities.<\/span><\/p>\n

We should consider<\/span> practices rather than individual behaviours. Healthcare professionals and systems should see risk factors as part of complex social practices. Instigating and maintaining change therefore goes beyond personal motivation to encompass social practices and networks.<\/span><\/p>\n

Socio-cultural factors should be seen as aspects of the wider context in which any intervention takes place. Socioeconomic, cultural, environmental and political factors impact on an individual\u2019s capacity to enact change. Understanding and supporting individual capacity is vital if change is to be sustained.<\/span><\/p>\n

Finally we need to confront structural barriers. Systems and structures, including fiscal and environmental factors, can act as barriers to effective engagement in preventive strategies and addressing risk factors. Social or cultural groups at the margins of society may be particularly vulnerable to structural barriers, such as policies to reduce benefits provision or access to healthcare. It is incumbent upon all those involved in healthcare to recognise and challenge these barriers.<\/span><\/p>\n

Healthcare systems and professionals should consider prevention burden if we aim to support behaviour change and address risk factor reduction without further widening inequalities in health. Acknowledging that risk factor reduction must take account of individual capacity and requires tangible work by individuals is the first step<\/span>. <\/span><\/i>To make a difference it is essential that policies and service provision acknowledge prevention burden, ensure health promotion activities are better tailored to meet the needs of diverse populations and are targeted proportionately at those in areas of greatest need. In this new world, where we learn to live with NCDs, multimorbidity and covid-19, such an approach is needed now more than ever.<\/span><\/p>\n

Catherine O\u2019Donnell<\/strong> is Professor of Primary Care R&D and a primary care scientist, University of Glasgow, UK. @odo_kate<\/a><\/span><\/em><\/p>\n

Peter Hanlon<\/strong> is an MRC Clinical Research Training Fellow and General Practitioner, University of Glasgow, UK. @PHanlon17<\/a><\/span><\/em><\/p>\n

David Blane<\/strong> is a Clinical Research Fellow and General Practitioner, University of Glasgow, UK. @dnblane<\/a><\/span><\/em><\/p>\n

Sara Macdonald<\/strong> is a Senior Lecturer in Primary Care and a sociologist, University of Glasgow, UK. @SaraMacdonald13<\/a><\/span><\/em><\/p>\n

Andrea Williamson<\/strong> is a Senior Clinical University Lecturer, University of Glasgow, UK. @aewilliamsonl<\/a><\/span><\/em><\/p>\n

Frances Mair<\/strong> is the Norie Miller Professor of General Practice, University of Glasgow, UK. @FrancesMair<\/a><\/span><\/em><\/p>\n

All authors have long-standing interests in the care of patients living in marginalised situations and the impact of social determinants of health on health and wellbeing and the organisation of health care.<\/span><\/em><\/p>\n

References:<\/strong><\/p>\n

    \n
  1. The Academy of Medical Sciences. Multimorbidity: A priority for global health research. London, 2018.<\/span><\/li>\n
  2. Foster HME, Celis-Morales CA, Nicholl BI, et al. The effect of socioeconomic deprivation on the association between an extended lifestyle score and health outcomes in the UK Biobank cohort. <\/span>The Lancet Public Health<\/span><\/i> 2018;3:e756-e85.<\/span><\/li>\n
  3. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: WHO, 2013.<\/span><\/li>\n
  4. Piepoli MF, Hoes A, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). <\/span>European Heart Journal<\/span><\/i> 2016;37(29):2315-81. doi: 10.1093\/eurheartj\/ehw106<\/span><\/li>\n
  5. Public Health England. COVID-19: review of disparities in risks and outcomes. London: Public Health England, 2020.<\/span><\/li>\n
  6. Rutter H, Bes-Rastrollo M, de Henauw S, et al. Balancing upstream and downstream measures to tackle the obesity epidemic: A position statement from the European Association for the Study of Obesity. <\/span>Obesity Facts<\/span><\/i> 2017;10(1):61-63. doi: 10.1159\/000455960<\/span><\/li>\n
  7. May C, Montori VM, Mair FS. We need minimally disruptive medicine. <\/span>BMJ<\/span><\/i> 2009;339:b2803.<\/span><\/li>\n
  8. Mair FS, May CR. Thinking about the burden of treatment. <\/span>BMJ<\/span><\/i> 2014;349:g6680. doi: 10.1136\/bmj.g6680<\/span><\/li>\n
  9. Kwasnicka D, Dombrowski SU, White M, et al. Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. <\/span>Health Psychology Review<\/span><\/i> 2016;10(3):277-96. doi: 10.1080\/17437199.2016.1151372<\/span><\/li>\n
  10. Holman D, Lynch R, Reeves A. How do health behaviour interventions take account of social context? A literature trend and co-citation analysis. <\/span>Health<\/span><\/i> 2018;22(4):389-410. doi: 10.1177\/1363459317695630<\/span><\/li>\n
  11. Blue S, Shove E, Carmona C, et al. Theories of practice and public health: understanding (un)healthy practices. <\/span>Critical Public Health<\/span><\/i> 2016;26(1):36-50. doi: 10.1080\/09581596.2014.980396<\/span><\/li>\n
  12. Maller CJ. Understanding health through social practices: performance and materiality in everyday life. <\/span>Sociology of Health & Illness<\/span><\/i> 2015;37(1):52-66. doi: doi:10.1111\/1467-9566.12178 <\/span><\/li>\n
  13. 13. Raphael D, Daiski I, Pilkington B, et al. A toxic combination of poor social policies and programmes, unfair economic arrangements and bad politics: the experiences of poor Canadians with Type 2 diabetes. Critical Public Health<\/i> 2012;22(2):127-45. doi: 10.1080\/09581596.2011.607797<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Non-communicable diseases (NCDs) and multimorbidity (the presence of two or more chronic conditions) are increasing globally.1 While newer lifestyle-related risk factors are emerging,2 the prevention of major NCDs often focuses […]<\/p>\n

    More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":48372,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-48605","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers"],"yoast_head":"\nWe should consider prevention burden in our approach to tackling NCDs - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"We should consider prevention burden in our approach to tackling NCDs - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Non-communicable diseases (NCDs) and multimorbidity (the presence of two or more chronic conditions) are increasing globally.1 While newer lifestyle-related risk factors are emerging,2 the prevention of major NCDs often focuses [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2020-09-20T19:29:46+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/population_england_london_PA-54240775.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"540\" \/>\n\t<meta property=\"og:image:height\" content=\"350\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"We should consider prevention burden in our approach to tackling NCDs\",\"datePublished\":\"2020-09-20T19:29:46+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/\"},\"wordCount\":1356,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/08\\\/population_england_london_PA-54240775.jpg\",\"articleSection\":[\"Guest writers\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/\",\"name\":\"We should consider prevention burden in our approach to tackling NCDs - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/08\\\/population_england_london_PA-54240775.jpg\",\"datePublished\":\"2020-09-20T19:29:46+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/08\\\/population_england_london_PA-54240775.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/08\\\/population_england_london_PA-54240775.jpg\",\"width\":540,\"height\":350,\"caption\":\"Saturday afternoon shoppers, some wearing face masks, walk along along Oxford Street in London, England, on June 20, 2020. Today has been the first Saturday of high street shopping since non-essential retail stores across England were allowed to reopen last week, having been closed under the coronavirus lockdown for nearly three months. Yesterday, monthly retail sales data from the UK's Office for National Statistics (ONS) revealed the beginnings of a rebound during May, with a 12 percent recovery from record falls in April, but sales nonetheless remained 13 percent below February's pre-pandemic total. Retail sales figures for June, taking into account this month's reopening of the sector, will be published by the ONS on July 24. (Photo by David Cliff\\\/NurPhoto)\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/09\\\/20\\\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"We should consider prevention burden in our approach to tackling NCDs\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"We should consider prevention burden in our approach to tackling NCDs - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/","og_locale":"en_US","og_type":"article","og_title":"We should consider prevention burden in our approach to tackling NCDs - The BMJ","og_description":"Non-communicable diseases (NCDs) and multimorbidity (the presence of two or more chronic conditions) are increasing globally.1 While newer lifestyle-related risk factors are emerging,2 the prevention of major NCDs often focuses [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2020-09-20T19:29:46+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/population_england_london_PA-54240775.jpg","type":"image\/jpeg"}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"7 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"We should consider prevention burden in our approach to tackling NCDs","datePublished":"2020-09-20T19:29:46+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/"},"wordCount":1356,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/population_england_london_PA-54240775.jpg","articleSection":["Guest writers"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/","url":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/","name":"We should consider prevention burden in our approach to tackling NCDs - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/population_england_london_PA-54240775.jpg","datePublished":"2020-09-20T19:29:46+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/population_england_london_PA-54240775.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/population_england_london_PA-54240775.jpg","width":540,"height":350,"caption":"Saturday afternoon shoppers, some wearing face masks, walk along along Oxford Street in London, England, on June 20, 2020. Today has been the first Saturday of high street shopping since non-essential retail stores across England were allowed to reopen last week, having been closed under the coronavirus lockdown for nearly three months. Yesterday, monthly retail sales data from the UK's Office for National Statistics (ONS) revealed the beginnings of a rebound during May, with a 12 percent recovery from record falls in April, but sales nonetheless remained 13 percent below February's pre-pandemic total. Retail sales figures for June, taking into account this month's reopening of the sector, will be published by the ONS on July 24. (Photo by David Cliff\/NurPhoto)"},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/20\/we-should-consider-prevention-burden-in-our-approach-to-tackling-ncds\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"We should consider prevention burden in our approach to tackling NCDs"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmj\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/48605","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=48605"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/48605\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media\/48372"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=48605"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=48605"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=48605"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}