MedCHAMPS: mediterranean studies of cardiovascular disease and hyperglycaemia: analytical modelling of population socio-economic transitions

This supplement focusses on the MedCHAMPS project (Mediterranean studies of cardiovascular disease and hyperglycaemia: analytical modelling of population socioeconomic transitions, http://research.ncl.ac.uk/medchamps/). MedCHAMPS was a European Commission funded research project involving institutions from North Africa and the Middle East (occupied Palestinian territory, Syria, Tunisia and Turkey). It aimed to make recommendations about policy initiatives likely to be the most cost-effective in reducing the burden of cardiovascular diseases (CVD) and diabetes. The project developed a conceptual framework, the policy effectiveness and feasibility loop (Bowman et al. 2012; Maziak et al. 2013), specifically designed to encourage the use of evidence in forming healthy public policies. The major components were qualitative situational analysis, epidemiological modelling including cost-effectiveness analyses (Abu-Rmeileh et al. 2012, 2013; Rastam et al. 2012; Al Ali et al. 2013; Saidi et al. 2013; Unal et al. 2013; Mason et al. 2014), and option appraisal. Three papers in this supplement illustrate key results of epidemiological modelling and cost-effectiveness analyses. The first described worrying adverse risk factor trends in each country studied. Mean body mass index (BMI) and diabetes prevalence were increasing steadily and smoking prevalence remained very high in men. A second paper applied the diabetes ‘‘IMPACT’’ model, a tool developed specifically for this research project, in Turkey. Adverse trends in major diabetes risk factors (BMI), in conjunction with population growth and ageing, could result in an increase in diabetes prevalence from 7 % in 1997 to 31 % by 2025 in Turkey. These epidemiological models identified possible targets for intervention which included reducing dietary salt intake. A third paper, building on an initial comparative analysis (Mason et al. 2014) estimated the cost-effectiveness of possible interventions to reduce dietary salt intakes in Syria. These included health promotion campaigns, labelling of salt content on packaged foods, and reformulation of salt content within processed foods. All were deemed potentially cost-effective, particularly salt labelling and reformulation. The other key, qualitative, strand included (1) a situation analysis of current CVD and diabetes policies, and (2) a contextual analysis of the ways in which healthcare systems managed CVD and diabetes. Research was designed around three distinct ‘levels’ of data collection: document analysis; key informant interviews; and clinic fieldwork. A particular challenge was that qualitative research was relatively new to these countries. We believe these papers are among the first to apply qualitative methods to assessing health systems and services in this region. Three of the four qualitative papers in this supplement—from Tunisia, Turkey and Syria—discuss the healthcare system problems of managing diabetes and CVD. The fourth—from Tunisia— This Editorial is part of the supplement ‘‘The rising burden of noncommunicable diseases in four Mediterranean countries and potential solutions’’.