Chronic disease, particularly cardiovascular disease (CVD), is the major cause of death in most developed countries (1
), despite the downward trend observed during the last three decades (3
). The risk factors for chronic disease are also well known in most industrialized countries (6
), and knowledge of risk factors has led to implementation of effective preventive programs (12
). Although CVD is emerging in developing countries, little is known about the level of CVD risk factors in these countries (14
). The problems of chronic disease are more serious for developing countries because many of them have not yet conquered communicable diseases, and their health systems are ill prepared to provide the costly care required for chronic diseases. Despite the new interest in and emphasis on public health and disease prevention in developing countries, it appears that the challenge of controlling CVD remains.
Tunisia is now facing the phenomenon of epidemiologic transition (16
): total mortality is decreasing, life expectancy is increasing, and lifestyles associated with chronic disease, particularly diabetes and CVD, are being adopted (17
). With this transition, the health care system in Tunisia is challenged with the expansion of chronic disease. Environmental and behavioral changes — such as new dietary habits, the lack of physical activity, and the stresses of urbanization and work conditions — can lead to the rise of CVD and its risk factors.
The major CVD risk factors — high blood cholesterol, high blood pressure, cigarette smoking, physical inactivity, and unhealthy diet — satisfy the public health criteria of causality (19
). In fact, strong epidemiological evidence suggests that these risk factors explain at least 75% of new cases of coronary heart disease (CHD) each year. Available evidence supports the feasibility and effectiveness of population-wide prevention programs directed toward increasing the proportion of people at low risk for CVD. The public health effort should be directed to this population-based approach (20
). Evidence shows that several risk factors and conditions are commonly associated with major chronic diseases. This means that integrated actions against selected risk factors (i.e., smoking, physical inactivity, and unhealthy diet) implemented within the social context can lead to the reduction of major chronic disease; the Countrywide Integrated Noncommunicable Diseases Intervention (CINDI) illustrates this idea at work (21
In Tunisia, a much-needed community-based intervention program to control CVD is being planned. This program will promote healthy living, smoke-free air, healthy nutrition, regular physical activity, and supportive living and working environments. Its ultimate goal is to reduce the burden of CVD.