摘要：Objectives. We sought to outline the framework and methods used by the World Health Organization (WHO) STEPwise approach to noncommunicable disease (NCD) surveillance (STEPS), describe the development and current status, and discuss strengths, limitations, and future directions of STEPS surveillance. Methods. STEPS is a WHO-developed, standardized but flexible framework for countries to monitor the main NCD risk factors through questionnaire assessment and physical and biochemical measurements. It is coordinated by national authorities of the implementing country. The STEPS surveys are generally household-based and interviewer-administered, with scientifically selected samples of around 5000 participants. Results. To date, 122 countries across all 6 WHO regions have completed data collection for STEPS or STEPS-aligned surveys. Conclusions. STEPS data are being used to inform NCD policies and track risk-factor trends. Future priorities include strengthening these linkages from data to action on NCDs at the country level, and continuing to develop STEPS’ capacities to enable a regular and continuous cycle of risk-factor surveillance worldwide. The global burden of chronic, noncommunicable diseases (NCDs)—largely heart disease, stroke, cancer, chronic respiratory disease, and diabetes—is increasing rapidly and will have significant social, economic, and health consequences unless urgently addressed. In 2012, the major NCDs accounted for 63% of all deaths, representing 38 million deaths a year. Eighty percent of these deaths are already occurring in low- and middle-income countries. 1 Because NCDs are largely preventable, these deaths can be significantly reduced. To address this global health problem, in 2013, the World Health Assembly—the decision-making body of the World Health Organization (WHO)—adopted a Global Monitoring Framework for NCDs with 25 key indicators to track progress in prevention and control of NCDs. The World Health Assembly also agreed on a set of global voluntary targets linked to the Global Monitoring Framework to prevent and control NCDs by 2025, including a target to reduce premature mortality from the 4 main NCDs by 25%, and targets for the main behavioral and metabolic NCD risk factors and 2 health systems targets. 2 Furthermore, in 2015, the 2030 Agenda for Sustainable Development recognizes the importance of addressing NCD issues with the inclusion of a similarly ambitious target to reduce the number of premature deaths from NCDs by one third by 2030. 3 The key to controlling the global epidemic of NCDs and meeting these ambitious but achievable NCD targets is primary prevention based on comprehensive population-wide programs. Effective prevention of NCDs is possible through identification of the major common risk factors and their prevention and control. 4–6 A few common and preventable risk factors underlie most NCDs. These NCD risk factors are the leading cause of the death and disability burden in all countries, regardless of their economic development status. The leading behavioral risk factors for NCDs are tobacco use, harmful alcohol consumption, unhealthy diet including high salt and sodium intake, physical inactivity, and overweight and obesity, and the leading physiological risk factors are raised blood pressure, raised blood glucose, and abnormal blood lipids. 7,8 Recognizing a global need for risk-factor data on these key NCD risk factors, WHO initiated the STEPwise approach to surveillance (STEPS) in 2002. The key goals of STEPS are to guide the establishment of risk-factor surveillance systems in countries by providing a framework and approach; to strengthen the availability of data to help countries inform, monitor, and evaluate their policies and programs; to facilitate the development of population profiles of NCD risk-factor exposures; to enable comparability across populations and across time frames; and to build human and institutional capacity for NCD surveillance. 9,10 Since its inception, the STEPS approach has advocated that small amounts of good-quality data are more valuable than large amounts of poor-quality data. 10 The STEPS approach supports monitoring a few modifiable NCD risk factors that reflect a large part of the future NCD burden and that can indicate the impact of interventions considered to be effective in reducing the leading NCDs. Because STEPS also promotes the collection of data on a number of different risk factors, it has the benefit over single risk factor surveys in that it allows an understanding of how risk factors cluster within a population and offers an opportunity for countries to estimate the small proportion of the population with high overall risk of a cardiovascular event for referral for possible treatment. 9,10 Our objective was to outline the framework and methods used by STEPS, to describe the development and current status of STEPS, to discuss the strengths and limitations of STEPS surveillance, and to highlight future directions.
