CARMEN involves a network of countries, organizations and institutions that share the common goal of reducing the burden of chronic diseases and their risk factors in the Americas. It serves as a cross-cutting initiative and intersectoral network spanning all areas of action related to chronic disease. It is the vehicle through which PAHO works to implement the four lines of action of the Regional Strategy for Chronic Diseases Prevention and Control:

• Policy and advocacy
• Health promotion (including diet and physical activity)
• Chronic disease surveillance
• Integrated management of chronic diseases

To provide a forum for sharing, learning, and collaborating among the countries of the Americas and partner organizations to reduce the burden of chronic diseases, their risk factors, and underlying determinants. For more details, see the Terms of Reference.

The interventions developed within the framework of CARMEN imply the definition of a population space (site, be it provincial or national) and the implementation of actions aimed at preventing risk factors for noncommunicable diseases. This involves implementing strategies such as integrated prevention, promotion of health equity, and demonstrative effect.

- Integrated Prevention

CARMEN advocates for integrated prevention as a central strategic component that simultaneously reduces multiple NCD risk factors at different levels. For practical purposes, an integrated intervention is one that includes the following:

Simultaneous prevention and reduction of a set of risk factors common to major NCDs. Simultaneous use of community resources and health services. Combined and balanced efforts for preventive health care and general health promotion, to enable communities to become active participants in decisions concerning their health. Strategic consensus-building among different stakeholders—such as governmental, non-governmental, and private sector organizations—in an effort to increase cooperation and responsiveness to population needs.

- Promotion of Health Equity 

Traditionally, chronic diseases have been related to high socioeconomic levels; but currently, there exists sufficient evidence to indicate that this relation has been inverted. Evidence clearly shows that the risk for some NCDs, such as cardiovascular diseases and certain forms of cancers, are higher at low socioeconomic levels, with an apparent increase of this trend in recent years.

Prevention strategies should consider such underlying influences on health inequalities as education, income distribution, public safety, housing, work environment, employment, social networks, and transportation, among others. It is important that strategies be aimed at reducing overall population risk while simultaneously reducing the gap among different population groups. In many instances, this requires redesigning and evaluating interventions of well-documented efficacy. It also entails identifying and paying special attention to key population groups, such as indigenous peoples, new urban migrants, and women.

- Demonstrative Effect

Interventions are first introduced in a demonstration area, so that acceptability and effectiveness can be measured in a given context. It is feasible to conduct evaluations by monitoring the impact of NCD risk factors, morbidity, and mortality.

In this context, the demonstrative effect measures whether the risk factors and mortality from corresponding noncommunicable diseases have been modified, and whether the observed changes have occurred within a logical time sequence with regard to the interventions. For practical purposes, it is necessary to

  - have a basal measurement that allows for later comparisons; 

  - have a surveillance system of mortality and risk factors; and 

  - make systematic collections of information related to the intervention, in order to evaluate its development.

Partnerships with academic centers are highly encouraged in order to strengthen evaluation and participation in international research training activities.

Protocol and Guidelines. Countrywide Integrated Noncommunicable Diseases Intervention (CINDI)

CARMEN Documents

English 

CARMEN Brochure

English 

Joining the CARMEN Network

English