CARMEN is a network of countries, organizations and institutions that share the common goal of reducing the burden of noncommunicable diseases and their risk factors through a multidimensional approach focusing on prevention and integrated management of non-communicable diseases (NCDs).

CARMEN stands for “Collaborative Actions for Risk Factor Prevention and Effective Management of Noncommunicable Diseases.” To find out more about the CARMEN network click here:

At the regional and subregional levels, the CARMEN initiative aims to:

• • Support the implementation of the Regional Strategy and Plan of Action on an Integrated Approach to the Prevention and Control of Chronic Diseases;
• • Serve as the principal agent to collect, analyze and disseminate information and share knowledge about the chronic disease problem and successful strategies for the formulation, execution, and evaluation of NCD policies and programs;
• • Promote best practices in health promotion and integrated prevention and control of chronic non communicable diseases;
• • Promote and support community participation in chronic disease prevention and control;
• • Stimulate and facilitate collaboration and networking among PAHO Member States, organizations, and institutions;
• • Coordinate actions with related WHO and PAHO initiatives and networks such as Healthy Municipalities, Healthy Schools, WHO Global Forum and similar initiatives in other regions (e.g. IMAN, MOANA, CINDI, SEANET);
• • Integrate the initiative with related resolutions from the PAHO Directing Council and the WHO World Health Assembly.

At the country level, the CARMEN Initiative aims to:

• • Raise political support and demonstrate commitment for the prevention of NCDs, their risk factors and determinants as a national public health priority;
• • Foster inter-institutional and intersectoral actions and create multidisciplinary teams to carry out the strategies for health promotion and integrated prevention and control of chronic non communicable diseases;
• • Conduct a situation analysis of NCDs and their risk factors and periodic monitoring, according to the abilities of each country;
• • Establish demonstration sites for interventions for the prevention and control of chronic diseases;
• • Implement the recommendations for Member States contained in the Regional Strategy and Plan of Action on an Integrated Approach to the Prevention and Control of Chronic Diseases;
• • Support the establishment of various networks (such as nutrition, physical activity, diabetes, etc) for sharing experiences and collaboration within countries.

Who is involved in the CARMEN network?

The CARMEN Network is a vital and inclusive network composed of: PAHO Member States with representation from the Ministry of Health programs on chronic diseases; partner organizations, institutions, and networks both within and outside of the health sector; and PAHO/WHO as the secretariat.

The Biennial Meeting of the CARMEN Network has been held since 1999, where members unite to examine progress, share experiences and stimulate adoption of new strategies to address NCDs.

Why a network for chronic diseases?

• • Networking achieves what individual countries may not be able to do alone, and:
• • Country initiatives can gain peer recognition and international credibility.
• • Countries can pursue common goals as a unified group.
• Innovative designs, implementation, and evaluation tools are more accessible for communities and countries.
• • The networking facilitates exchange of experiences and information on technical and management issues, plans cooperative ventures, and launches new activities.
• • The CARMEN Network is an arena where continuous improvements in integrated NCD prevention can be achieved.

What are the CARMEN strategies?

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 non-communicable 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 non-communicable 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.
• Additional CARMEN documents:

The CARMEN Initiative