<International Circulation>:  Have you seen any exemplary newer healthcare systems in or outside of the developing world that are really concentrating on both prevention and treatment?
　　Dr Smith: The discussions I hear are that in China they are really going to start focusing on hypertension and smoking as preventative measures. Kaiser in the United States has a focus on the importance of prevention in their enrolment programs. There is one very well-known cardiologist in the United States whose famous question for medical students is “What do doctors do?” The answer that he is looking for to that is， doctors do what they get paid to do just like everyone else. What he is stimulating is a discussion about how the healthcare system needs to evolve to the point where you earn your living by reading tests and doing procedures with much less reward than some of the cognitive issues that focus on patients. Do all preventative interventions need to be done by a doctor? One of my research projects now in China is looking at the use of nurses in the team and how that usage is not as high as in the United States. I have quickly come to understand that a nurse is not a nurse is not a nurse at the educational level. The educational level of nurses in the United States is higher than those involved in nursing in China. The project underway is looking at four groups of eight hospitals and will be finished by the end of next year. The question is that if you involve the nurses in the team and their function is to be sure the patients understand the medications they take: one group of nurses is to continue doing business as usual; another group of nurses gives the patient the form; the third group of nurses is actually educated about why the patient should be taking aspirin， statins and so forth; and in the fourth group the nurses are going to be educated in relevant topics and be issuing the patient the form. If you want to increase compliance with a patient and you feel that the nurses’ exposure is as part of the team， does the nurse have to be fully educated or just be able to give out a form or both? I think it is really innovative project. When the results are turned in to the Ministry of Health and there is some discussion about developing teams， it becomes a lot more powerful when you realize that the UN and WHO are in the game. These bodies want to do something about heart disease; and that is really big when the endorsement of the United Nations is behind you.
　　<International Circulation>: The WHF was instrumental in making that happen I understand. What did it take to get the United Nations involved in NCDs?
　　Dr Smith:  The cry came from CARICOM in the Caribbean. They are small; they are not a heavy hitting superpower that stood up and said do this. This collective of small nations and dependencies made the point that they were being ravaged by heart disease and cancer and diabetes. That got the United Nations on side and very quickly we were able to form the NCD Alliance. The NCD Alliance is the four major international groups: the World Heart Federation， the UICC， the International Diabetes Federation， and the Union (a lung disease group). It quickly grew to over a thousand members who were showing up and advocating at the UN Meetings. Several of us went and spoke at the meeting in Russia in April last year attended by Vladimir Putin， the US Secretary of Health， Kathleen Sebelius and ninety-five Health Ministers. There was another meeting of the UN in June and then the big meeting in September when they agreed to do something. I would say that the collective pressure from the NCD Alliance was helpful in advocating this but the original cry went up from the Caribbean islands. We had a meeting yesterday and the Board is made up of the intercontinental societies and representatives from the international foundations and the incoming Vice-President， who is from Jamaica and former President of the Inter-American Foundations， spoke about what it was like to get the signal and advance it and push it to spark the fire. I wanted her to do that because I wanted people to understand that it appears that if you are vigorous enough and you have the right message， it doesn’t matter how big you are， you can get something done. I think continued advocacy is going to be very important.