Prevention research plays a crucial role in data gathering, and developing best practices and strategies for fighting one of the biggest issues in global health today – the epidemic of non-communicable diseases (NCDs). In this month’s blog, Vasilka Lalevska reflects on how, why and when prevention research matters in this context.
Part of my daily work is to speak about NCDs through the lens of representing the views of people living with NCDs. When I speak about what I do, I frequently get the question ‘Wait, what are NCDs?’. And it is interesting that the awareness of the term NCDs is different from the awareness on cancer, diabetes, psoriasis, cardiovascular diseases, individually. All of them, and more – are NCDs.
‘NCDs’ stands for diseases that are chronic (long lasting), non-communicable (cannot be transmitted from person to person), and are a result of genetic, physiological, environmental and behavioral factors.
It was exciting to be in Geneva during the 71st World Health Assembly at the end of May, where a lot of the discussions and events addressed non-communicable diseases (NCDs). NCDs have evolved into one of the largest challenges in global health today, and for good reason.
– NCDs leave a massive footprint – they are responsible for an equivalent of 70% of deaths globally
– NCDs are disproportional – they affect people from low and middle-income countries disproportionally more than the rest
– NCDs go beyond health – NCDs are chronic in nature and living with an NCD can go beyond healthcare – to relations with family and friends, productivity, finances, quality of life, and ultimately – happiness! For example, according to the World Psoriasis Happiness Report, people living with NCDs, such as psoriasis, are less happy than the rest of the population, while also being more lonely, depressed and anxious.
How the world reacts to NCDs
The paradox of NCDs is that, despite their devastating impact, they can also be largely preventable. This factor, combined with the growing impact of NCDs, has been driving both the United Nations and the World Health Organization, together with governments, civil society, private sector, think-thanks and more, to make NCDs a priority in national health policies.
The Sustainable Development Goals (SDGs) include a specific goal on health (Goal 3), and a specific target for NCDs (3.4). However, progress on this has varied and with the current tempo – the world will not be able to meet the indicator of reducing the premature mortality from NCDs by one third.
Additionally, the 66th World Health Assembly endorsed the WHO Global Action Plan on the Prevention and Control of NCDs 2013-2020, to help in strengthening the national efforts on reacting to NCD. This plan includes a set of policy options, which when implemented, would accomplish to nine voluntary targets. Similarly to the SDGs, when analyzed, implementation varies.
I believe that two key factors are responsible for the varying implementation of these bold global commitments:
– Lack of coherence and alignment – too many policies on different levels that are unrelated with each other. Global challenges such as NCDs do not benefit from ‘wearing different hats,’ as it is the same governments (and sometimes even people) that commit to the SDGs, regional works, and national targets. The three need to be aligned in the interest of effect, resources and time.
– Lack of priorities in research – there is limited direction in how research methods can be most effective, which is needed if a positive change in NCD prevalence and mortality is to be achieved. The World Health Organization (WHO) could be an important actor in setting these priorities, and bringing coherence among research projects and initiatives at all levels.
Where research meets policy
The current WHO Global Action Plan focuses on four main NCDs – cardiovascular diseases, cancer, diabetes and respiratory diseases. At the same time, it focuses on four main risk factors – tobacco and alcohol use, physical activity and diet. The specific area of the plan that references the risk factors is in Appendix III, which lists a number of ‘best buy’ policy options for Governments to implement that would help prevent and control NCDs. How do these policy options come to life? Through gathering and evaluating research, according to specific criteria and scope!
While I am convinced that there are more than four factors and more than four NCDs that need to be included in the Plan, I also believe that the list of recommendations needs to be extended and enriched with new, innovative and effective measures, based on research that comes from the same mindset.
In 2020, the Global Action Plan expires, and at this point we can see it as a window of opportunity. 2018 and 2020 are key years for prevention researchers to keep an eye on new developments, a new Plan, and a new chance to keep the SDG target in scope.
On September 27th, 2018, the 3rd High-Level meeting on NCDs will take place in New York. This wil probably be the last occasion to directly address these issues ahead of 2020. What matters to the future of NCD will be determined there, so we need to keep watching!