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Submitted by Sundararajan S. Gopalan on
The Regional study on NCDs (along with a separate more detailed study on Sri Lanka) is being launched not a day too early. Strong advocacy on this issue is long overdue and we have to hope that these reports will add impetus to the recognition that communicable diseases (CDs) and MCH issues are not the only significant public health problems even in the low-income countries (LICs) of South Asia. There are lots of specific technical points related to the topic. But I would highlight just three important policy considerations: a) tackling NCDs while the CDs and MCH issues need not be a zero-sum game. Yes, additional resources would be required to carry out activities (e.g., screening for NCDs, providing long-term care and medication to keep risk factors such as cholesterol or blood sugar under control) which have traditionally been absent even in the best-designed package of "essential" health services that most LICs have been focusing on. And yes, compared with the cost of controlling infectious diseases, the NCD control and prevention costs could seem unaffordable by LICs. But if resource allocation and program implementation are done smartly, much of the systemic improvements can contribute to the control of both types of diseases. b) under-nutrition, especially in the very early ages, might well be the rallying point that links CDs and NCDs. As evidence is being increasingly reported that such under-nutrition can result in higher NCD risk in later life, we have always known the connection between under-nutrition and childhood infections. So, in light of the new recognition of the NCD burden, program managers dealing with CDs, MCH and NCDs are bound to fight over limited resources (notwithstanding the first point about this not being a zero-sum game); but addressing childhood under-nutrition is a cause that all of us can immediately agree upon. c) though certain NCDs have certain commonalities - in terms of risk factors, and strategic actions needed - it is important to recognize that NCD is a very broad-brush description of a host of very disparate conditions (ranging from cancers to cardio-vascular to endocrine disorders to injuries to mental illnesses). Therefore, while studying the NCD burden is a useful approach - especially in the context of the demographic and epidemiological transition - for enhancing awareness and aiding the necessary advocacy for policy actions, and some strategies such as tobacco control or reduction of overweight could help control more than once NCD, when it comes to specific actions, many individual NCDs will require individually tailored strategies.