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The cat is out of the bag: UN summit on NCDs

Patricio V. Marquez's picture

As a World Bank staff member, I feel privileged to have participated in two landmark global public health events.

In June 2001 at a UN General Assembly Special Session, world leaders collectively acknowledged—for the first time—that a concerted global response was needed to arrest the HIV/AIDS pandemic. This led to the establishment of the Global Fund and bilateral initiatives such as PEPFAR, which helped fund a scaled-up response to HIV/AIDS, as well as to malaria and tuberculosis. The net result for the most part has been impressive: a dramatic expansion in access to treatment that has saved millions of lives, a significant reduction in the vertical transmission of HIV (mother to child), technological progress resulting in cheaper, more effective treatments, and better knowledge about HIV transmission to guide prevention efforts—while highlighting the need to revamp health systems to make the effort sustainable.

I’m in New York this week at the UN Summit on Non Communicable Diseases (NCDs), where more than 30 heads of state, 100 ministers, international agencies, and civil society organizations are discussing a pressing global health issue: NCDs. This is a policy nod in the right direction, as NCDs have been largely ignored in development circles even though they cause two-thirds of all deaths in the world (most of them prematurely) and long-lasting ill health and disability, and due to NCDs’ chronic nature, increase the risk of impoverishing millions of people who lack or have limited access to health systems.

In spite of the high expectations for the Summit, there is a sober realization that we are living in a different world than in 2001. Because the severity of the economic slowdown and fiscal deficits—particularly in the developed world—may constrain international assistance in the upcoming years, there is a growing understanding that countries will need “to do more with less” and that they “cannot treat their way out of the NCD challenge” as stressed in a World Bank report launched prior to the Summit.

So, I am optimistic that the post-Summit will bring forward some sound and effective approaches to deal with NCDs. The last ten years of global public health history offer multiple lessons to guide the response, particularly to avoid the false dichotomies of communicable versus non-communicable diseases, prevention versus treatment, and vertical programs versus health systems—they are mutually reinforcing. And, the World Bank, as a multisectoral institution, is well-positioned to assist countries in adapting (I would like to stress adapting and not adopting.) those lessons to their respective institutional and cultural realities—particularly in dealing with some of the social determinants of behaviors (e.g., smoking) and biological risks (e.g., obesity, hypertension due to poor diets high in trans fats, saturated fats, salt, and sugary drinks) that are associated with the onset of NCDs, as well as to strengthen the health services centered around a strong primary care system and universal health financing arrangements.
 

Comments

Submitted by K.M. Venkat Narayan on
Thanks Patricio. Nice blog. We need to build on the momentum of the UN HLM (which I also enjoyed attending), and explore innovative models to: (a) implement and rigorously evaluate evidence-based public health interventions to prevent NCDs; (b) expand the base of science and population-based data in Low- and Middle-income nations to assist evidence-based decision-making, and also build local science capacity through North-South collaborations; and (c) develop and test several innovative health systems and financing models to deliver evidence-based integrated care, and also to evaluate the feasibility and challenges of integrating management of NCDs alongside communicable diseases in the same populations. - Venkat

In full agreement with your comments. Perhaps I would just like to add the South-South crossfertilization dimension along with the North-South collaboration--a la peer to peer learning. Also, on NCD prevention as shown by the New York City experience under Mayor Bloomberg and before by the landmark North Karelia Program in Finland, the establishment of partnerships with the food industry all along the food chain is critical to deal the twin plagues of obesity and diabetes. And certainly, the development of integrated care models is the new imperative away from hospital centric approaches.

Patricio - Nice perspective. Agree with Venkat's comments. Also would like to suggest that private providers (of all types) who probably in many low and middle income countries disproportionately bear today the responsibility of providing significant amount of care for key NCDs - hypertension etc needs to included in testing/designing of innovative delivery and financing models. Today in many of these countries private providers (especially those paid out of pocket) mainly provide reactive urgent care with many lost opportunities for health education or preventive interventions - which is required for the long-term individual behavior change that is required for NCD risk reduction (no smoking, eating right). This would probably require curriculum reform/training for providers such as community health workers, nurses, doctors in addition to exploring innovative approaches to changing behavior.

Egbe--Points well taken. Besides changes in health care organization and financing, particularly to modify the incentives framework for physicians, there is the need to focus on how physicians and nurses are trained. Indeed, medical and nursing education reform, particularly curriculum and teaching reform, is critical to modify the existing clinical paradigms that guide disease prevention and treatment. And as you said, the public/private dichotomy is no longer tenable, particularly given the ever growing expansion of virtual arrangements for the delivery of health services (e.g., public financing and private provision under contractual arrangements). Therefore, the systemic changes advocated need to include all the actors or stakeholders.

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