David Watkins and colleagues in The Lancet explore how countries can get back on track to achieve sustainable development Target (SDG) 3.4 to reduce premature mortality from cancer, cardiovascular disease, chronic respiratory disease and diabetes by one third by 2030. Drawing on disease control priorities and what the World Health Organization considers “the best option,” they synthesize evidence from 21 interventions that rapidly reduce non-communicable disease (NCD) mortality National implementation. In practice, Watkins and colleagues suggest that the world could achieve SDG 3.4 with an additional $18 billion per year. The ratio of economic benefit to cost of this investment will exceed 19:1. In the process, 39 million premature deaths from NCDs could be avoided – resulting in huge health and economic dividends for a small outlay. Some countries have implemented extensive interventions in addition to these recommendations. Many other countries may not have strong enough health systems or resources to implement ambitious, comprehensive action plans for NCDs, and the health policy article by Watkins and colleagues provides a framework to help these countries make further progress on NCDs. At the same time, it is an effective way to escape the effects of COVID-19.
COVID-19 has had a huge impact. An assessment by the World Health Organization early in the pandemic found that 94% of countries reported that all or some of the staff who had been working on NCDs in the health sector had been transferred to work on Covid-19. Screening and treatment of NCDs has declined markedly as intermittent lockdowns and high infection rates exacerbate pressure on health service systems. Cancer registries and screenings have declined rapidly in most countries, even in those with low Covid-19 rates, such as New Zealand, where cancer registries have fallen by about 40%. The result is that millions of people are underscreened. Results of a prospective cohort study of more than 20,000 patients in 61 countries showed that one in seven patients in areas under total lockdown had delayed curative cancer surgery due to Covid-19. Even under the best of circumstances, NCDs are complex situations that are difficult to manage. With millions of people around the world now waiting for diagnosis and treatment, the magnitude of the problem is truly daunting. It is not advisable to stick to pre-pandemic measures and go ahead and expect a different outcome. So: what should be done now for NCDs?
To date, research on NCDs has focused disproportionately on mortality. But prevalence — a burden on billions of people’s lives — can be a powerful lever for action. The The Lancet NCDI Poverty Commission states that “addressing the under-resourced access of the poor to adequate nutrition, safe living and access to health services “It doesn’t get enough attention. NCDs remain a neglected developmental problem. Organizations should try to break down the structural barriers that prevent “meaningful patient engagement” by expanding community advocacy against the unfair focus of funding, expertise and attention on high-income people in low- and middle-income countries) to drive relevant dialogue and decisions. Focusing on the business determinants of health and appropriate industry regulation to create an environment that promotes health must be a priority.
More importantly, resilient health systems must be built with sufficient capacity to deliver NCD care during and post-pandemic times. Information should be the backbone of this reimagining, especially when it comes to expanding diagnostic capabilities. The Lancet Commission on diagnostics found that 47% of the world’s population has little access to diagnostic services. Accurate information on disease prevalence and access to resources such as treatment and medical services will provide the basis for countries to strategically reform their health systems. Success in reducing the burden of NCDs is closely related to universal health coverage and the quality of primary health care. To achieve population-level change, the entire health system must be repositioned and a cross-cutting care delivery model adopted. On April 12, the President of Ghana, the Prime Minister of Norway and the Director-General of the World Health Organization will host an international strategic dialogue on NCDs and SDGs. We must recognize that now is the time for a complete overhaul of the health system around NCDs. END
References
For more on the economic case for investing in NCDs see
https:https://www.who.int/publications-detail-redirect/9789240041059
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