The prevention and control of non-communicable diseases (NCDs) is a major focus of the United Nations General Assembly and related events in New York City this week, where UN member states as well as the prominent global development and health organizations, private sector companies, and NGOs converge for Global Goals Week. Among the many critical issues up for discussion, the global burden of NCDs and how we can transform healthcare systems to respond should be given the highest priority.
Concerted action on NCDs – not just plans or deliberation – is the real focus.
Through the Sustainable Development Goals, we have reached global consensus that NCD care is an indispensable element of ensuring healthy lives and well-being at all ages. Since 2013, the UN has sought to establish measures to protect people from dying too young from heart and lung diseases, cancers and diabetes. Around the same time, the 66th World Health Assembly endorsed the WHO Global Action Plan for the Prevention and Control of NCDs, which provides policy options and a roadmap to reduce premature mortality from NCDs by 25% by 2025.
Sustained action across the NCD care spectrum – prevention, diagnosis and treatment – will be necessary to achieve this ambitious target. In order to prevent NCDs, we must build awareness of NCD risk, educate people, address the social determinants of health, discourage tobacco use and excessive alcohol intake, and promote physical activity. In order to more effectively and efficiently treat NCDs, we must increase access to medical facilities and medicines, build health-worker skills, and bolster primary, secondary and palliative healthcare.
But what about intervention opportunities in the space between prevention and treatment? Nearly everyone agrees that early detection and diagnosis are critical to bring down costs of NCD treatment. Yet today, the majority of low- and middle-income countries are challenged to design and implement comprehensive programs to detect NCDs early on and expand access to reliable and definitive diagnostics in conjunction with adequate treatment programs.
To learn more about the specific role that early detection and diagnosis play in the fight against NCDs, we surveyed a diverse group of over 1,200 health professionals and more than a dozen NCD experts from around the world, and shared their insights in our report, Early Detection and Diagnosis: A critical link for effective NCD management.
First and foremost, health professionals point to the importance of strong primary healthcare in confronting NCDs and driving early detection and diagnosis: nearly half of the survey respondents indicate that the leading reason strong primary healthcare contributes to the fight against NCDs is because it provides early detection and diagnosis capability.
When looking across specific NCDs – cancer, cardiovascular disease, chronic respiratory disease and diabetes – a majority of our respondents believe treatment is currently receiving disproportionate levels of attention, while prevention and diagnosis are under-prioritized and under-invested. Nearly all survey respondents believe early detection and diagnosis of NCDs is a good economic investment because it can reduce the need for more expensive interventions.
To improve overall NCD management, we learned the importance of both health-seeking behavior and detection and diagnostics capability in primary healthcare. From this perspective, education and awareness can be viewed as part of early detection and diagnosis because it helps people recognize the early symptoms of NCDs so they can visit a clinic to get a diagnosis. Approximately half of respondents believe education and awareness make the biggest difference to improve diagnostic referral systems and clinical pathways in developing countries, while the remainder believes investment in detection and diagnosis – including checkups, labs and equipment – makes the biggest difference.
Governments around the world must step up to the challenge by designing and implementing the right policies and solutions. By way of illustrating how much work is left for us to do, 92% of survey respondents believe most developing countries lack early detection equipment, tools and training that could combat and help control NCDs, and 90% found government policies on NCDs inadequate.
According to our respondents, international donors and foreign aid agencies have an important role to play in contributing to financing in order to introduce and scale up diagnostic technology, determine successful approaches, and share that knowledge with governments to pave the way for more private sector engagement. Along with civil society and private-sector partners, they can also build other aspects of a more robust early detection and diagnostic infrastructure by empowering civil society and community health networks and workers, scaling capacity through training and funding, collecting and leveraging data for better medical decision-making, and pursuing innovative finance models that leverage the power of government and private industry.
In Cameroon, where chronic diseases cause 31 percent of deaths each year, knowing the symptoms of disease is essential to getting diagnosed and receiving timely treatment. However, widespread stigma associated with NCDs can often prevent people from getting a checkup for early diagnosis. Healthcare workers are working to help change attitudes through "Know your numbers", a nation-wide awareness campaign that reaches a total of 1 million people via community drives and in local Cameroon Baptist Convention (CBC) hospitals nationwide, encouraging them to check their blood pressure and body mass index. But the challenges do not stop at diagnosis. Many people face another huge issue: access to medication. To counter this issue, Novartis Social Business partnered with CBC Health Services in 2015 to increase access to medicines for NCDs for less than $2 per treatment, per month. The Novartis Access program aims to reach the whole of Cameroon.
Moving the needle on NCDs will also mean an advanced role for private sector companies. The private sector can contribute innovations, and work in partnership with governments and civil society at global, national and subnational levels, including offering the early detection and diagnostic technology and tools suitable to confront different NCDs in various contexts.
To give an example: over the past four years, Philips has been collaborating with governments, donors and NGOs to increase access to quality healthcare in Africa, by helping to build Community Life Centers (CLCs) in rural and peri-urban regions that previously lacked access to primary care facilities. The main objective of the CLCs is to provide effective community outreach and create a referral structure to specialized care units.
In Colombia, prostate cancer diagnosis through the public system takes 90 days, while diagnosis through the private system takes only 30. With the support of the Philips Foundation, La Liga Contra el Cáncer – a non-profit private healthcare organization in Bogotá that is bringing diagnostic services to communities – is holding 30 community workshops between June 2018 and June 2019, aiming to educate communities on the signs and symptoms of prostate cancer and provide early diagnosis for over 1,600 men over the age of 40 for the disease using Philips technology.
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Just throwing money at a problem is never going to move the needle – it is crucial to work on business models that are sustainable in the long-term in a local context. This requires companies to be flexible, to rethink their strategies, and to design products and services that are addressing specific needs, while keeping in mind inevitable resource constraints in low and middle-income countries.
Investing in prevention and early diagnosis of NCDs is an essential and rewarding factor to help reduce the long-term cost of treatment and to maintain accessible, inclusive healthcare systems. To make this a success, all stakeholders must work together in forward-looking partnerships to increase access, raise the quality of care, and seamlessly integrate new technologies and ways of working. In the end, this will enable us to achieve better health at lower cost for everyone, globally.