How can research stem the tide of the NCD pandemic?
7 April 2017
By Glenda Gray, Chair of the Global Alliance for Chronic Diseases (GACD)
On World Health Day (7 April 2017) governments should consider long-term investments in high-quality peer-reviewed implementation research on tackling non-communicable diseases (NCDs), also known as chronic diseases, in health systems.
Using implementation science, we can find simple, cost-effective ways of redesigning health systems to suit our population’s needs. This in turn, will contribute to easing the global burden of non-communicable diseases (NCDs), which has just been highlighted again by research from The Economist Intelligence Unit, The next pandemic? Non-communicable diseases in developing countries.
Sharing of knowledge and research developments is crucial in the quest to find appropriate solutions to the NCD crisis. In a playground in a primary school in Changzhi in northern China, 11 year-olds have been learning about the health benefits of reducing the amount of salt used at home. A joint project between UK- and China-based universities has been empowering children to educate their families. In India, joint research teams from Hyderabad, Delhi, Gurgaon and Sydney, Australia, have been looking at how to develop the evidence base for a national salt reduction programme, using population, stakeholder and food surveys. Teams like these meet annually under the umbrella of the Global Alliance for Chronic Diseases (GACD) and share strategies, whilst contributing to global working groups across a spectrum of interventions.
Governments can take the evidence forward from this global approach to NCD research by using the evidence to implement programmes at scale. A memorandum of understanding signed between the GACD and the World Bank Group will see China working with international research teams using an implementation science approach to take their hypertension prevention and management programmes to scale. The intent of this World Bank-GACD collaboration is to integrate implementation research into large-scale health systems reforms, which aim to achieve universal access to simple solutions to combat the rising tide of NCDs. The initial focus of the partnership will be on the prevention and control of hypertension in two districts in China.
China’s experience mirrors the NCD story in upper middle-income countries, with an estimated 82% of the country’s disease burden due to NCDs. With high levels of salt intake and tobacco use, incidence rates for heart attack and stroke are very high. Additional NCD risk factors such as lack of exercise and excessive alcohol consumption can also have damaging effects in developing-country settings. Many developing countries just do not have the infrastructure and resources to cope with the rise in NCDs. For example, in Sub-Saharan Africa (excluding South Africa), not a single country has more than one radiotherapy machine per 1m people (by contrast, in North America, there are ten machines per 1m).
Solutions to these health challenges can come from innovative implementation research, which generates context-specific evidence, so that governments have the data to bridge this gap effectively. The more countries invest in joint research partnerships, the more we might begin to learn from multidirectional innovations. Low- and middle-income countries can thus build valuable partnerships with middle- and high-income countries, while benefiting from knowledge sharing about cost-effective practical solutions to wider NCD and global health problems.