Making NCDs a Priority: The issues surrounding global escalation of NCDs have sparked high-level strategy discussions at IANPHI annual meetings

One of the liveliest discussions during the 2012 IANPHI annual meeting occurred in a well-attended session led by Juan Rivera, a leading policymaker at Mexico’s National Institute of Public Health (INSP), on the role of NPHIs in limiting death and disability from non-communicable diseases (NCDs).

Dr. Rivera’s observations on the combined burden of cardiovascular and lung diseases, cancer, and diabetes were seconded by numerous NPHI directors from around the world. “If no action is taken, over the next three decades, the cost of the NCD burden will amount to trillions of dollars of lost resources,” he said.

The urgent need for national public health institutes to take action on NCDs is an area where IANPHI’s members - which span a continuum from fledgling institutes with a focus on infectious diseases to more comprehensive ones that lead NCD surveillance, policy development, programs and research – are in complete agreement. 

Numerous IANPHI members have had long and well-established roles in identifying and understanding the underlying risk factors for chronic disease, using data to promote sound public health policies and implementing programs to save lives. THL-Finland’s North Karelia project provides a gold standard: population surveys over 25 years identified risk factors for cardiovascular disease; community-based programs to address the risk factors led to a substantial reduction in coronary heart disease and a 10-year increase in life expectancy. 

Likewise, injury data compiled by the U.S. Centers for Disease Control and Prevention led to national laws including mandatory seatbelt use, lower speed limits, more stringent limits on drivers' blood alcohol levels, and – ultimately - fewer deaths and injuries from accidents. INSP findings are influencing policy and practice in Mexico, which launched a campaign to counter obesity and malnutrition and now prohibits smoking in public places. China CDC’s research on tobacco use will play a key role in government decision-making. 

As they begin developing national strategies for NCD surveillance and control, lower-resource countries are able to study the lessons learned from partner NPHIs in Finland, Mexico and elsewhere as well as to use IANPHI’s tools, including case studies and the IANPHI Framework for the Establishment of National Public Health Institutes, which outlines the essential functions NPHIs could consider when establishing NCD initiatives. 

IANPHI’s partnerships in seven lower-resource countries – many of which are undertaken with pro-bono technical assistance from a fellow NPHI member - assist national leaders in achieving their vision for evidence-based, health-systems approaches to NCDs. In BANGLADESH, researchers from the Institute for Epidemiology, Disease Control, and Research (IEDCR) in 2012 piloted a cellphone-based Behavioral Risk Factor Surveillance System in Dhaka to determine behavioral risk factors for NCDs and injuries. The end product - an overview of the health and socio-demographic status of the city’s population – will now be expanded to the whole country with support and technical assistance from a fellow NPHI, the U.S. CDC. Tanzania’s National Institute for Medical Research (NIMR) wants an increase NCD surveillance in order to provide more data that will sway policy makers to make NCDs a funding priority. “Understanding risk factors is key,” says Dr. Mwele Malecela, which since 2007 has received IANPHI support to develop tools, train staff, and build capacity to support facility-based surveillance for NCDs. KENYA’s Department of Disease Prevention and Control (DDPC) is now responsible for surveillance and prevention of both infectious and noncommunicable diseases. In partnership with IANPHI, initial NCD data collection will begin this year followed by an intensive project to analyze, and use data on NCDs to influence policy and decision-making. 

In ETHIOPIA, IANPHI has supported the Ethiopian Health and Nutrition Research Institute’s (EHNRI) evolution into a more comprehensive national public health institute including EHNRI’s new Health System Research Department’s work to determine facility-based rates of NCDs in Addis Ababa. Rwanda’s Institute of HIV/AIDS, Disease Prevention and Control (IHDPC), established in 2011, now includes an NCD division that will address cancer, cardiovascular diseases and diabetes as well as injuries and disabilities. IHDPC plans to build visibility about NCD threats and leverage NCD prevention and control on top of existing infrastructure. The U.S CDC, in partnership with IANPHI, in the process of funding a project to support these and other NCD-related priorities. The Nigerian Institute of Medical Research (NIMR) led a multidisciplinary research team to study lifestyle factors that contribute to NCDs in three urban slums in Lagos. The two-year project provided important information that can be used to encourage further investments and prioritize NCD prevention in Nigeria. Mozambique’s National Institute of Public Health (INS) has made NCD research a key new part of its national research agenda and will provide the federal Ministry of Health with data on diabetes, hypertension, stroke, cancer, tobacco, trauma, chronic respiratory diseases and asthma. 

Dr. Rivera’s Mexico City seminar was a unique opportunity for NPHI directors from all countries – whether they have long-term experience in NCD prevention or are just starting along the continuum - to share strategies, successes and challenges. These collaborations will continue throughout the year in interest groups and at regional and national gatherings, with NCD control expected to be a major topic of discussion during the 2013 annual meeting in Arusha, Tanzania.

The issues surrounding global escalation of NCDs have sparked high-level strategy discussions at IANPHI annual meetings. Dr. Christopher Murray, who heads the Institute for Health Metrics and Evaluation (IMHE) at the University of Washington and is co-author of the Global Burden of Disease Study presented its findings at the 2012 Annual Meeting in Mexico City, Mexico, which also featured other NCD-related presentations as did the 2011 Annual Meeting in Helsinki, Finland. Learn more about burden of disease measurement and how to use data to influence policy at the Institute for Health Metrics and Evaluation.