Tackling non-communicable diseases during the pandemic
By World Healthcare Journal-
According to the World Health Organisation (WHO), non-communicable diseases (NCDs) kill 41m people each year, equivalent to 71 per cent of all deaths globally. Four groups of diseases account for most NCD deaths – cardiovascular diseases are the most prolific, followed by cancers, respiratory diseases and diabetes.
At least 15 million people die from NCDs between the ages of 30-70, and most of these premature deaths can be avoided or delayed by governments putting policies in place that reduce risk factors for NCDs and increase screening, early diagnosis and treatment. In 2011, the UN General Assembly acknowledged NCDs as one of the major challenges for the 21st century. Yet today, NCDs remain one of the most underfunded sectors within public health.
For Dr Ren Minghui, Assistant Director-General for Non-Communicable Diseases at the WHO, the problem lies with the often slow burn of these illnesses. In an exclusive interview, he stresses the need for governments to fulfil their commitments made at the UN General Assembly, taking into account the guidance provided by the World Health Assembly, to tackling NCDs as we face the future and build back better.
“Despite the rapid progress made during the first decade in reducing the risk of premature death from any one of the four main NCDs, the momentum of change has dwindled during the second decade, with annual reductions in premature mortality rates slowing for the main NCDs. Diabetes has even gone up during the second decade. But we know that they continue to pose a huge burden on all economies and communities, requiring long term investments and political commitment – NCDs are not minor issues,” he says.
This view is borne out by the facts: an estimated 41m people worldwide died of NCDs in 2016, equivalent to 71 per cent of all deaths. Four NCDs caused most of those deaths: cardiovascular diseases (17.9m deaths), cancer (9m deaths) chronic respiratory diseases (3.8m deaths), and diabetes (1.6m deaths).
In his role, Dr Ren oversees a complex portfolio of technical programmes at WHO covering HIV, viral hepatitis, tuberculosis, malaria, neglected tropical diseases, sexually transmitted infections, non-communicable diseases, mental health and substance use.
He currently represents WHO on the boards of the Global Fund to Fight AIDS, TB and Malaria, UNAIDS, and UNITAID. Prior to his appointment as Assistant Director-General, he spent nearly 30 years working in public health in his native China.
“On 1 June 2020, WHO published the outcomes of a survey showing that many people who need treatment for NCDs have not been receiving the health services and medicines they need since the pandemic began, because more than half of countries have disrupted NCD services. We need to stop the destruction of central services, particularly now we have a pandemic,” he continues.
“People living with cancer are not able to go for treatment because the lack of personal protective equipment, and their decreased immunity, puts them at risk of life-threatening infections. On a daily basis, we are alerted to the devastating impact of COVID-19, with updates on the number of new infections, hospital admissions and deaths. At the same time, we don’t receive daily reminders of the toll of NCDs on communities, while we need to ensure that these essential services, including early diagnosis and appropriate treatment and care, are delivered to all who need, particularly through primary health care systems. ”
Tackling NCDs with governments
For Dr Ren, the pandemic has exposed the extraordinary fragilities on global healthcare systems. “Universal health coverage should be every country's business, no matter the country's development status and whether it's poor or rich. Investing in health is an important long term issue as no country has a perfect health system,” he says.
“But all counties have to own these issues. Some have a huge challenge in strengthening health systems and addressing critical health risks. The African region faces some of the largest challenges, with major gaps in providing essential services for NCDs and mental health. The impact of globalisation of marketing and trade, rapid urbanisation and population growth in the 30-70 age group means that national challenges like NCDs also require global and regional action and solutions. It would be great to see collaboration between countries and communities, working with WHO and other partners to develop tailored plans and strategies to improve systems, to address all emergency and poverty health issues and gradually to reach the target of universal coverage in the country, the region and the globe. ”
The first step to go beyond the COVID-19 emergency is to generate high-level commitment that any response to COVID-19 and recovery from COVID-19 needs to go hand-in-hand with action to address NCDs. We cannot postpone screening, early diagnosis and treatment of hypertension and diabetes. Addressing NCDs and COVID-19 simultaneously and at enough scale requires a response stronger than any seen before to safeguard lives and livelihoods. A high-level independent review panel has been established to review the response to the pandemic. Its formal results and recommendations will be key to guide WHO, countries and partners to build back better systems for health and to better prepare for any future global health crises.
“Health is a global issue - no country is safe until the global village is safe. That's a very strong story from this crisis response,” he says.
Global challenges for NCDs
But even with global cooperation, some countries will continue to battle entrenched challenges such as poverty, social inequality, civil unrest, weak infrastructure, poor communications and lack of essential services. For NCDs, even if a diagnosis is reached, the services, medicines and other health commodities required for treatment and long-term care may not be available or affordable, stretching already tight health budgets and driving families into poverty.
“Communication is key to this,” he says. “We have learnt from the COVID-19 pandemic how misinformation, disinformation and lack of information have undermined evidence-based programmes and created mistrust and confusion among communities. For NCDs, people need to be aware of the risks they face, the most effective prevention and treatment options, the services that they can readily access so they are not exposed to the wrong advice which may be costly and harmful. For some, the message may just be about the eating the right diet, stopping smoking and taking regular exercise rather than seeking out costly pills or even surgery. ”
WHO works with countries and local partners to produce guidance that takes into account the country context, social norms and local language. “We have to move beyond developing recommendations and producing guidelines, to invest more in making this guidance readily available in countries and translated into country actions,” he says.
For example, for many years the major challenge for diabetes treatment has been around availability and affordability of insulin. WHO is monitoring and reviewing pricing policies and examining the possibility of establishing a global price report mechanism for insulin and other diabetes commodities purchased by national programmes in low and middle-income countries, taking into account the lessons learned from WHO Global Price Reporting Mechanism for HIV, tuberculosis and malaria. This is very timely, as the world marks the 100th anniversary of the discovery of insulin in 2021.
HPV and cervical cancer are another key areas of action, with the aim of eliminating cervical cancer by 2030. “With the arrival of the HPV vaccine we are excited that this could be the first NCD that can be eliminated,” Dr Ren states.
But many countries do not have national HPV vaccination programmes yet, and these no doubt would be delayed by the current pandemic. In addition, there are cultural issues in many countries that need to be addressed, particularly around the vaccination of boys for the HPV virus. To eliminate HPV all youngsters need to be vaccinated, and boys in particular, recognising that HPV infection is contributing to increasing rates of head and neck cancers in middle-aged men.
“The HPV vaccine is important for the whole family, for your partner, for your children and for your generation,” says Dr Ren. “We need to mobilise country endorsements for the WHO cervical cancer vaccination strategy to eliminate this disease across the globe. We somehow have to learn how exactly we can build on the previous momentum to make sure that improvements in the NCDs response aren’t just talked about by politicians, but really delivered. ”
INTERVIEW: SARAH CARTLEDGE
To help increase the reach of WHO’s efforts to stop the COVID-19 pandemic and prepare for the future, the WHO NCD/WIN Working Group on COVID-19 and NCDs has been established to support efforts to “Strengthen the design and implementation of policies, including for resilient health systems and health services and infrastructure, to treat people living with NCDs and prevent and control their risk factors during the COVID-19 outbreak, with a particular focus on countries’ most vulnerable to the impact of COVID-19”, taking into account the corresponding commitment made by Heads of State and Government in paragraph 40 of the 2018 UNGA Political Declaration on NCDs.
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