Burning Questions in the NCDs Response

Last week, my colleague Sebastien shared his thoughts on the global epidemic of non-communicable diseases (NCDs), and opportunities for pharma companies to promote access. He raised many good points, and I thought I’d build on this with a couple of other big questions amid the global response to NCDs.

Question 1: What are we learning from the global response to infectious diseases? Assessing the response to the rising burden of NCDs against a few of the lessons from HIV, TB, and malaria shows mixed results:

  • Focus global attention and make the crisis tangible: The 2001 UN General Assembly Special Session on AIDS marked a turning point in the HIV response, and this September’s high-level meeting on NCDs has similar potential. While the appetite for a major new global funding structure may not be there, we need to make sure we’ve got the leadership champions (see Kofi Annan’s important role in 2001) and strong advocacy organizations in place to inspire strong global action. 
  • Don’t get locked into disease-specific silos: The constituencies around specific NCDs have done an admirable job in coming together and promoting a multi-disease, multi-risk factor focus. But there is more work to be done in linking NCDs to broader questions of health systems strengthening. We need new infrastructure in place (e.g., electronic medical records) if we want health systems to address the whole gamut of patient needs. 
  • Balance attention to prevention, diagnosis, and treatment: To date (and perhaps rightly so), the main focus of most groups’ NCDs activities have centered around reducing the major risk factors like obesity, lack of physical activity, and tobacco use. But in reflecting on all of the swings in focus in HIV between prevention and treatment, we should ensure there is a more comprehensive response to these diseases – including diagnosis and treatment.

Question 2: How can we move from many disparate efforts within sectors, to a collective impact response? There are many efforts underway to align priorities on NCDs. The World Economic Forum is emerging as an information-sharing platform for companies making NCDs commitments; the NCD Alliance is a central hub for much of the civil society response; the WHO has coordinated the development of a global research agenda on NCDs. See Richard Smith’s insightful post over at the BMJ for an interesting assessment of each of these efforts.

But we need more examples of how these sectors can actually collaborate to achieve real impact on the issues. The WHO has developed strong research priorities, but how will they partner with governmental research agencies to support this work? Corporations are rolling out compelling workplace wellness programs, but how will they support implementing NGOs to scale their impact? Hopefully the preparations for the September meeting will unveil more of these cross-sector collaborations, including further thinking on the best coordinating structures for these efforts. See here for more of FSG’s thinking on collective impact approaches

Question 3: Where will innovation in the NCDs response come from? Many current efforts are focused on translating approaches and tools from the developed world into low-income countries (e.g., implementing tougher tobacco policies in emerging markets, pharmaceutical companies expanding access to current products).

But I’ve seen less momentum on innovation and new solutions in the space. What new strategies for scaling do we need based on locally-specific characteristics of NCDs? What drugs, diagnostics, and devices require the development of new formulations or entirely new technologies? What supporting services (e.g., packaging innovations, new human resources approaches) are needed? The organizations that answer these questions will be the real innovation leaders in the NCDs response. 

These are just a few of the questions that are percolating for me on the subject – I’d love to hear others’ thoughts!

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