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A WHO GCM/NCD Prompt from Our Own Dr. Kishore

By Eric Obscherning Moderator | 26 Jan, 2016

Sandeep Kishore, President of the Young Professionals Chronic Disease Network and a public health physician at Yale University is asking all of you:
 
How can we address the huge gap between producing knowledge for NCD management and ensuring that this knowledge is accessible and translated into action, at the policy, practice, and grassroots level?
 
Here, let me push. And if I may, dig a little bit deeper.
 
I would like refer back to Dr. Richard Horton’s framing of the NCD issue in the 12th December issue of the Lancet that Dr. Bente Mikkelsen highlighted on the opening of this Forum. Following the Dialogue, Dr. Horton highlights gaps in the ability to communicate - to frame the NCD issue — as one of social justice:
 
"The central failure has been to convince governments that NCDs represent a threat to their present and future security. NCDs are not Ebola. They don’t kill millions of children. And there is no civil society movement demanding government action. NCDs are “lifestyle diseases,” driven by the products of legal (if not loved) multinational corporations. They are by-products of our freedoms, unfortunate but inevitable consequences of human advance. The global health community needs to tell a different story about NCDs. It is struggling to do so. Yet that story is inspiring if only it could be told passionately and without the obfuscating technical baggage that saps the commitment of even the most committed of ministers...
 
 ...But where is the anger and the activism in response to its own diagnosis of a “global scandal”? Where is the urgency? Where are the Presidents and Prime Ministers corralled by WHO to lead nations in their fight against NCDs? The NCD movement is too quiet, too pedestrian and too polite to make the impact it deserves. It has allowed process to kill action. I sat in the UN General Assembly in 2011 with friends from WHO and saw their sense of achievement for at last getting NCDs onto the global political agenda. That moment should have been the beginning, not the end. The NCD community needs an electric shock to its semi-comatose soul. But who has the courage to deliver it?"
 
This analysis gave me great pause. It gave me pause because there is — to me — some strong truth in his assessment. And I could not help but ask four questions: What, Why, Who and How?
 
What is the story that we articulate at the policy, practice and grassroots level? What is the story we are currently telling? And what is the story that we must tell? How might this community be more effective communicators?
 
Why do we — or do we? — lack passion and boldness in making case for tackling afflictions that murder the world’s people earlier and earlier in their lives? Will we let process kill action? Is there really no sense of urgency? Are we pedestrian and too polite to drive the impact we sorely need?
 
Who will step to deliver the electric shock that Dr. Horton calls for? What does that shock look like?

How are we ensuring that this story is translating into action? Are we effectively closing the gap between producing and articulating the necessary knowledge base and supporting an inclusive and timely access to this knowledge at the practice and grassroots level ?
 
To the participants, I would be keen to engage in dialogue on these communication and translation questions.
 
What type of communication strategies/ framing tools have been used to influence practice and go beyond “advocating and promoting” activities related to NCDs?

Please share your success stories and challenges in reaching and sharing knowledge at the practice and grassroots level."

To respond to these questions please comment on this discussion.

Replies

 

Justin Zaman Replied at 2:43 PM, 26 Jan 2016

I was inspired to become interested in global cardiovascular health in 1999 when I was a junior doctor interested in coronary stents by this article: http://link.springer.com/article/10.1023%2FA%3A1007727924276

Yes, 1999. So I and others were talking about global health (that didn't mean just infectious diseases) before the term 'global health' ever got applied to non-communicable diseases.

Sadly, despite lots and lots and lots of research, policy statements, educational courses etc., the world does not seem committed to change in this area, focussing more on the 'human right' to be able to live a lifestyle that is atherogenic.

Is there a solution? Well, I believe money talks. Somehow economics must be able to persuade all on this planet that buying into healthier lifestyles can be financially more lucrative for all, not just the consumer, but also for the multi-national food producer and government. Stephen Leeder framed these arguments over a decade ago and the thesis still holds firm: http://earth.columbia.edu/news/2004/images/raceagainsttime_FINAL_051104.pdf

It's a similar argument for the environment. 'Social justice' isn't going to persuade the '1%' to care. The UN is impotent in most things now, and health is way down the agenda. I knew the UN meeting in 2011 would be a talk shop and despite Sandeep saying I should at least be in the city during the meeting, I didn't bother heading across the Pond. Perhaps the World Bank and those in Davos last week might do better than us 'polite' public health professionals.

Dr Justin Zaman | Consultant Cardiologist | BSc MBBS MRCP MSc PhD
James Paget University Hospitals NHS Foundation Trust
Honorary Senior Lecturer, University of East Anglia
Lead Consultant, Cardiac Rehabilitation, Anglia Network
Associate Editor, EHJ-QCCO

NB I am not a stenting cardiologist!

Raja Karthikeya Replied at 5:29 PM, 26 Jan 2016

I'm not a health professional, but have followed the discussions on
this forum with interest for some years now. I completely agree with
Sandeep that a sense of urgency is lacking among policymakers when it
comes to NCDs. As someone who's not a health professional but works
alongside policymakers, I'd like to make a few suggestions for the
forum to consider:

1. Part of the problem appears to be the nomenclature of NCDs. Why
distinguish diabetes or heart disease or cancer by "what they are not
"- i.e. communicable diseases,? Would it not be better to call them
instead according to what they are, i.e. leading causes of mortality
(LCM?)

Changing public health nomenclature may be difficult, but if we want
NCDs to be taken up as an issue of social justice, the terminology
itself would need to change to generate a sense of urgency. Calling
NCDs as LCMs or by any such other name may help generate a greater
buzz around them and put them where they should be - at the apex of
policymakers' priorities.

2. The urgency that helped create the Global Funds against
communicable diseases came from advocacy in which the "effect on
working-age population" was distinctly emphasized. When it was said
that one-third of all working age males in a X country in sub-Saharan
Africa will die before the age of 30 due to HIV, it created an
unparalleled sense of emergency. Without necessarily replicating such
a sense of alarm, could the NCD community still talk in terms of
"working age population mortality numbers"?

3. We know the linkage between NCDs such as heart disease or obesity
and a person's diet. We also acknowledge that globally diets are
changing, esp. with increasing prosperity in middle-income countries.
So could the NCD community shift some of its focus from advocacy aimed
at the Pharma industry to advocacy aimed at the Food industry? This
should sit well from a NCD prevention standpoint. While this may
involve fights with corn farmers' lobbies etc, it may perhaps be just
a trifle easier than battles over pharma patents.

4. Last but not least, the national security pitch. NCDs are a
national security concern for two reasons. For political leaders, from
a grand strategy perspective, the prospect of losing young people to
NCDs is alarming given its impact on future "comprehensive power" of
the country. For armies everywhere, NCDs are a threat that no amount
of spending on biological defense can help against. (It was no
surprise that the US Army identified Obesity as a major concern that
is affecting the pool of potential recruits). In short, NCDs could be
framed as a "national security" issue when it is pitched to individual
governments.

Overall, these suggestions are all about "re-framing" the issue of
NCDs for advocacy with policymakers who are not health professionals.
The NCD community has made great strides in recent years, and to keep
up the momentum, perhaps we can keep the tone but change the pitch.

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