Lessons Learned from International Experience with NCD

1. Lessons Learned from International Experience with NCD Professor David R MacLean MD Simon Fraser university Canada International NCD Seminar, January 5-12 2010

2. Lessons Learned from International Experience with NCD • They are preventable through interventions against the major risk factors and their environmental, economic, social and behavioural determinants in the population. • Reducing exposure of individuals to risk factors and reducing progression of their disease through clinical care is not enough. A comprehensive approach is needed which includes prevention of the emergence of risk factors in the first place. • In a population those at moderate risk contribute more to the total burden of non-communicable diseases than those at high risk. Consequently, a comprehensive prevention strategy is an approach aimed at reducing risk factor levels in the population as a whole as well as those at high-risk. International NCD Seminar, January 5-12 2010

3. Lessons Learned from International Experience with NCD • For a significant population impact delivery of interventions should be of appropriate intensity (dose) and sustained over extended periods of time. However, even modest changes in risk factor levels will have a substantial public health benefit. • Success of community-based interventions requires community participation, supportive policy decisions, intersectoral action, appropriate legislation, health care reforms, and collaboration with nongovernmental organizations, industry and the private sector. • Decisions made outside the health sector often have a major bearing on elements that influence the risk factors. International NCD Seminar, January 5-12 2010

4. Lessons Learned from International Experience with NCD • Significant health gains can be achieved by influencing public policies in sectors such as trade, food and pharmaceutical production, agriculture, urban development, and taxation policies than by changes in health policy alone. • The present organizational and financial arrangement of health care in most countries is not sufficient to comprehensively deal with NCD. Member States need to address the challenge in the context of overall health system reform. • Activities need to be outlined that will provide a practical agenda that people can carry out, one that is consistent with their norms, values and resources. International NCD Seminar, January 5-12 2010

5. Lessons Learned from International Experience with NCD • Sustainability of the effort is a major issue. Little is ultimately gained in the long run from programs that are dependent on external resources for the long term. • The route to sustainable actions is through community based approaches which build capacity for health development in existing community infrastructure. • The best return on investment comes a focus on public health. In those countries where resources are available for care the best return in terms of population health will occur when priority is given to the development of primary health care. International NCD Seminar, January 5-12 2010

6. Lessons Learned from International Experience with NCD • Balance the focus on strategies and interventions designed to improve individual capacity to strategies with interventions which have more of an ecological focus on communities and populations. • This involves a shift to policy thrusts with emphasize capacity building to empower communities to take action. This often needs system structural change to allow for more decentralized program development and delivery. • Invest in systems that go beyond demonstration. There is a need to link demonstrations to national policy to achieve priority and gain resources. There needs to be connectivity at all levels. International NCD Seminar, January 5-12 2010

7. Lessons Learned from International Experience with NCD • Surveillance is very important but needs to be linked to policy and programs. Surveillance not linked in this manner can consume a great deal of resources without much health benefit. • Policy and programs need ultimately to be linked to deployment (scaling up) otherwise efforts and resources will not be realistic to do the job. International NCD Seminar, January 5-12 2010