Despite COVID, It Is Still Possible to Reduce NCD Mortality by One-Third by 2030: New Lancet Study
A woman gets her blood pressure tested. The paper suggests investment in how to deliver more effective hypertension treatment.

Despite the negative effects of the COVID-19 pandemic on health systems worldwide, it is still possible for low and middle-income countries (LMICs) to reduce premature mortality from non-communicable diseases (NCDs) by a third between 2015 and 2030.

This is the optimistic message from a new Lancet study in the ”NCD 2030 Countdown” series published Friday, which stresses that a cost-effective package of NCD prevention and treatment interventions is “feasible to implement in countries at all levels of income”.

“There’s a widespread belief in the global health and development community that tackling NCDs is too expensive and that it isn’t feasible in countries with very limited resources. Our report thoroughly debunks this idea,” says lead author Drt David Watkins from the Department of Global Health at the University of Washington’s Hans Rosling Center for Population Health.

The paper focuses on 21 interventions – both clinical and policy-based – to reduce NCD-related mortality, which is the United Nations Sustainable Development Goal 3.4.

The 15 clinical interventions are weighted towards addressing cardiovascular disease as heart disease and strokes are the most deadly NCDs, and include dispensing aspirin for suspected acute coronary syndrome, chronic heart failure treatment, primary prevention of cardiovascular disease and treatment of early-stage breast cancer

The six policies focus on taxing and regulating unhealthy products such as tobacco, alcohol, salt and transfats.

Interestingly, the paper does not mention taxing sugary drinks, the consumption of which is contributing to diabetes and hypertension, or regulations to address air pollution

A key source working with the WHO on NCD policies expressed disappointment that air pollution regulation had been excluded, as the seven million people who died from air pollution each year died from NCDs including heart disease, stroke, chronic respiratory diseases and cancers. 

Taxing tobacco is one of the six key policy proposals.

Emphasis on health system delivery

Watkins says that the proposed interventions are aligned with the WHO best buys but they go further in terms of the clinical and health system interventions. 

“The best buys mostly focus on population-level policies and a very modest investment in medical treatments to prevent cardiovascular disease in primary healthcare settings,” Watkins told Health Policy Watch.

“We include these interventions but also include several more, such as long-term drug therapy for chronic heart failure and treatment of acute exacerbations of asthma and chronic obstructive pulmonary disease (COPD),” he said.

In addition, Watkins’ proposals focus on the healthcare system, advocating that most of the short-term mortality gains in NCDs “could be realised through targeted investments in clinics and hospitals, especially by improving the quality of existing care”.

The paper effectively scores interventions based on their value for money, providing governments with cost-effective guidelines. In the case of hypertension – a disease that all countries are struggling to address effectively – the authors argue that resources might be better spent on researching and developing how to deliver this treatment more effectively.

“Telehealth, drone-based supply chains, and other innovations could help us do that, but we need to go all-in on R&D and public goods,” said Watkins.

Modest price tag

Implementing the most efficient package of interventions across the world would require an additional $18 billion each year from 2023 to 2030. The end result would be 39 million lives, which would generate an average net economic benefit of $2·7 trillion – a return in investment of 19 to one.

By 2030, ministries of health would need to contribute about 20% of their budgets to high-priority NCD interventions, asserts the paper, advising governments to raise funds through “general taxation or social health insurance, coupled with fiscal reforms”.

There have been massive increases in NCDs in LMICs. In Ethiopia, for example, deaths from NCDs increased from 19% in 2000 to 37% in 2017, and almost all adults now have at least one NCD risk factor, yet over 90% of the country’s health centres and hospitals do not have adequate staff to manage NCDs.

If the proposed package was implemented, deaths from the four top NCDs in people aged 30 to 70 years across all 123 LMICs would be reduced by 35%, and all regions except Latin America and the Caribbean and Oceania would achieve the SDG target (although several countries in each region would not be able to achieve the target).

“To my knowledge, this is the first paper to give a ‘price tag’ for achieving the SDG 3.4 target,” said Watkins. “The price tag estimates are aimed both at national governments and at the development community to give them a sense for how much more money is needed to accelerate progress—and just as importantly, exactly what to invest in.”

Katie Dain, CEO of the NCD Alliance, said that the Lancet paper “reinforces what we already knew to be true pre-pandemic and more so today: that with relatively low investment, most countries could make big inroads into their chronic disease burdens and simultaneously reach UN targets by 2030.”

COVID-19 has been the cause of strokes by blocking larger blood vessels.

No more disease silos

“Advocacy for NCD financing and collective action should not be framed as another global health initiative. The COVID-19 pandemic has shown that siloed programmes are increasingly unfit for purpose and need to be integrated within primary health care,” it argues.

“The growing burden of multimorbidity and the bidirectional relationships between communicable diseases and NCDs underscore the need to dismantle disease-specific silos, emphasising reforms and investments that improve a wide range of health outcomes. Additionally, missed opportunities to prevent NCDs have arguably increased population susceptibility to COVID-19-related mortality, a pattern that could repeat itself in future pandemics.”

Image Credits: NCD Alliance, WHO AFRO, GJBrainResearch/Twitter.

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