NCDs: Where the future development jobs will be

More than 80 percent of noncommunicable diseases affect populations in low- or middle-income countries — yet NCDs aren’t always considered a development issue. The Lancet Taskforce on NCDs and economics found a strong connection between controlling NCDs and economic growth, stating that “poverty drives and is driven by NCDs.” Despite the increasing problem of NCDs, NCDs haven’t found themselves on the global development health agenda. “Traditionally, maternal and child health and immunization was the focus of primary health care … but what was left out was, again? NCDs,” Cherian Varghese, coordinator of WHO’s management of NCDs, told Devex. Lack of prevention and investment in NCDs has serious health, economic, and societal consequences on a country, revealed a recent World Health Organization report “Time to Deliver.” The report stated that “[If] low- and lower-middle-income countries put in place the most cost-effective interventions for NCDs, by 2030, they will see a return of $7 per person for every one dollar invested.” In addition, NCDs can significantly impact a country’s development, particularly when its workforce is affected and “the workforce is something that all countries are concerned about,” Varghese said. Conversations around NCDs are gaining momentum in the global development space. Devex spoke with experts for their insights into development careers around NCDs and how the job landscape is changing — requiring some surprising roles, including urban designers and economists. An emerging sector There has been a definite increase in the awareness of NCDs as a development issue over the past decade, said Katie Dain, CEO of the NCD Alliance. “When you look back to 2009, it was a very different picture,” she said. During this time, NCDs lacked visibility in the development sector, she added, and policymakers were reluctant to recognize them as the next big global health challenge. However, the entry into force of the Sustainable Development Goals in 2015 brought NCDs into focus within global health, Dain said, and the third United Nations High-level Meeting on NCDs is taking place in New York at the U.N. General Assembly later this month. “We are, here and now, facing the avalanche of NCDs on us.” --— Cherian Varghese, coordinator at WHO’s management of NCDs Traditionally, experts have warned that as populations age, communicable diseases will fall and NCDs will become the major problem, Varghese explained. “The time has come; it’s no longer in the future,” he continued. “We are, here and now, facing the avalanche of NCDs on us.” Overcoming this avalanche will require the involvement of a number of new professionals from sectors that have not previously been involved in the fight against NCDs. New horizons According to Varghese, NCDs are “very complex problems with a multitude of determinants,” adding that health education alone will not prove effective. “The three main interventions are legislation, regulation, and taxation,” he said, adding that efforts in these areas require economists, lawyers, legal experts, and others to formulate effective prevention measures. To help governments craft and develop such policies, Varghese said, those with legal and regulatory capacities, food science and nutrition capacity, policy drivers, and urban planners, among others, will be required. For example, urban designers and transportation experts might routinely be required to give input on legislation concerning the reduction of harmful pollutants, improved road safety, and the provision of bicycle lanes and walkways. Once policies have been laid out, effective implementers are vital to see them through, Varghese continued, stressing the role of both international agencies and local implementers to inform populations, enforce regulations, and monitor and evaluate progress. Big data expertise is another valuable tool to help understand and drive change among populations, as well as to ascertain which policies or interventions are working. But technology and innovations should not be the only answer, Varghese added. Varghese is also optimistic about progress in developing country contexts, and that it could be relatively swift. “Maybe we don’t have to go through all the steps that high-income countries have gone through in the last 50 years for NCDs,” Varghese said. “We can actually leapfrog into many of the new technologies.” To effectively reach people also requires new ways of approaching and connecting with society, “so we need communication experts, social scientists, [and] anthropologists,” Varghese said. Along with these new positions entering the NCDs sphere, there is also a growing demand for skilled professionals in current NCD job roles, which require a greater knowledge and understanding of NCDs. But sourcing professionals with a combination of experience in public health, NCDs, and low-resource settings is proving challenging. “It is difficult to get such people, but their need is going to increase exponentially,” Varghese said. Increasing demand in current roles The roles currently involved in NCDs come under four areas, which will all see a growing number of positions opening up in future, according to Dain: Policy and advocacy; technical expertise; project management; and research. Policy and advocacy positions tend to lie within international NGOs and think tanks, she said, adding that raising awareness and continuing to build momentum around NCDs as a development issue is — and will continue to be — increasingly important. Across the other three areas, there is significant demand for professionals with a specific understanding of NCDs, particularly within the development context. “There’s a huge need for more research in NCDs as a developing country issue,” Dain said. “A lot of [technical experts] have huge expertise in other areas of global health, but NCDs is a fairly new area for them.” The same applies for project managers, with an increasing number of NCD-focused projects in developing countries — whether strengthening health systems, prevention efforts at the country level, or projects in humanitarian sectors, Dain said. However, Dain also sees a number of other job roles opening up to tackle NCDs in a holistic way. “NCDs do cut across so many different areas of health and development, so it can’t just be the medical profession that is leading the response,” she said. “It’s really got to be people from all walks of life.” Overall, tackling NCDs will require a transformation, including a need for new skills in jobs. “It needs a large number of new jobs, new skills, existing people with new competencies, and upcoming generations and the people who are in training and the people who decide on curricular and job competencies to look at this new reality of the world,” Varghese said, adding that in order to fill new positions, public health schools and training institutions need to focus on equipping future professionals with these capabilities. For more coverage of NCDs, visit the Taking the Pulse series here.