Opinion: How nurses can lead the fight against NCDs

Since 1948, the annual death toll from tuberculosis in England and Wales has plummeted from over 15,000 to well under 400 in 2015, rates of maternal mortality have decreased significantly, and there has not been a case of polio since 1984.

To put this in a global context, there were over 10 million cases of tuberculosis in 2016, risk of maternal death remains as high as 1 in 41 in some countries, and in 1988 there were still 350,000 cases of polio internationally. Much of the United Kingdom’s progress in health outcomes, highlighted by these three examples, can be attributed to the U.K.’s National Health Service, which celebrates its 70th birthday today.

The health challenges facing the U.K. in 2018 — and the world — have evolved since the 1940s. Rather than infectious diseases such as TB and polio, the diseases most likely to put an end to a person’s life — cancer, heart disease, stroke, lung disease, and liver disease — are chronic rather than contagious, making up a broader category defined as noncommunicable diseases.

Even in countries where TB is still a major challenge, such as South Africa and India, NCDs are still on the rise. NCDs prematurely kill 15 million people each year and hit the poor particularly hard, with people in low-income countries four times more likely to die of an NCD than those in high-income nations. One of the major risk factors for NCDs, smoking, is intrinsically linked with poverty and low education levels; in-need smokers are less likely to be able to afford the health care that will stop them suffering from the likes of heart disease and lung cancer.

As life expectancies lengthen and child mortality rates are lowered, NCDs will only escalate as an issue over the next 30 years — up until the 100th anniversary of the NHS — and beyond. Given their long-term nature and complex causes, there is one group of health care professionals that is especially well-placed to managing the challenge of NCDs: Nurses.  

No other health professionals are closer to communities than nurses, who lead on the frontlines of care, doing all they can for those in need. With their person-centered approach to care, nurses instinctively put the needs of populations first, not just in a headline-grabbing crisis but also in those that unfold slowly behind-the-scenes, such as NCDs.

Equipped with a holistic mindset, nurses can readily contend with the many drivers of NCDs, which have their roots in social and economic factors, just as much as medical ones. Chronic in nature, NCDs can require care and treatment for decades, which taps into nurses’ capacity for compassion. Through their links with communities, nurses can also direct the health promotion and disease prevention work to stop people contracting NCDs in the first place.

Nurses are recognized for their “especially crucial roles to play in health promotion and health literacy, and in the prevention and management of NCDs” in the recent report from the World Health Organization's Independent High-level Commission on NCDs. As capable “practitioners, health coaches [and] spokespersons,” nurses are vital allies, not just to NCDs, but to related challenges, such as mental health disorders and obesity, also covered by the report.

But what does leadership by nurses in beating NCDs actually look like? Below are three examples of how nurses are driving progress in disease prevention, health promotion, and treatment.

1. Lead in prevention

Nurses in Botswana are leading a new approach to screening for the human papillomavirus, or HPV. HPV causes cervical cancer, a disease that WHO has made a flagship commitment to eliminating. Just west of Botswana’s capital Gaborone, nurses are using their strong links with communities to bring the benefits of innovation to people who often do not benefit from the cutting edge of health care.

This ability to expand access to health-enhancing measures and initiatives — broadly defined to encompass more than just treatment — has been recognized at the top echelons of global health. The Pan American Health Organization has argued that nurses should play a bigger part in providing primary health care, motivated by the recognition of just how effective nurses are at promoting health — without leaving anyone behind.

2. Be a trusted coach

When it comes to health promotion, nurses can tap into their profession’s status as the world’s most trusted. They can draw on this credibility with the public to serve as “health coaches” who can incentivize patients to change their behavior to defend against NCDs by taking precautions such as quitting smoking, eating more healthily, and being physically active on a daily basis.

For example, to reduce the risk of stroke nurses can explain the benefits of change in tangible and meaningful ways, and help people believe in themselves and come with up plans for overcoming barriers to live more healthily. Nurses can also factor in where they live, and communicate with an appreciation of the unique needs and characteristics of the individual in front of them.

3. Circumvent obstacles

Nurses can navigate bureaucratic hurdles and a lack of resources to get patients the treatment they need. For example, nurses in Nigeria made an urgent and public call for better mental health care in Nigeria, in particular, the upgrade and expansion of neuro-psychiatric hospitals outside of the country’s most affluent areas.

Whether it’s keeping women cancer-free, championing healthier lifestyles, or supporting increased investment in mental health, nurses have a vital role to play. And as the burden of NCDs increasingly weighs on countries, governments, and health care, systems must step up their efforts to nurture nurses to fulfill their full potential.

For more coverage of NCDs, visit the Taking the Pulse series here.