A multistakeholder collaborative approach with locally-tailored solutions is key to reducing the burden of noncommunicable diseases in low- and middle-income countries, says Dr. Chandrashekhar Potkar, chief medical officer of emerging markets at Upjohn, a division of Pfizer, focused on relieving the burden of NCDs worldwide.
NCDs — including cardiovascular disease, cancer, chronic respiratory disease, and diabetes — kill 41 million people each year. Over 85% of these are considered “premature deaths,” the majority of which occur in LMICs. While tobacco use, physical inactivity, harmful alcohol consumption, and unhealthy diets are contributing factors to the NCD burden, so too is a lack of universal health coverage, regulations, funding, data, and health care worker capacity in LMICs.
To bridge the NCD health care gap between LMICs and high-income countries, a holistic approach to build sustainable health care systems that address all stages of the patient journey is needed, Potkar said.
“We need to promote a shift in perspective from ‘sick-care’ to ‘preventative care,’ where solutions are focused on root causes.”— Chandrashekhar Potkar, chief medical officer, Pfizer Upjohn Emerging Markets
“Local solutions have to be tailored to the local country’s needs, so we must identify local solutions within the patient journey,” he said, adding that this approach alongside collaboration will allow for tangible gains to be made.
Speaking to Devex, Potkar explained how to adequately address NCDs in LMICs, the impact of COVID-19 on NCDs, and the role of the private sector in driving solutions forward.
This conversation has been edited for length and clarity.
How does the increasing burden of NCDs continue to impact LMICs?
Systemic solutions for addressing NCDs in LMICs
In September 2019, experts from across the health sector in LMICs formed a think-tank to understand and examine the challenges in tackling the NCD burden in LMICs, and to offer potential opportunities for improvement. Read the full report on the evidence and pragmatic solutions to combat NCDs here.
NCDs are a silent threat to global public health. Out of the 56.9 million total deaths we see every year, 71% are due to NCDs with one-third occurring in people who are 30 to 69 years old. What is most shocking is 85% of these premature deaths happen in LMICs, which gives you an indication of the significant issue LMICs are facing.
Governments across the world need to allocate a certain percentage of gross domestic product for tools to combat NCDs, but this can be difficult in LMICs. Economic growth is lagging behind the cost of health care in these countries. We believe that the cost of instituting preventative measures around NCDs is far lower than it would be if countries did not invest in this type of care at all.
How are acute illnesses like COVID-19 creating additional barriers to NCD prevention and care around the world?
COVID-19 has shown us that vulnerable patients — including those with existing NCDs — need to be protected and assisted in responsibly managing their underlying chronic conditions. The pandemic also underscores the need for adequate mental health services, which are poorly addressed in LMICs, largely due to the impact of stigma.
It is important to have a holistic, integrated care approach that looks at NCDs, communicable diseases, and emerging health crises by focusing on building reliable health care systems. We need to promote a shift in perspective from “sick care" to "preventative care," where solutions are focused on root causes.
What are the biggest challenges LMICs face in addressing NCDs?
There are gaps around policy, research and clinical capacity, and the patient journey. Of these, a couple are important for us to really highlight: the gaps around care — especially the capacity of health care workers and the training and education of health care workers — and the need for intersectoral partnerships.
When we talk about the workforce, we’re talking about the gap between capacity, availability, and the education of primary health care providers. We need a comprehensive approach to the training of health care providers that focuses on identifying a patient’s critical risk factors, recommended lifestyle modifications, and the potential need for treatment. This is one area where we see a significant opportunity.
We also see a significant need for intersectoral partnerships. NCDs are such a big, important issue that we cannot have one stakeholder responsible for everything. We need the public and private sectors to come together.
How do these challenges compare to what you might see in other markets?
The burden of NCDs is evident across high-, middle-, and low-income countries, but there are distinct differences among these regions, which suggests the need for targeted intervention strategies.
In LMICs, most of the challenges occur at the beginning of the patient journey, which has five stages: awareness, screening, diagnosis, treatment, and adherence. When a patient comes to a clinic for the treatment, they’re already at stage four in the patient journey. To help with this challenge, Pfizer Upjohn developed the strategic segmentation for NCD country action plans, or SNAP framework. This segments countries based on key variables affecting their development of NCD action plans, optimizing intervention strategies based on a country’s policy readiness and NCD burden.
What more can the private sector do to support efforts and increase progress in tackling NCDs in LMICs?
The private sector is key to driving progress and the patient is central to everything we do. By engaging multiple stakeholders across the health care value chain and providing the funding needed to move research, education, and awareness forward, we can meaningfully improve health care delivery and quality.
For example, we started a collaboration with the American College of Cardiology in 2016 on the Global Prevention Program, which aimed to improve guidelines and education at the primary care level in China, so that we could bend the curve of cardiovascular disease. Since its launch, the program has helped an estimated 230 million patients globally by equipping more than 70,000 clinicians across 10 countries with the latest science, technology, resources, tools, and best practices in treating patients along the cardiovascular disease continuum.
In May, we launched the next phase of the program called the NCD Academy. The NCD Academy is a user-friendly, interactive web-based platform designed to equip health care professionals with educational resources and skills to enhance their ability to prevent and treat NCDs around the world.
What else is Pfizer Upjohn doing to reduce the burden of NCDs?
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By understanding specific NCD burdens and a country’s preparedness to combat NCDs, we can help develop the appropriate frameworks at the local level.
For example, we partnered with the NCD Alliance to publish a report on the urgency of enabling our health workforce to better tackle NCDs. The report, which was published during the 2019 UNGA, highlighted the current gaps, challenges, and barriers to an effective health workforce, focusing on frontline health workers at the primary care level.
In late 2019, we also gathered experts from across the health sector in LMICs to participate in an expert forum on NCDs in Dubai. The forum was designed to help identify the largest NCD-related issues in LMICs and provide practical solutions to addressing the rising burden.
We believe we will only succeed in addressing patient-specific challenges in NCD prevention and management if we partner with stakeholders on the frontlines of policy development and patient care in each country.
To find out more about systemic solutions for addressing NCDs in LMICs, click here.