What we know about early detection and diagnosis of NCDs

Noncommunicable diseases are among the most talked about health issues of 2018. Despite being the leading cause of death worldwide — with 85 percent of those occurring in low- and middle-income countries — it is only now, in large part owing to the inclusion of targets to tackle such diseases in the Sustainable Development Goals, that an unprecedented emphasis is being placed on NCDs.

Last week’s third United Nations High-level Meeting on NCDs further highlighted the seriousness of this global crisis and reinforced the urgent need for international action.

Due to the scope and complexity of the problem, however, attention and investments from multiple stakeholders across several key areas — from awareness to prevention, and diagnosis to treatment — are needed, as well as recognition of the existing gaps and imbalances. More attention is often paid to the prevention and treatment of NCDs, for example, while intervention opportunities in the space between prevention and treatment are often misunderstood and underinvested.

With these challenges in mind, Devex, in partnership with international health technology company Philips, surveyed more than 1,200 health care professionals about the roles early detection and diagnosis play in the fight against NCDs. Over a dozen NCD experts were also interviewed, to understand where and how early detection and diagnosis fits into effective NCD management and contributes to the commitment toward universal health coverage. Here are five things we learned from the report: “Early detection: A critical link for effective NCD management.”

1. Strong primary health care underpins the global response to NCDs

Progress in this particular area of global health has been slow, with NCDs often taking a backseat to infectious diseases, such as HIV/AIDS, claimed survey respondents. If the sustainable development agenda is to be achieved by 2030 — and the increasing burden of NCDs in developing countries addressed — it is imperative action be taken.

But where does the action start? According to 75 percent of respondents, with a strong primary health care system.

Respondents stressed the importance of building awareness, detection and diagnosis skills, and early treatment capabilities within such systems. However, in many LMICs, primary care infrastructure remains inadequate.

“In many developing countries, people must travel far distances to better hospitals, so we must take that equipment to the primary care clinics in order to facilitate early detection,” said one respondent.

Respondents also suggest that the NCD community can leverage lessons learned from the fight against infectious diseases and the use of the primary care system to improve NCD care.

2.  Early detection and diagnosis are being underprioritized

As with any illness or condition, earlier detection leads to quicker treatment. This can mitigate possible socioeconomic and other health effects. Yet the majority of respondents believe that NCD treatment receives a disproportionate level of attention in comparison to diagnosis and detection.

“Early detection is important, but is not sexy,” said José Luis Castro, president and CEO of Vital Strategies. “It ...does not always resonate with the public or decision-makers.”

And why not? Respondents cite health care facilities as often lacking basic diagnostic tools and explain that doctors are more incentivized to treat patients suffering from advanced stages of NCDs than to detect them at an early stage. Others state that some NCDs are “invisible” until they get serious, making early diagnosis difficult.

Despite this, 98 percent of survey respondents believe early NCD detection is not only beneficial to patients but is a good economic investment.

“That inability to diagnose early enough or well enough basically means that you end up spending more, treating more, and having a more complicated case,” said Eduardo Banzon, principal health specialist at the Asian Development Bank.

By detecting cancer, diabetes, or heart disease at an early stage, the need for high capital interventions later on can be reduced.

3. Governments must step up and lead their own response to NCDs

Survey respondents stress that in order for NCD care to improve, particularly around early detection and diagnosis, political will and leadership from developing country governments is critical. They are best positioned to understand local context and adapt solutions to fit it. However, only half the respondents believe governments have the right policies in place to tackle NCDs.

"That political commitment will lead to appropriation of resources and opportunities to engage productively with the private sector,” said Vital Strategies’ Castro. “Without that political commitment, it is very difficult to make progress.”

The health professionals explain that NCD policies and resource decisions, particularly in the case of prevention strategies, are too often delegated to ministries of health, but more sustainable and comprehensive solutions require leadership at the highest levels of government, or even discussions with other ministries such as trade, agriculture, information and communication technology, and finance.

4. International agencies, the private sector, and civil society need to be front and center of any approach

Governments don’t have to do this alone. Some 93 percent of survey respondents believe cross-sector partnerships are critical to building a system capable of preventing, detecting, and treating NCDs.

“NCDs cannot be fought in isolation. Everyone has a very key role and I think to achieve the targets that have been set out in the given timeframe, we have to come together as one,” said Sameer Pujari of the Be He@lthy, Be Mobile program at the World Health Organization.

Like many other global development challenges, building strong health systems to tackle NCDs and achieving UHC will require a coordinated and sustained effort from businesses, NGOs, local authorities, and civil society.

To read the full report and discover key actions on how early diagnosis fits into effective NCD management and what needs to be done to implement and scale these solutions, click here.

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