The Role of Noncommunicable Diseases in the Pursuit of Global Health Security

Noncommunicable diseases and their risk factors are important for all aspects of outbreak preparedness and response, affecting a range of factors including host susceptibility, pathogen virulence, and health system capacity. This conceptual analysis has 2 objectives. First, we use the Haddon matrix paradigm to formulate a framework for assessing the relevance of noncommunicable diseases to health security efforts throughout all phases of the disaster life cycle: before, during, and after an event. Second, we build upon this framework to identify 6 technical action areas in global health security programs that are opportune integration points for global health security and noncommunicable disease objectives: surveillance, workforce development, laboratory systems, immunization, risk communication, and sustainable financing. We discuss approaches to integration with the goal of maximizing the reach of global health security where infectious disease threats and chronic disease burdens overlap.

World NCD Federation guidelines for prevention, surveillance and management of noncommunicable diseases at primary and secondary health-care for low resource settings

Noncommunicable diseases (NCDs) have emerged as a major public health problem globally due to demographic, epidemiological, nutritional, and socioeconomic transition. NCDs attributed to 73% of global deaths in 2017 and need urgent action guided by the global action plan for prevention and control of NCDs 2013–2020 to achieve the Sustainable Development Goal (SDG). NCDs also cause premature deaths (≤70 years) and nearly 80% of premature deaths happen in low‑ and middle‑income countries (LMICs). In the global framework of “Public Health Approach” to combat any disease, it needs a standard protocol to screen, diagnose, and manage. However, there are no comprehensive guidelines or
protocols available on the prevention, surveillance, and management of common NCDs at primary and secondary healthcare facilities of low resource settings, except for a few conditions. The current guideline provides simple and comprehensive guidance on the prevention,
surveillance, and management aspects of common NCDs targeting primarily healthcare professionals, including community health workers (CHWs), program managers, policy maker, and implementers at these healthcare settings. These evidence‑based, operational guidelines have been developed by experts from various national and international organizations and are explained under the heads of prevention, surveillance, and management. The management part is developed by nine subgroups one for each NCD, namely type 2 diabetes mellitus (DM), hypertension, cardiovascular diseases (CVDs), chronic respiratory diseases (CRDs), cancers, mental health disorders, cerebrovascular diseases/Stroke, chronic kidney diseases (CKDs), and chronic liver diseases (alcoholic liver disease [ALD] and nonalcoholic fatty liver disease [NAFLD]). The guidelines describe the policy and non-policy interventions for the prevention of NCDs, management strategies separately for primary and secondary healthcare settings including when to refer to tertiary healthcare facility, and an implementation framework for uptake of these guidelines at gross root level. These guidelines will serve as a basic tool for the practicing physician and CHWs at every level of healthcare to deliver quality NCD prevention and care. It has been developed taking the primary and secondary health settings and the provisions
and strategies under the National NCD Program.
The World NCD Federation envisions appropriate and effective implementation of these guidelines for reduction of premature NCD mortality, especially in the context of the low resource setting. In a way, this will help to reorient the existing health systems to combat the NCDs. The guidelines will be helpful to take further steps in capacity building for various cadres of healthcare staff on prevention, surveillance, and management of NCDs and evaluation at national, regional, and international levels.

Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery

Efforts from the developed world to improve surgical, anesthesia and obstetric care in low- and middle-income countries have evolved from a primarily volunteer mission trip model to a sustainable health system strengthening approach as private and public stakeholders recognize the enormous health toll and financial burden of surgical disease. The National Surgical, Obstetric and Anesthesia Plan (NSOAP) has been developed as a policy strategy for countries to address, in part, the health burden of diseases amenable to surgical care, but these plans have not developed in isolation. The NSOAP has become a phenomenon of globalization as a broad range of partners – individuals and institutions – help in both NSOAP formulation, implementation and financing. As the nexus between policy and action in the field of global surgery, the NSOAP reflects a special commitment by state actors to make progress on global goals such as Universal Health Coverage and the United Nations Sustainable Development Goals. This requires a continued global commitment involving genuine partnerships that embrace the collective strengths of both national and global actors to deliver sustained, safe and affordable high-quality surgical care for all poor, rural and marginalized people.