The ABCs of NCD Care
Achieving global health security certainly requires managing headline-grabbing infectious diseases such as Ebola, the Zika virus, and others that have not even appeared yet. But it also requires a deeper commitment to systems of long-term preventive care and management of chronic noncommunicable diseases like diabetes.
GENEVA – The World Health Organization recently began sounding the alarm about a deadly new pathogen called Disease X. In fact, Disease X does not actually exist, at least not yet. Rather, it is part of a clever public-awareness campaign by the WHO to prepare people and governments for the threat posed by new infectious diseases.
The emergence of dangerous new infectious diseases is not a matter of if, but when. As the WHO announcement makes clear, we urgently need to develop stronger, more responsive public health systems to confront future epidemics.
But while outbreaks of infectious illnesses such as Ebola, flu, Zika, SARS, and – hypothetically – Disease X tend to capture headlines, most global health practitioners understand that noncommunicable diseases (NCDs) like diabetes, hypertension, and cancer pose an even greater threat to health and economic stability. According to the World Obesity Federation, obesity-related NCDs could cost the world as much as $1.2 trillion per year by 2025. That will have a profoundly destabilizing effect on low- and middle-income countries, and it could derail efforts to achieve global health security.
Avoiding such an outcome will require us to rethink investments in global health systems. At the same time that we prepare for the emergence of Disease X, we must also strengthen the kind of supportive health-care systems that help patients live full, healthy lives. To that end, health-care providers, non-governmental organizations, governments, and businesses in some of the highest-risk countries are collaborating to develop innovative approaches to combat NCDs.
One promising initiative is Casalud (a portmanteau of the Spanish words for “house” and “health”). Created by the Carlos Slim Foundation with the backing of the Mexican government and evaluation support from Eli Lilly and Company, Casalud uses a multi-pronged approach to improve detection, diagnosis, and treatment of Type 2 diabetes. It also works to prevent the disease by raising awareness of key risk factors such as excess weight.
Diabetes poses an especially grave threat to Mexico, where urbanization and other social changes are pushing people toward more sedentary lifestyles and triggering a surge in obesity-related diseases. If current trends continue, the number of people living with diabetes in Mexico is expected to increase from 11.5 million to 16 million – over 10% of the population – between 2016 and 2035.
One of the main challenges Mexican health-care providers face in tackling the problem is that many people with NCDs are managing their diseases outside the hospital setting. Most of the country’s diabetes specialists are concentrated in referral centers. Yet roughly 30 million Mexicans have access only to primary-care clinics operated by the Seguro Popular, Mexico’s public health system for people without health insurance. This implies a significant gap in diabetes management for a large portion of the population.
That is where Casalud comes in. To fill the gap in care, Casalud introduced a program of integrated mobile devices and continuing education to empower primary-care providers – including nurses and clinical workers – to be more proactive in screening for diabetes. The program’s use of mobile technology allows health-care workers (and others) to measure blood sugar and other vital indices as part of a regular checkup.
Casalud also created an online information management system to coordinate patient care and referrals, and to manage the supply of necessary medicines. Most important, Casalud planners, understanding that primary-care providers in clinics have only a small window to educate patients on improving their own quality of care, introduced mobile technologies to enable ongoing monitoring and patient-provider communication between visits.
The program’s technological features have also made life easier for providers. Before the mobile inventory-management system was introduced, 44% of pharmacies routinely ran out of key medicines; now, just 15% of pharmacies do.
The expansion of the Casalud system in recent years attests to its success. Initially launched in 2009 in clinics across seven Mexican states, by 2015, it had been extended to clinics in 20 states, serving 1.3 million patients per year. Now, the Mexican government has incorporated it into its national strategy to combat obesity and diabetes.
The WHO should be commended for raising awareness about the threat of new infectious diseases. But we should also remember that global health security is about more than protecting people from the latest bug. It means accompanying patients along the full continuum of care, to ensure that they live long, healthy, and productive lives.
To do that, we will need to strengthen current health systems, educate and empower frontline health-care workers, and maximize cost-saving technologies. We have already seen the high returns of this approach in Mexico. Now it is time to bring it to the rest of the world.