ncdrt briefing slides (july 14 2016)

The Emerging Crisis of Noncommunicable Diseases

Congressional Briefing on Non-Communicable Diseases

July 14, 2016

First CFR Task Force Devoted to Global Health

Task Force Members

David Agus

Barbara Bryne Dan Glickman Betsy Nabel

J. Brian Atwood Jean- Paul Chretien

Eric Goosby David Satcher

Sandy Berger Mitchell Daniels* Vanessa Kerry Donna Shalala

Karan Bhatia Steve Davis Michael Klag Ira Shapiro

Tom Bollyky Thomas Donilon* Risa Lavizzo-Mourey

Tommy Thompson

Nancy Brinker Ezekiel Emanuel Christopher Murray

Questions

• Are NCDs an emerging crisis in low- and middle-income countries?

• Do the United States and other donors have interest in addressing that crisis?

• Why Now? in it?

Are NCDs an emerging crisis in low- and middle-income countries?

Causes of NCD deaths in LMICs

Proportion of NCD Death & Disability that Arises under 60

Worse Outcomes

Not Merely a Byproduct of Success & Unhealthy Lifestyles

Bollyky et al., Health Affairs (2015)

Source: The Gapminder Foundation Source: Institute for Health Metrics and Evaluation, Global Health Spending Database (2013).

Source: United Nations, World Urbanization Prospects (2014)

Top Health Risks in LMICs

The Case for Greater Engagement on NCDs

US FY13 Global Health Budget

Health Burden in U.S. Priority Countries

Proportion of DALYs due to NCDs by Age

Source: Bloom et al., World Economic Forum (2011)

Why Now?

Case for Engaging on NCDs Now

Thank you!

[email protected]

Rachel Nugent, Ph.D. RTI International, Vice President

One-third reduction in premature mortality from NCDs

Presenter

Presentation Notes

As RTI develops its expertise in NCD costing, research, and intervention, and partners with the private sector, NGOs, and governments, we can effectively work to move the needle on incidence and prevalence rates of NCDs in countries, low-, middle-, or high-income. We will directly affect the Sustainable Development Goal of ensuring healthy lives and promote wellbeing for all at all ages. We will have the resources, capacity, data, and credibility to lead this global effort.

Thank you!

Health and the Economy: The Impact of Wellness on Workforce Productivity

The urgent need for public private partnerships to address the rise of chronic disease John F. Steele Senior Director, International Government Affairs Eli Lilly and Company

Presentation Topics

• Victoria University multi-country study on the increasing economic toll of NCDs—and the increasing engagement of the business community in addressing this threat to their workforces

• Closer country level look: South Africa

• The role the private sector can play working with governments

• Lilly case study of an on-going public-private partnership in NCDs

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Chronic Disease Economic Impact Study

• Study about the link between health and productivity

• Estimates the economic impact of: • Absenteeism (sick and absent from work) • Presenteeism (present at work but not working at full capacity due to illness ) • Early retirement due to ill health (retired 50-64 due to ill health)

• Multi-country study of 18 countries • Using mainly international data sources

• Presentation draws on four reports sponsored by : • APEC Life Sciences Innovation Forum • APEC Business Advisory Council • US Chamber of Commerce

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Ageing is rapidly increasing the proportion of older workers in many countries

Some countries have a rapidly ageing workforce e.g. China and some other developing countries.

Some countries, e.g. Japan, and the United States, already have ‘old’ workforces.

Both types of countries need older experienced workers. Therefore, keeping older workers healthy and working becomes an issue for economic growth and development.

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Source: International Labour Organization 2016, ILOSTAT Database.

Burden of disease: Non-communicable diseases (NCDs)

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NCDs (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes and mental illness) are generally thought of as a challenge only for developed economies, when in reality the disease burden of NCDs is as high among DEVELOPING economies as developed economies.

Source: Institute of Health Metrics and Evaluation (IHME) 2015, GBD Data.

Among the countries surveyed, NCDs, as measured by years lived with disability (YLDs) are as high for developing as developed countries. NCDs are 86% of the total morbidity disease burden.

Presenter

Presentation Notes

The double challenge: Ageing and the burden of disease

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The burden of NCDs rises steeply with age. On average the burden at age 65 is about 50% higher than at age 45.

Productivity loss 2015

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% GDP

Presenteeism averages 3.3% of GDP compared with 1.3% for absenteeism and 2.4% for early retirement

Presenteeism, that is, sick but at work, is a far greater cost to productivity than absenteeism.

Absenteeism, presenteeism and early retirement, 2015

0123456789

Early retirement due to ill health as % GDPPresenteeism as % GDPAbsenteeism as % GDP

SOUTH AFRICA RELATIVE MORTALITY - HIV vs T2 DIABETES – [PRIVATE SECTOR]

Lilly NCD Partnership

Finding new community-based solutions that can be

adapted, replicated and scaled.

Partnering with leading

health organizations

Strengthening healthcare systems

Expanding access to

medicines

Creating shared value

Leveraging Lilly’s Research, Report, and Advocate

framework

Focusing on 4 countries with high diabetes & NCD

burdens: Brazil, Mexico, India, South Africa

Company Confidential ©2015 Eli Lilly and Company

Presenter

Presentation Notes

NCDs, such as diabetes, are increasing rapidly around the world. These are no longer predominantly diseases of richer nations. As they increase in prevalence everywhere, many low- and middle-income nations, especially those where diabetes is a relatively new public health problem, are not equipped to effectively address this burden. In order to help these – and other nations – develop their health systems to better address diabetes, we are focused on addressing key unmet health system gaps in four high and growing burden countries by: Finding new community based solutions Partnering with leading health organizations to strengthen health systems, expand access to medicines and create lasting and shared value Leveraging Research-Report-Advocate so other countries and benefit and apply learnings from our programs. [If asked about specific work in different countries, our partnership does the following: In Mexico, helping bring diabetes care to the primary healthcare system. In Brazil, helping prevent type 2 diabetes in women who had gestational diabetes during pregnancy AND developing a new standard of care, including education, for juvenile (type 1) diabetes. In South Africa, increasing public awareness and engagement on diabetes and training health workers in both impoverished urban communities and rural areas. In India, improving access to diabetes care through health provider diabetes training, public awareness and education.]

Global Health Programs

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Problem definition Context: Rising burden of Type 2 diabetes

in settings with high prevalence of HIV/AIDS and TB

One of world’s highest rates of obesity

Socio-economic disparities lead to challenges in specific settings (urban, rural)

National shortage of qualified MDs

Gap: • Current diabetes care model

does not fully utilize the capabilities of other healthcare providers, such as nurses and community healthcare workers

Making Life Better

Partnership Approach(es) • Train community-based health workers to diagnose

and refer patients, launch peer support groups to raise awareness and manage diabetes, and strengthen clinics

• Conduct an assessment of current HIV/AIDS

treatment capabilities and apply a similar model to diabetes care

Expected Impact • Increased access to diabetes prevention services,

integrated diabetes and hypertension treatment primary care services, improved diabetes self-management, improved quality of life.

SOUTH AFRICA

Presenter

Presentation Notes

Tuberculosis is listed as one of China's major infectious diseases. In the past 10 years, the country has identified 8.29 million cases of tuberculosis. According to the World Health Organization, China remains the world's 2nd TB high-burden country, with 14% of global number of TB cases, ranking second in the world. In recent years, the number of Tuberculosis cases reported each year was about 1 million; the risk of MDR-TB has become increasingly prominent with an estimated 120,000 MDR-TB cases each year. In order to reduce TB infection, a National tuberculosis prevention & control plan has been approved (2011-2015) and the National Health and Family Planning Committee (Ministry of Health) is also encouraging international exchanges and expanded international cooperation. The NHFPC has established definite targets for increasing the number of MDR-TB patients diagnosed and treated over the next few years and therefore the national partners most involved in the diagnosis and management of TB/MDR-TB are working hard to meet the requirements in terms of provider training and readiness to meet these targets. The Lilly Foundation committed US $30 million to support the Partnership during its third phase (2012 - 2016), which involves two areas of focus: Healthcare provider training, and Improving supply and access to safe, effective and quality-assured second-line drugs. The Lilly MDR-TB Partnership will cooperate with Chinese well recognized Organizations to train healthcare professionals across China. The partners will design, implement, test, refine and report on training approaches in 11 provinces. In those provinces our partners will run the so called “Pilot centers” which are structured on existing selected TB hospitals. A pilot center will be established in each province. For each center, there will be one key city covering the counties and villages. The project has been selected to cover a range of demographics, geographic and social economy settings and the high burden provinces in China. The selection of target provinces is upon the priority of NHFPC depending on their working focus, implementation procedure and resource allocation through a joint-effort with NHFPC, CHINA CDC and CMA TB Society, which exactly reflected the focus of national plan. With this approach we aim at covering the whole country and collect feedback on the training model which will be implemented. Recognizing the importance to provide social support to the patients, the Lilly MDR-TB Partnership is also supporting the IFRC to work in Shanxi province.

Global Health Programs 43 Making Life Better

Partners • Donald Woods

Foundation

• Project HOPE Locations • Mbashe Region, Eastern Cape • Zandspruit, Johannesburg

SOUTH AFRICA

Presenter

Presentation Notes

An estimated 14.7 million people suffer from diabetes in sub-Saharan Africa, at least 78 percent of whom are yet to be formally diagnosed. The International Diabetes Federation calculates the number of people with diabetes could almost double by 2030. In South Africa, the problem is exacerbated by the fact that the vast majority of the population rely on a public health system already stretched in its response to an array of health challenges, including tuberculosis and HIV. The Lilly NCD Partnership has two partners in South Africa. We work with the Donald Woods Foundation in the rural Mbashe region to combine diabetes diagnosis and referral with an existing program of home-based care for people with HIV and TB in remote and poorly serviced areas. Our goal is to improve the quality of health care and patient safety in some of the poorest parts of South Africa. Our work focuses on expanding access to medicines, as well as other treatment and care in remote, rural communities of the Eastern Cape. We are collaborating to develop pioneering approaches, methodologies, and tools to ensure optimal outcomes in several key priority areas: HIV/AIDS, TB, diabetes, hypertension, and maternal and child health. We also aim to significantly reduce the costs of health services and patient access, with a goal of replicating successes in other locations. Resources Donald Woods Foundation Website: http://www.donaldwoodsfoundation.org/ Lilly NCD Partnership photos for South Africa (DWF photos start at number 166): http://globalhealthprograms.smugmug.com/Other/NCD-South-Africa/26426222_LtL8mf#!i=2212606355&k=LH6vc2b Lilly NCD Partnership photos for South Africa, including launch of partnership (DWF location shots begin at number 59): http://globalhealthprograms.smugmug.com/Other/NCD-SA-Launch-2012/26887277_Dkt6ZC#!i=2253270025&k=bZDbzwc

Key takeaways

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• With aging populations, conserving labor supply by extending working lives becomes an issue for economic growth and development

• High and increasing levels of NCDs are imposing significant social and economic costs on economies and threaten economic development

• Need for government and business to work in partnership to address NCDs, for example through:

• Prevention and treatment – Workplace wellness programs, screening and early

detection, health education, leveraging technology and innovation in delivery systems

• Organizational innovation – A “whole of government” approach (i.e., dedicated interagency team) and “whole of society approach (i.e., national NCD action plan)

• Financing – Innovative financing schemes

• Healthcare infrastructure – Primary care and building a health workforce that includes allied workers and community practitioners

Thank you!

http://www.ncdroundtable.org/

ncdrt briefing slides (july 14 2016)

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