Evan Lee: Three Learnings for the Global Noncommunicable Diseases Fight

 By Evan Lee, MD, Vice President, Global Health, Eli Lilly and Company 

Working in global development, it’s impossible to avoid seeing the heavy personal and societal tolls being wrought by cancer, chronic respiratory disease, diabetes, heart disease, and mental health. These noncommunicable diseases (NCDs) account for three out of every five deaths across the world. The impact is even greater in developing countries, where limited resources and structural barriers hamper access to care.


There is, however, reason to be hopeful. Public health campaigns, supported by commitments through the U.N. Sustainable Developments Goals, are mounting a global response to address these diseases. And much has already been learned about how to tackle the multi-faceted barriers to health care access through collective and coordinated action. As we look to make widespread impact against NCDs, three lessons emerge that should guide our work. 


1. Harness the power of partnership. Driven by growing demand for equitable progress, many businesses are evolving beyond traditional philanthropy to adopt more integrated approaches to development. Companies like Nestle, Nike, and several pharmaceutical companies including Lilly increasingly tailor business strategies to maximize societal value in limited-resource settings.


This is the goal of a new multi-stakeholder partnership that was launched last week by the World Bank, the Union for International Cancer Control and 22 pharmaceutical companies. The initiative, called Access Accelerated, aims to improve NCD prevention, diagnosis, and treatment in the hardest-hit regions through new collaborations to expand health care access, eliminate systemic barriers, and share solutions with governments and health care leaders. Rigorous monitoring and evaluation will ensure that the impact of the work is understood and can inform wider health care decision-making.


2. Double down on primary care. In many low- and middle-income countries, grassroots-level primary care is the first and only entry point into the health care system. This represents our best opportunity to assess people, diagnose disease, and treat or refer patients to get the care they need to address NCDs. Establishing strong connections to patients at the point of primary care is essential to delivering the care they need to manage chronic conditions over time, and eventually enable people to take greater ownership for their health. On this foundation, effective integrated support systems can be built for the management of many chronic diseases.


Mexico’s approach is a case in point. For several years we have partnered with the Carlos Slim Foundation which developed and piloted the CASALUD healthcare model—a comprehensive approach to address diabetes in primary care clinics. This model, known as MIDO, rests on locally developed proprietary technology that promotes both active and passive patient management. When people come to the clinic, providers use the system to measure weight, blood pressure and glucose levels. If needed, MIDO then offers personalized guidance on treatment options, while reporting the data to regional and national health authorities. A backpack version of this technology enables healthcare workers to perform the same tasks at a person’s home, empowering them to proactively engage community members about their health and lifestyle practices—and increasing early detection and prevention of disease.


The primary care-focused CASALUD has proven so effective that the Government of Mexico adopted it as part of the country’s National Strategy Against Obesity and Diabetes. By investing in a comprehensive approach to target diabetes at the primary care level, Mexico has been able to not only improve management of the disease, but also apply and expand the learnings to target key NCD risk factors nationwide.


3. Embrace and share learnings. Efforts to prevent and treat NCDs must go hand-in-hand with measurement and evaluation to understand how different approaches work—or not. Many development professionals—including those of us in the private sector—depend on success to ensure steady funding and program support. But whether a project succeeds or fails, the most important takeaway is what we’ve learned and how it informs and improves our next steps. Making these learnings known to others is also critical to wider spread benefits.


This objective guides our global health work at Lilly. We hold an annual summit to convene partners from India, South Africa, Mexico, and Brazil to share their results and learnings, and we’ve found that much of this knowledge translates across borders. Our partners have gained insight they can apply at the local level from discussions, for example, about optimizing the transition from screening to diagnosis for diseases like diabetes and hypertension, and best practices for utilizing software to manage large amounts of data that accumulate in chronic disease management.


These three lessons can help the global development community make widespread gains against NCDs. By working together more effectively, doubling down on primary care, and learning from our work—both success and failures—we can strengthen the global response to NCDs and ensure fewer people suffer from preventable and treatable diseases.



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