The NCD Alliance is consulting with people living with a range of NCDs, including care partners on the following:
The experience of living with/managing NCD conditions during the COVID-19 pandemic
Their recommendations to shape stronger health systems and more resilient communities as part of and beyond the COVID-19 response
Their perspectives to inform a Global Charter on the Meaningful Involvement of People Living with NCDs planned for 2021, aiming to promote an NCD response that puts people first
The online consultation survey is available in three languages: English, Spanish or French. The surveywill close on Sunday, 25 October 2020.
#NCDVoices Stronger, Together: We invite you to share the consultation survey with your networks of people living with NCDs!
Read more about the Our Views, Our Voices initiative here. If you have any questions or clarifications, please feel free to contact Manjusha Chatterjee at [email protected]
Among high-income countries, only Denmark, Luxembourg, New Zealand, Norway, Singapore, and South Korea are on track to meet the SDG target of a third reduction in NCD mortality by 2030 for both men and women at current rates of decline.
Relationship between COVID-19 and non-communicable diseases highlights urgent need for governments to implement policies to prevent avoidable deaths from chronic diseases.
Around the world, the risk of dying prematurely from preventable and largely treatable chronic diseases such as stroke, heart disease, and stomach cancer has declined steadily over the past decade, but death rates from other chronic diseases such as diabetes, lung cancer, colon cancer, and liver cancer are declining too slowly or worsening in many countries.
Many countries are falling short or behind on their commitments to reducing premature mortality from chronic diseases, or NCDs. Among high-income countries, only Denmark, Luxembourg, New Zealand, Norway, Singapore, and South Korea are on track to meet the SDG target for both men and women if they maintain or surpass their recent rates of progress.
These are the findings of the 2nd edition of the NCD Countdown 2030 report, published on Friday 3 September in TheLancet, ahead of the Global Week of Action on NCDs 7-13 September week. The 1st NCD Countdown Report was released in 2018.
NCDs currently kill over 40 million people a year worldwide, making up seven out of ten deaths globally. 17 million of these deaths are of people younger than 70 years old and classed as premature; the great majority (15 million) of these deaths are between 30 and 70 years.
In 2015, world leaders signed up to achieve the United Nations’ Sustainable Development Goal 3.4 of a one-third reduction in deaths between 30 and 70 years of age from four key NCDs – cancer, cardiovascular disease, chronic respiratory disease, and diabetes – by the year 2030. The NCD Countdown 2030 report, led by Imperial College London, World Health Organization, and the NCD Alliance, reveals that the global goal to reduce premature mortality from NCDs by one third by 2030 is still achievable but many countries are falling short.
“No country can reach that target by simply addressing a single disease – what is needed is a package of measures, a strong health system, which addresses prevention, early detection and treatment, tailored to the national situation,” said Majid Ezzati, Professor of Global Environmental Health at Imperial College London, who led the study.
“Young people must lead the fight against NCDs. An estimated 150 million people will lose their lives too early from a noncommunicable disease over the next decade and right now NCDs are intensifying the impact of COVID-19,” said Dr Bente Mikkelsen, Director of NCDs, World Health Organization. “We must ensure that all NCDs are addressed in COVID-19 recovery plans so that we can turn this deadly tide. We cannot allow NCDs to become a generational catastrophe, where human potential is wasted, and inequality is exacerbated.”
NCDs in the context of the COVID-19 pandemic
People living with many NCDs are being disproportionately affected by COVID-19 – they are at a considerably higher risk of suffering severe illness and dying from the disease. At the same time, the ability to reach the UN targets is being challenged by the added impact of the COVID-19 pandemic which is severely disrupting the capacity of national health services to deliver regular screening, diagnosis, treatment and prevention of NCDs.
COVID-19 has exposed how a failure to invest in effective public health to prevent NCDs and provide health care for people living with NCDs can come back to bite us,” said Katie Dain, CEO of the NCD Alliance. “The good news is that all countries can still meet the 2030 targets, with sound policies and smart investments. NCD prevention and treatment can no longer be seen a ‘nice to have’, it must be considered as part of pandemic preparedness.”
In an editorial, The Lancet highlights that: “COVID-19 and NCDs form a dangerous relationship, experienced as a syndemic that is exacerbating social and economic inequalities… COVID-19 is a pandemic that must highlight the high burden that NCDs place on health resources. It should act as a catalyst for governments to implement stricter tobacco, alcohol, and sugar controls, as well as focused investment in improving physical activity and healthy diets. COVID-19 has shown that many of the tools required for fighting a pandemic are also those required to fight NCDs: disease surveillance, a strong civil society, robust public health, clear communication, and equitable access to resilient universal health-care systems… COVID-19 must stimulate far greater political action to overcome inertia around NCDs.”
Tracking country progress on SDG 3.4
The UN measure of progress towards the SDG target 3.4 is reducing by one-third the risk of death between 30 and 70 years of age from four major groups of NCDs (cancers, cardiovascular diseases (CVDs), chronic respiratory diseases, and diabetes), termed NCD4. Based on recent (2010-2016) trends, the NCD Countdown 2030 report finds that:
Among high-income countries, only Denmark, Luxembourg, New Zealand, Norway, Singapore, and South Korea are on track to meet this target for both men and women if they maintain or surpass their 2010–16 average rates of decline.
17 countries are already on track to reach the SDG target 3.4 for women: Belarus, Denmark, Iran, Kazakhstan, South Korea, Kuwait, Luxembourg, Latvia, Maldives, Norway, New Zealand, Russian, Federation, Singapore, Serbia, Timor-Leste, Ukraine.
And 15 countries are on track for men: Bahrain, Belarus, Czech Republic, Denmark, Finland, Iran, Iceland, Kazakhstan, South Korea, Luxembourg, Maldives, Norway, New Zealand, Singapore, Slovakia.
The risk of dying prematurely from NCD4 is declining rapidly in central and eastern Europe.
However, large countries that showed stagnation or small increases in risk of premature death from these NCDs are Bangladesh (men), Egypt (women), Ghana (men and women), Cote d’Ivoire (men and women),Kenya (men and women), Mexico (men), Sri Lanka (women), Tanzania (men) and the USA (women).
Tracking progress on four major groups of NCDs
Worldwide, deaths from stroke, heart disease and stomach cancer are falling, although overall progress has slowed compared to the previous decade, according to WHO [3]. Deaths from diabetes, lung cancer, colon cancer and liver cancer are stagnating or rising in many countries. The NCD Countdown 2030 report shows that (see figure 2):
The risk of premature death from ischaemic and haemorrhagic stroke, heart disease, chronic lung diseases and stomach cancer declined faster than that of other causes. However, heart disease remains the leading cause of premature death in most countries for men and in about half the countries for women.
In contrast, the risk of premature death from diabetes, colorectal cancer, liver cancer, breast cancer and prostate cancer declined more slowly than other causes, as did lung cancer among women.
For lung cancer in women and colorectal, liver and prostate cancers in men, the risk of premature death increased in more than half of countries.
Policies to accelerate decline in premature mortality
The report notes that although premature death from NCDs is declining in the majority of countries, the pace of change is too slow to achieve SDG target 3.4 in most. The authors used mathematical modelling to assess how many options countries have for accelerating mortality decline. “To move forward we must learn from those countries that are doing well and replicate their strategies to NCD prevention and healthcare,” said Professor Ezzati. “Our analysis shows that every country still has options to achieve SDG target 3.4 but they need to address multiple diseases and have strong health systems.” [2] To that end the report highlights the set of interventions needed to move countries forward:
Tobacco and alcohol control and effective health system interventions, such as a ban on advertising, increasing taxes, plain packaging, public smoking/drinking bans.
Quality primary care – including equitable access to doctors’ surgeries and community-based clinics.
Quality referral systems and consistent maintenance of people in care to help patients get the right treatment at the right time.
A range of medicines and techniques available for early diagnosis and treatment – such as increased equitable access to preventative cholesterol-lowering, hypertension and diabetes medicines.
Effective cancer screening and treatment – to diagnose and treat cancers earlier, reducing long-term health impacts and premature deaths.
Dr Vicki Pinkney-Atkinson, Director of SA NCD Alliance says, “People living with NCDs believe it’s a health right to have proper access to care and medicines, especially now during a time of pandemic. Before COVID-19, the NCDs group of conditions killed most South Africans and remained neglected within government policy and budgets. For so long the many millions of people living with NCDs have lamented, ‘it would be better if I had HIV, then I would get access to quality care and medicines.”
NCDs, called underlying conditions during COVID-19, cause most deaths in South Africa. Diabetes kills more women than any other single illness for many years. (1) Government media acknowledge that 90% of those who die following COVID-19 infection had one or more NCD. (2)
Act on NCDs Now – Accountability
The early figures coming out of Wuhan showed that NCDs increased the risk of complications and dying. It was clear that survival depended on well-managed conditions such as diabetes. It immediately exposed the fault lines in NCDs care.
The aim is to get government to implement ongoing care for those living with NCDs by health workers during and beyond COVID-19. This includes ensuring adequate supply of medications that don’t involve travel and visits to facilities and making use of online and tools for consultations to minimise physical interaction and exposure.
The Alliance further proposes performance indicators to assess government’s response to COVID-19 and ongoing NCDs care such as maintenance of food and medicine supply chains, protection and support for vulnerable and neglected people and maintenance of usual health services.
“As South Africans went into lockdown in March, the SA NCDs Alliance initiated online support, counselling and information services to keep people healthy such as the diabetes care line. Those of us living with diabetes soon learned that optimal blood sugar control is the best way to survive a COVID-19 infection. However, getting care and a regular supply of medicines in the public sector involved a stark choice; get your medications or get the virus. Unlike for HIV and TB, a remote non-clinic supply point is a rare option. Insulin, absolutely critical to sustain life in diabetes, is only available at a hospital-level even if there is a clinic next door,” elaborated Pinkney-Atkinson.
Zodwa Sithole, Head of Advocacy for CANSA added, “Patients are feeling frustrated and despondent as they struggle to access vital support services. A cancer patient’s low immunity and high infection risk for COVID-19, results in anxiety and physical distancing and hygiene measures add to a feeling of isolation even as lockdown levels are eased. Part of the response was the launch of our CANSA Tele Counselling service offering free, confidential cancer-related telephonic counselling available in seven languages.”
Nosipho (3) puts the human face on the access issue. In late pregnancy, she always needs insulin and asthma medication. Being a savvy diabetic, she knows she is at risk and tries to avoid the minimum five-hour round trip to get her insulin in central Cape Town during the COVID-19 surge. She knows that the risk of infection is high by using public transport and the long waiting lines at the hospital. When asked, the government sectors were unable to offer a solution.
For other NCDs like cancer, there are implications of delaying any screening that can result in cancers being detected at a later stage and affecting treatment outcomes.
Pinkney-Atkinson concludes, “What works to keep diabetics and other people living with NCDs safe, is not a mystery. There is plenty of evidence, we need action to provide ongoing NCDs care during COVID-19. (4) During the COVID-19 pandemic and beyond, we must go beyond stopping the virus and our right to get our ongoing essential services safely. We need these drugs and supplies (needles and syringes) to stay alive.”
For more information, please contact Dr Vicki Pinkney-Atkinson, Director of SA NCD Alliance at email [email protected]
Call 083 38 38-159. Alternate contact is Lucy Balona, Head: Marketing and Communication at CANSA at email [email protected].
Call 011 616 7662 or mobile 082 459 5230.
References:
(1) Statistics South Africa. Mortality and causes of death in South Africa, 2016: Findings from death notification [Internet]. Pretoria; 2018 [cited 2018 Mar 28]. Available from: http://www.statssa.gov.za/publications/P03093/P030932016.pdf
(2) SA Government News Agency. SA COVID-19 cases rise to 3 034. SANews.gov.za. 2020;2
(3) Not her real name
(4) Young T, Schoonees A, Lachman A, Kalula S, Mabweazara S, Musa E, et al. Taking stock of the evidence. Cape Town: Better Health Programme South Africa; 2020. 50 p
About NCDs+
NCDs are a large group of health conditions that are generally not spread from person to person and used to be called chronic illness until 2000 when the Millennium Develop Goals force a new definition. Often the 5 main NCDs groups of conditions are noted: diabetes, circulatory disorders, mental health, cancer, and chronic respiratory illnesses. However, there are many more conditions that do not get a mention. Globally NCDs conditions are responsible for 41 million deaths annually and they are leading cause of death in South Africa since 2013. Diabetes is the leading cause of death of South African women.
However, the NCDs agenda is not just about illness it goes to a whole of society and whole of government response and for this we need an expanded understanding, meaning, NCDs+. The expanded NCDs+ advocacy agenda includes prevention, vulnerable populations, stigma control and disability. NCDs+ has many determinants (social, economic, and commercial) that disproportionately impact poor people. The Sustainable Development Goals (SDGs) address NCDs+ and its inclusion as an equal part of universal health coverage. (National Health Insurance in South Africa).
About the SA NCDs Alliance
The SA NCDs Alliance, established in 7 years ago, is a civil society partnership between three trusted NCDs advocacy organisations: CANSA, Diabetes SA and the Heart & Stroke Foundation SA.
Its mission is for the people of South Africa have equitable access to quality NCDs+ prevention and management within universal health coverage/ NHI.
For this important COVID-19 and NCDs+ advocacy project nearly 90 civil society organisations are collaborating:
The SA NCDs Alliance’s goal in this programme it to ensure that the policy window of opportunity opened by the COVID-19 pandemic is used to make NCDs a priority in government policy through collaboration with NCDs civil society to put it on a par with HIV & TB. www.sancda.org.za
20 civil society alliances in mainly low- and middle-income countries, including the South African Non-Communicable Diseases Alliance, were awarded grants to accelerate the response to the COVID-19 pandemic. The grants, made by the first Civil Society Solidarity Fund on Non-communicable Diseases (NCDs) and COVID-19, were announced today by the global NCD Alliance during a high-level online event.
Todd Harper, President of the global NCD Alliance, said: “The COVID-19 pandemic shows many intersections between COVID-19 and NCDs. People living with NCDs are more vulnerable to COVID-19, with a substantially higher risk of becoming severely ill or dying from the virus. The pandemic also impacts the poorest communities around the world and the most vulnerable people in every country. The civil society solidarity fund was born out of the need to tackle NCDs as fundamental to health security and to prevent a reversal of gains made in NCDs prevention and control around the world”.
The fund, totalling $300,000, competitively awarded grants of up to US$15,000 to national and regional NCD alliances. The purpose of the grants is to support alliances to address the critical needs of people living with NCDs during COVID-19 via advocacy and communication activities that will support stronger organisational stability and resilience.
Dr Vicki Pinkney-Atkinson, Director of SA NCDs Alliance, states: “Until the COVID-19 pandemic exposed the inequitable fault lines in the health system, NCDs+ are a neglected priority in South Africa. In South Africa, 99% of the people who have died because of COVID-19 are those of us living with NCDs+. The funding is a cause for celebration in an otherwise dark time with record daily number of new infections and deaths. It will allow the participation of people living with NCDs+ to building back a better health system with equity for NCDs prevention and treatment. We can work alongside the government to ensure that NCDs public health plans are equal to those for HIV and meet our needs.”
Katie Dain, CEO of NCD Alliance, added: “This is a first-of-its-kind fund to support NCD civil society organisations (CSOs) response to COVID-19. During pandemics, momentum in several health and sustainable development issues, notably HIV/AIDS, Ebola and climate change, have repeatedly reinforced the critical role of CSOs and community-led efforts in accelerating action from local to global levels. Civil society are proven campaigners, change agents, experts, implementers and watchdogs”.
The millions of South Africans living with NCDs+ are a critical at-risk, vulnerable group during COVID-19. No community is spared from the impacts of COVID-19 or NCDs, affecting rich and poor alike. The COVID-19 pandemic, despite its huge negative impact, offer a policy window of opportunity to work together to build a better health system and society free from the preventable suffering, disability, and death caused by NCDs.
The NCD Alliance Civil Society Solidarity Fund on NCDs and COVID-19 is possible thanks to generous financial contributions of global NCD Alliance’s supporters: The Leona M. and Harry B. Helmsley Charitable Trust, Access Accelerated, Takeda, AstraZeneca and Upjohn (Pfizer). The Fund received 45 submissions from national and regional alliances across all regions, which were reviewed by a selection committee. The Fund recognises the essential work of NCD advocates, which now becomes even more critical than ever to ensure political and media attention to the needs of people living with NCDs as one of the most vulnerable groups to COVID-19.
The recipients of the Civil Society Solidarity Fund are from Africa, Asia, Europe, Eastern Mediterranean and Latin America:
The Southern Africa Food Lab notes with concern indications in the media and from first hand reports that government is acting to limit civil society initiatives for food security and food relief.
The lockdown, which was imposed on 27 March 2020, while necessary in slowing the spread of the virus, has had numerous consequences, the most serious of which has been growing anger. With many industries shut down and people already living on the breadline, there are neither wages nor savings to fall back upon. In addition, the closing of schools has meant that some 9 million children stopped receiving a daily meal through the school feeding scheme. Recent research conducted by Ask Afrika estimates that 1 in 3 adults in South Africa now go to bed hungry. The downturn in economic activities and capacity means that the need will continue to outstrip relief even as we shift to Level 3 restrictions.
One of the great positives to have resulted from this crisis has been the response of civil society organising independently and almost instantaneously to feed people. In addition to existing feeding schemes and soup kitchens ramping up, countless initiatives have started up across the country to feed the nation’s hungriest. Such initiatives have complemented the central role of government.
It is therefore unfortunate that government has responded with counterproductive attempts to exert control over these civil society initiatives. This impulse to control civil society responses ignores the magnitude, complexity, and human costs of the hunger crisis, as well as the inherent constraints that the government faces in responding.
As the Southern Africa Food Lab, we believe that both the science-based response of government to the pandemic and the vital contributions of civil society initiatives to addressing hunger must be recognised and celebrated.
We further believe that the only reasonable way forward if we are to avoid widespread starvation requires that government and other large organisations recognise the complementarity between their efforts and those of emergent networks and initiatives. While such networks must be diligent in abiding by strict standards of health and safety, government officials must commit to helping rather than hindering such work given that the collective goal is the same: that of ensuring the safety of our nation both from COVID-19 and hunger.
What has been demonstrated by the COVID-19 crises is that the nationally controlled and governed food system is flawed. We need far more integrated and local scale responses to food and nutrition security. The pandemic has exposed the inadequacy of existing governance processes and structures to progressively realise the right to food, and the attainment of food and nutrition security. We do not need a Ministry of Food, but for people that are part of local food systems to play a more proactive role in food questions. And for the structures of the state to enable these to work for everyone. This approach, which integrates the experience at a local level, will strengthen policy processes and avoid legal challenges such as the recent judgement allowing soup kitchens and NGOs to continue to operate. Civil society and nonstate actors may also need to engage in different ways of working in intersectoral forums, which may well require strategies for ‘stretch’ collaborations if they are to yield valuable new solutions.
These forums are part of the necessary efforts to coordinate deep and wide engagement through a multi-sectoral response with a clear goal in mind. A major reason for vulnerabilities in our provisioning systems is the lack of collaboration and cooperation between different actors within government, the market, and civil society. It’s time to activate the long discussed intersectoral approach to the food system. Among other things, we need to integrate nutrition more explicitly in our development discourse, including government policies in trade, investment, health, social development and agriculture, amongst others. Non-state actors’ critical role in the current relief response shows again that they must be involved in such co-ordination efforts towards a more just and inclusive food system.
Collaboration rather than control is essential if we are to effectively combat this crisis.
GENEVA-All over the world, the COVID-19 pandemic is causing significant loss of life, disrupting livelihoods, and threatening the recent advances in health and progress towards global development goals highlighted in the 2020 World Health Statistics published by the World Health Organization (WHO) today
“The good news is that people around the world are living longer and healthier lives. The bad news is the rate of progress is too slow to meet the SDGs and will be further thrown off track by COVID-19,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
“The pandemic highlights the urgent need for all countries to invest in strong health systems and primary health care, as the best defence against outbreaks like COVID-19, and against the many other health threats that people around the world face every day. Health systems and health security are two sides of the same coin.”
WHO’s World Health Statistics — an annual check-up on the world’s health — reports progress against a series of key health and health service indicators, revealing some important lessons in terms of the progress made towards the SDGs and gaps to fill.
Life expectancy and healthy life expectancy have increased, but unequally.
The biggest gains were reported in low-income countries, which saw life expectancy rise 21% or 11 years between 2000 and 2016 (compared with an increase of 4% or 3 years in higher income countries).
One driver of progress in lower-income countries was improved access to services to prevent and treat HIV, malaria and tuberculosis, as well as a number of neglected tropical diseases such as guinea worm. Another was better maternal and child healthcare, which led to a halving of child mortality between 2000 and 2018.
But in a number of areas, progress has been stalling. Immunization coverage has barely increased in recent years, and there are fears that malaria gains may be reversed. And there is an overall shortage of services within and outside the health system to prevent and treat NCDs such as cancer, diabetes, heart and lung disease, and stroke. In 2016, 70 per cent of all deaths worldwide were attributable to NCDs, with the majority of deaths (85%) occurring in low and middle-income countries.
This uneven progress broadly mirrors inequalities in access to quality health services. Only between one third and one half the world’s population was able to obtain essential health services in 2017. Service coverage in low- and middle-income countries remains well below coverage in wealthier ones; as do health workforce densities. In more than 40% of all countries, there are fewer than 10 medical doctors per 10 000 people. Over 55% of countries have fewer than 40 nursing and midwifery personnel per 10 000 people.
The inability to pay for healthcare is another major challenge for many. On current trends, WHO estimates that this year, 2020, approximately 1 billion people (almost 13 per cent of the global population) will be spending at least 10% of their household budgets on health care. The majority of these people live in lower middle-income countries.
“The COVID-19 pandemic highlights the need to protect people from health emergencies, as well as to promote universal health coverage and healthier populations to keep people from needing health services through multisecotral interventions like improving basic hygiene and sanitation,” said Dr Samira Asma, Assistant Director General at WHO.
In 2017, more than half (55%) of the global population was estimated to lack access to safely-managed sanitation services, and more than one quarter (29%) lacked safely-managed drinking water. In the same year, two in five households globally (40%) lacked basic handwashing facilities with soap and water in their home.
The World Health Statistics also highlight the need for stronger data and health information systems. Uneven capacities to collect and use accurate, timely, and comparable health statistics, undermining lower income countries’ ability to understand population health trends, develop appropriate policies, allocate resources and prioritize interventions.
For almost a fifth of countries, over half of the key indicators have no recent primary or direct underlying data, another major challenge in enabling countries to prepare for, prevent and respond to health emergencies such as the ongoing COVID-19 pandemic. WHO is therefore supporting countries in strengthening surveillance and data and health information systems so they can measure their status and manage improvements.
“The message from this report is clear: as the world battles the most serious pandemic in 100 years, just a decade away from the SDG deadline, we must act together to strengthen primary health care and focus on the most vulnerable among us in order to eliminate the gross inequalities that dictate who lives a long, healthy life and who doesn’t,” added Asma. “We will only succeed in doing this by helping countries to improve their data and health information systems.”
