Diseases do not recognize silos (Watch Video)

In the recently released Global Burden of Disease report (see here), we see evidence that giant strides have been made towards reducing death and disease from infectious disease. This is largely due to the concerted mobilization of resources, financial and otherwise, towards the attainment of the Millennium Development Goals (MDGs).  At the same time, fears expressed in numerous quarters have been confirmed (see here and here ).

In developing economies all over the world, there is an increase in death and disease due to non-communicable disease (NCD). In 2010, NCDs accounted for two out of every three deaths globally. As a matter of fact, within the next decade, NCD is expected to overtake infectious disease, even in the poorest countries, as the predominant population health challenge. At the same time, premature death from infectious disease remains an intractable problem in many parts of the world.

What are NCDs (Non-Communicable Diseases)

What are NCDs (Non-Communicable Diseases) -Close Me

The term NCDs are used to refer to medical conditions/diseases that are non-infectious and non-transmissible/passed from person to person. These types of diseases are generally of slow progression and often last for a long duration. The four main types of NCDs on a global focus now are chronic diseases like Cardiovascular diseases (such as Heart Attack and Stroke), Cancers, Diabetes and Chronic Respiratory diseases (such as Chronic Obstructed Pulmonary Disease, COPD and Asthma). Disease entities that constitute NCDs are distinct by being of non-infectious origin unlike other priority high disease burden diseases of infectious origin such as Malaria, HIV/AIDS, Tuberculosis, etc.

However, bearing in mind that the Sub-Saharan part of the continent already bears the highest burden of preventable infectious diseases, the concern for NCDs in Africa is best summarized by the WHO 2011 factsheet as follows:

“NCDs already disproportionately affect low- and middle-income countries where nearly 80% of NCD deaths – 29 million – occur. They are the leading causes of death in all regions except Africa, but current projections indicate that by 2020 the largest increases in NCD deaths will occur in Africa. In African nations deaths from NCDs are projected to exceed the combined deaths of communicable and nutritional diseases and maternal and perinatal deaths as the most common causes of death by 2030.”

Population health is a complex issue. It is now understood that multiple interacting determinants feed into the causation of most diseases. Obesity for example was extensively studied in the United Kingdom’s Foresight program. One only needs to look at the resulting causal map to see the numerous enablers of and barriers to behavioral change relating to obesity. In many societies, the factors that keep people from staying healthy are often seemingly unrelated to health:

  • Unemployment that preclude access to health insurance and health care;
  • Poor housing and ventilation that accelerates the spread of tuberculosis;
  • Food deserts that constantly present us with unhealthy but cheaper food options; or
  • Gender inequality that limits the rights of women to protect their bodies and children in societies all over the world.

Our health is therefore intimately connected to the situations in which we are born, grow, live and work.  Thus in spite of the commendable effort towards attaining the MDGs, even in some of the most advanced economies on earth, people cannot stay healthy, even if they want to. Rather than narrowing down to a few goals and priority diseases, there is a need for approaches to solving population health challenges that embrace their inherent complexity.

We need to break down the silos between academic disciplines, sectors and countries. Diseases do not recognize these silos, so neither should we.

The context in which people experience health is constantly changing in different ways resulting from the interactions of numerous independent agents and institutions. Dynamic conditions call for dynamic solutions. In systems thinking, global health may have found an approach that does just that. In a concerted call for action, the World Health Organization and health system experts recently put forward recommendations towards the adoption of systems thinking to guide policy, education of health workers and front-line practice in global health. What we need are simple rules that frame our overarching aims of improved health outcomes, equity and social justice. We need to provide freedom for local actors to innovate and tailor solutions to suit their unique context. We need to be prepared to learn from failure and harness success. We need to break down the silos between academic disciplines, sectors and countries. Diseases do not recognize these silos, so neither should we.


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