Non-communicable diseases (NCDs) were once described as lifestyle diseases: the problems of an aging or privileged population arising from excess. Not anymore. These days, when we think of diseases such as cancer, diabetes or cardiovascular disease, one would be hard-pressed to find someone – anyone – who has not been touched. Increasingly, these NCDs are a major health threat worldwide, responsible for more than 38 million deaths annually, with close to 75% of these occurring in low- and middle-income countries.
For developing countries, the rapid rise in NCDs will lead to a greater social and economic burden. Many of these countries are still struggling with communicable diseases, resulting in a dual burden of disease. This may have implications on poverty reduction efforts on a macro-level as greater resources are allocated to healthcare. At the household level, high healthcare costs associated with long-term management of NCDs can drive families into poverty.
To address the need for stronger action against NCDs in sub-Saharan Africa, RTI International, in partnership with Kenya’s Ministry of Health, convened an NCD Symposium in Nairobi in September 2016. This was the first symposium dedicated to NCD research to be held in Kenya.
Addressing the opening plenary, Dr. Joseph Kibachio, head of the Ministry’s NCD Division, called for the development of an implementation science research agenda to examine what works best and for whom in the African context, to respond to an epidemic that is responsible for an estimated one in four deaths annually in countries like Kenya.
He also urged that a collaborative research roadmap be developed by stakeholders from across all sectors — not just limited to health — to inform policy, planning and implementation in order to underpin a robust, multi-sectoral body of evidence for NCD-actionable policies.
This clarion call reflected a bold vision for the NCD response, which acknowledged the limitations of the existing research agenda. Current research on NCDs remains rather limited to assessing the extent or magnitude of a given disease within a given population. To really understand NCDs, it is necessary to modify the traditional epidemiological research methods typically applied to infectious disease, for a number of reasons:
- NCDs share common risk factors. There is no one-to-one relationship between NCDs and their risk factors. One risk factor may be related to many NCDs and one NCD may be related to many risk factors. Alcohol use, for instance, is a risk factor for cardiovascular disease and some types of cancer, as well as diabetes.
- NCDs develop progressively over an individual’s lifespan. Exposure to risk factors in childhood or adolescence may lead to development of NCDs in adulthood or old age. NCD research must consider approaches to prevention and management over the lifespan. Equally, patients may require long-term care so NCD research needs to employ a cohort model that looks at long-term and continuous assessment of care and its outcomes.
- NCDs typically do not occur in isolation. Associated illnesses (co-morbidities) are common, so research should therefore examine co-existing conditions as well, rather than a single disease of interest in isolation.
- NCDs require a combination of multiple interventions. This includes behavioral and clinical interventions whose effectiveness in combination should be investigated. Besides, active involvement of patients in their own care is critical. In this regard, NCD patients are highly involved in self-care and need to be informed as to how to best-manage their conditions. In fact, they should be considered partners in the research process as they generate and use evidence.
At APHRC, we are working across sectors to seek to fill some of the research gaps that are limiting our knowledge on the continent about how to best respond to the emerging threat posed by NCDs. One of the areas we are most committed to is the strengthening of research capacity that would address key gaps while considering core skills and competencies that are required for NCD research.
We consider it imperative to magnify efforts to stimulate long-term career interest in NCDs among researchers across Africa. Collaboration among research institutions, universities and government ministries should focus on equipping early- and mid-career researchers with fresh approaches and relevant skillsets for NCD research.
We also see immense value in a thoughtful and deliberate realignment from an epidemiological research approach to a contextually relevant one that addresses the multifaceted and complex relationships at the core of NCD prevention, management and response. Only when all stakeholders — from health to treasury; from agriculture to labor; from planning to education — engage in a coordinated approach can we ensure research uptake into policy and decision-making.
This widening of scope and approach to research requires innovation, courage and determination, as well as a significant investment of financial resources. We see value in exploring public-private partnerships to support this innovation, alongside traditional investments by development partners enhancing domestic resource allocations, to help address the gaps in knowledge and management of NCDs and to ensure ownership of the results.