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Developing a dynamic online library of NCD policies and actions to track progress towards the 25×25 goals
The PISCO project aims to develop a dynamic online library of NCD policies and actions to coordinate and track progress towards 25×25 goals, with an initial effort on policies to address salt intake.
As a global health communicator, Benn Grover believes that everyone deserves the right to live a healthy life, and he tries to do his part to see that happen. Prior to his current work, Benn was the Director of Strategic Communications for the National Forum for Heart Disease and Stroke Prevention. While at the National Forum, he oversaw the development and launch of the Policy Depot, an innovative social network for individuals worldwide who are committed to non-communicable disease policy solutions. Benn also volunteered as the Chief Communications Officer for NCDFREE, a youth-led social movement that creates political and social action that addresses non-communicable diseases through local, inspiring narratives. Before these positions, Benn was the Managing Editor for ProCor, a leading global platform for heart health and prevention in low-resource settings. Benn also sat on the global steering committee for the Young Professionals Chronic Disease Network. He earned an MA in Health Communication from Emerson College and a BA in English from the University of Massachusetts, Boston.
Jill is an epidemiologist and exposure scientist who designs empirical studies to assess the role of environmental pollution in cardiovascular disease development. She studies exposure to environmental pollutants including air pollution from the combustion of solid fuels and their impact on cardiovascular health in the context of urbanization and development. Jill has a joint Ph.D. in Population Health Sciences and Environment & Resources from the University of Wisconsin-Madison and a Masters in Population and International Health from Harvard University. She is excited to meet the new group of Emerging Leaders and look forward to working together to develop creative ideas and new strategies for cardiovascular disease prevention.
Juan Carlos uses his background in Psychology, Management of Human Resources, Biostatistics and Epidemiology in the Center of Excellence in Chronic Diseases CRONICAS to lead Cardiovascular Diseases Projects; especially, those related to prevention tools and intervention programs. In 2013, he successfully applied for a grant from NHLBI to study the functioning of CVD risk scores in Peruvians. In this study, it was concluded there was poor concordance between six known CVD risk scores, demonstrating the uncertainty of choosing any of them for public health and clinical interventions in Peruvian populations. Since these findings, we started to prepare new studies about the recalibration of CDV scores and implementation of behavioral change programs supported by informatics technology and guided by trained health personnel. Currently, Juan Carlos is also a lecturer of Biostatistics at UPCH. At present, his research activities are centralized at CRONICAS and the Peruvian Institute for Psychological and Psychosocial Research (PSYCOPERU).
Kirsten is a post-doctoral research fellow with the Chronic Diseases Initiative for Africa at the University of Cape town and the Nuffield Department of Primary Care Science at the University of Oxford. Kirsten completed her undergraduate medical training at the University of Cape Town and her PHD in epidemiology in the Cancer Epidemiology Unit at the University of Oxford. Her current research is focused on using mobile-phone based technology to improve the management and outcomes in people with chronic diseases in low resource settings.
Dan is currently the Principal Investigator of the Ellisras Longitudinal Study (ELS) which started in 1996 in the Ellisras rural areas of South Africa. The ELS enrolled 2200 children, in preschool and primary school, for long term follow-up through the collection of biannual anthropometric measurements, lifestyle characteristics, education, physiological, psychological, and health parameters. Dan will continue to oversee the ELS as it further follows up with these participants to collect data on socioeconomic status, dietary intake, nutritional habits, mortality and morbidity, alcohol consumption, smoking habits, physical activity, psychological questionnaires and blood samples for lipids.
Renzo is an emerging young leader in global health research, advocacy and education. Aside from consultancies with WHO, EU, and IOM, his current work focuses on the nexus between climate, energy, and health. Renzo is a member of the University of the Philippines Manila’s Universal Health Care Study Group, WHO steering committee on social determinants of health and transformative health workforce education, and The Lancet-University of Oslo Youth Commission on Global Governance for Health. He is a member of numerous national and international networks, including the International Federation of Medical Students’ Associations (IFMSA) in which he served as Liaison Officer to the WHO, Regional Coordinator for the Asia-Pacific, and Founding Coordinator of the IFMSA Global Health Equity Initiative. Renzo has published widely on diverse subjects, ranging from climate change and universal health coverage to medical education and migrant health, and has given lectures and workshops in more than a dozen countries. An ardent advocate for the prevention and control of non-communicable diseases (NCDs), he supports initiatives in tobacco control and health promotion. In 2014, his team from the University of the Philippines was selected as a finalist in the Asia-Pacific leg of the Hult Prize in Shanghai for their social innovation idea for combatting NCDs in slum communities.
Sailesh is academically trained in medicine, public health and cardiovascular epidemiology. At PHFI, he is involved in chronic non-communicable disease (NCD) research, teaching and training. He leads various NCD research projects and also directs a course on NCD Prevention and Control for international public health scholars. He has been a recipient of the CIHR Canada HOPE Fellowship Award. Sailesh has been a temporary advisor/technical expert to the World Health Organization (WHO) on NCDs since 2011 and has authored many WHO technical briefs/papers. He has also served as a member of influential policy-making committees of the WHO and Government of India on NCD prevention and control.
Sandra currently works as a lecturer in the Department of Medicine, Faculty of Clinical Sciences at the University of Port Harcourt and is an honorary consultant cardiologist at the University of Port Harcourt teaching hospital. While she is actively involved in clinical medicine and undergraduate medical training, she plans to develop a career in clinical research. Her special interests include cardiovascular disease prevention with an emphasis on total risk estimation and modification. She is passionate about learning and is looking forward to meeting all the emerging leaders and sharing knowledge while learning from their diverse experiences.
Non-communicable diseases (NCDs) cause 36 million deaths yearly and account for over half of deaths in all regions except sub-Saharan Africa. In 2011, the UN General Assembly adopted a political declaration that committed its member states to the prevention and control of NCDs. Subsequently, countries agreed to adopt nine global targets, including an overarching target of reducing premature mortality from cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes by 25% relative to their 2010 levels by 2025 (i.e., 25×25 target). Countries also agreed on targets for selected NCD risk factors: tobacco use, salt intake, harmful alcohol use, obesity, raised blood glucose and diabetes, raised blood pressure, and physical inactivity.
Reducing NCD risk factors and meeting the 25×25 target can be achieved through cost-effective national and regional policies that address factors including access, pricing, and advertising, among others. According to the WHO, decisions, plans, and actions undertaken to achieve specific health care goals within a society are referred to as health policies. Clear health policies should outline priorities and the expected roles of different groups while building consensus and informing people (WHO, 2015). Furthermore, policies can be considered to be ‘best buy’ policies if their implementation is highly cost-effective, cheap, feasible and culturally acceptable. Tobacco use is the most policy-responsive of targeted risk factors, with major successes in tobacco control in many countries. Less is known about other NCD policies like salt intake and physical activity.
High blood pressure (hypertension) is a global public health problem, causing 9.4 million deaths around the world annually. It is a major risk factor for CVD and high salt intake is a major contributor to high blood pressure. Furthermore independent of its effect on blood pressure, high salt intake has also been shown to increase the risk of stroke, renal disease and left ventricular hypertrophy. Lowering dietary salt helps to lower the blood pressure and this has been shown to be an important determinant of the decrease in CVD mortality in some high-income countries (Elliot et al., 1996; Zhou et al., 2003; He & MacGregor, 2009). Salt reduction strategies are the best buy in the prevention of NCDs as it has been estimated that if salt consumption is reduced by 6 g/day, up to 2.5 million deaths could be prevented each year (He & MacGregor, 2009). Although salt reduction policies in some high-income countries like Finland, France, Ireland, Japan and the United Kingdom, have demonstrated some positive, measurable results, locally applicable salt reduction or substitution strategies are needed in low- and middle-income countries where salt intake remains high, with countries like India and South Africa taking initial steps to reduce salt intake through policy efforts. As a whole, however, these policy efforts have not been coordinated across regions or risk factors.
In 2012, the World Health Organization launched the Global Database on the Implementation of Nutrition Action (GINA), an interactive database that allows users to access information on the implementation of policies and interventions related to nutrition in member UN countries. As of May 2013, over 3,500 policies and actions in over 176 countries were included on the website, which facilitates comparison of commitments and actions for global nutrition. To our knowledge, there is not currently a similar effort to compare policy commitments with implemented action in the global NCD effort to achieve 25×25.
We propose to develop an online database of NCD-related policies that would support a more integrated approach to policy formulation and monitoring of progress in the global effort to prevent and control NCDs in the 25×25 and post-2015 development agendas.
The proposed policy database is an intended resource for three primary audiences: (1) policy-makers in member states who are involved in developing and implementing NCD-related policies in their countries; (2) researchers seeking to investigate the health and mortality impacts of implementation of selected population-based interventions/policies, and estimated the financial costs of their implementation under different scenarios; (3) policy organizations such as the World Heart Federation and UN foundation who are seeking to track global and national progress in specific policy actions to meet their targets for NCD risk factors by 2025. Ideally, the database will not only identify synergies and gaps in policy implementation for 25×25, but also foster discussions towards improved planning and coordination and the promotion of the most effective policies.
To develop a dynamic online library of NCD policies and actions to coordinate and track progress towards 25×25 goals, with an initial effort on policies to address salt intake. Our specific objectives are to:
Identifying relevant policies and actions
We will use evidence-based search strategies to identify national and regional (i.e., state or provincial) policies on salt reduction in the target countries of Canada, India, and Peru. These policies will include key documents (paper copies as well as Web-published) in English. To identify these relevant policies, we will:
Constructing the database
We will conduct qualitative key informant interviews to obtain information about what features stakeholders would consider important in such a platform, barriers they encounter in searching policies when conducting policy audits, perception of the policy landscape surrounding salt reduction, etc. This information will be taken into consideration and all obtained policy documents and actions will be organized and thematically categorized using a relevant analysis framework and ATLAS.ti.
We will begin with the following set of broad categories including country, state or province (if applicable), policy or action title, type (action vs. policy), and date of adoption. We will provide a hyperlink to relevant policy or action documents, when available. For each policy or action, we will further provide information on the implementing organization, date of adoption (if applicable), and a summary of the goals, objectives or targets that relate to NCD prevention. Though the pilot study will be limited to information on policies and actions on salt intake for NCD prevention in English language, the shell database will be developed so that it can include multilingual uploads and information and information on policies/actions related to other major risk factors for NCDs.
Piloting the online platform
We will develop and pilot an online format for the database that will include searchable library of policies and actions in member states and a series of data visualizations that facilitate comparison of commitments and actions. In addition, end-users will be able to upload policies directly onto the database. For sustainability, we plan to link it up to WHF website with a system that flags up when new policies are added using keywords such as health, policy, NCD, etc.
Establish new collaborations for health modeling
An important next step following this pilot project is to map policies and actions against potential or realized health benefits and costs. Through existing relationships with the World Heart Federation, we will begin to establish new collaborations with population health modeling groups at the WHO that are currently developing methods to assess the population health benefits of various scenarios. Future outputs could include website data visualization of potential – or realized – health benefits of specific policies or actions in member countries.