Noncommunicable Diseases in India: Setting the Research Agenda

8/3/2019 Noncommunicable Diseases in India: Setting the Research Agenda

1/22

Dr Prashant Mathur

Scientist D

Division of Noncommunicable Diseases

Indian Council of Medical Research, New Delhi

Email: [email protected]

Noncommunicable Diseases in India:

Setting the Research Agenda


2/22

CVD

Cancers

COPD Diabetes

Endpoints

Intermediate

Risk Factors

Raised BP

High BMI

Dyslipidemia

Raised blood

glucose

Tobacco use

Unhealthy Diet Alcohol

Phys. Inactivity

Behavioural

Risk Factors

NCD: From Risk Factors to DiseaseEvidence, Policy, Action, Partnership

Determinants and Facilitators

Social Economic Cultural Environmental

Age Gender Genes


3/22

Scope for NCD prevention - A Life Course Approach

Age

FetalLife

Adult LifeAdolescenceInfancy andChildhood

SESnutritiondiseaseslineargrowthobesity

obesitylack of PA,

diet,alcohol,smokingSEpotential

established adult

risk factors

(behavioral/biological)

SESmaternalnutritionalstatus &obesity,

fetalgrowth

Accumulated

risk

Range ofIndividualRisk

Accumulated Risk


4/22

The Iceberg Phenomenon


5/22


6/22

From infectious disease control to

chronic disease control


7/22

Whole of Society Transformation

7

Life style changes (Food habit, Physical activity,Psychosocial status)

Changes in health of populations/ individuals

Globalization, Industrialization,Urbanization

Transition in economics Changes in mobility and

labor saving options

Emergence of business Emergence of educationalactivities

Shifts in food production,

retailing, distribution and

Consumption pattern

Infrastructure, build

environment & land use

Changes in social and

cultural values

Media penetration


8/22

Source: Kumanyika Ann Rev Pub Health 2001

INDIVIDUAL

EnergyExpenditure

POPULATION

%OBESE

OR

OVERWTFood

intake :Nutrient

density

FACTORS

INTERNATIONAL

SchoolFood &

Activity

WORK/SCHOOL/HOME

Infections

Labour

WorksiteFood &

Activity

LeisureActivity/Facilities

Agriculture/Gardens/Local markets

COMMUNITYLOCALITY

HealthCare

System

PublicSafety

PublicTransport

Manufactured/Imported Food

Sanitation

NATIONAL/REGIONAL

Food &Nutrition

Urbanization

Education

Health

Social Security

Transport

Family&Home

Media &CultureMedia

programs&

advertising

Development

Globalizationof

markets

Obesity Prevention


9/22

Whole of SocietyTransformation

The Argument

Biology

Mismatch

NCDs


10/22

InformationTechnology

Science andTechnology

RuralDevelopment

Social Justice &Empowerment

Education

Transport

Finance

Environment

& Forest

Industry

Civil Society

Urban Development &

Poverty Alleviation

Chemicals &Fertilizers +Agriculture

Healthy Public Policy

Health


11/22

Guiding Principles for Prioritized Research on NCDs

Need assessment

Generate contextualized evidence

Promote equity

Provide convergence

Address resources

Encourage stakeholdership


12/22

Domains of Research Prioritization

1. Burden and epidemiology of NCDs

2. Interventions for reduction of NCDs,

their risk factors and determinants3. Health care research

4. Multi-sectoral partnerships


13/22

Burden and epidemiology of NCDs and their risk

factors

Methods for monitoring trends of NCD morbidity,mortality and risk factors

Observational cohorts to study social, cultural and

economic determinants of behavioural risk factors

Quantify personal risk related to phenotypes,genotypes and multiplicative risks

Development of alternative, low cost and feasiblestrategies for screening and diagnosis of NCDs


14/22

Characterize nutrition transition, physical inactivityand its determinants

Investigate the biological basis of health risksrelated to poverty

Examine the influence of poverty on the adoption ofhigh-risk behaviour

Identify negative effects of economic growth onhealth

Develop comprehensive and sustainable databasesfor NCDs and risk factors (including non-healthdeterminants)

Burden and epidemiology of NCDs and their

risk factors


15/22

Interventions for Reduction of NCDs, and Risk

Factors

Workout cost-effective strategies for a comprehensive

risk reduction at community and individual level in

diverse cultural and socioeconomic settings

Develop/adapt interventions for managing specific

NCDs (eg. CVD, Diabetes)

Scoping studies for optimal utilization of AYUSH onpromotive and curative aspects of NCDs


16/22

To evaluate strategies used in empowering

communities for prevention and control

To assess different strategies, organizational

models, interventions, technologies (e.g. IT) for riskreduction and early detection/treatment

Studying behavior management strategies for

modifying risky behaviors

Assess economic interventions in promoting risk

reduction

Interventions for Reduction of NCDs, and Risk

Factors.


17/22

Health Care Research

Models for reorienting health systems in deliveringaffordable and equitable health care

Structured knowledge for health promotion

Integrated training of health workforce to deliver health careas a package

Culturally specific and nationally/sub-nationally appropriateresources for training health-care workers

Ensure that disadvantaged communities have adequateresource allocations in health care & in preventative practice

Identify modes of effective publicprivate partnerships


18/22

Health Care Research

Opportunities for synergies with effective caredelivery systems that have been established fordiseases such as HIV, TB and MCH

Suitable options for financing equitable health care

Equity issues in use of essential medicines and inhealth service delivery (accessibility & affordability)

Affordable drugs (including combined drugs),vaccines and technologies and evaluate them


19/22

Multi-sectoral Partnerships

Self assessment in health sector, assessments of othersectors and analyse area of concern

Define engagement of other sectors

Framework to foster common understanding betweensectors

Engaging Govt depts in partnerships for prevention

Includes collaborations within Health also Research activities for health that bridge govt depts

(e.g., transport, civic planning, health, education,environment)


20/22

Multi-sectoral Partnerships

Strategies for improving awareness and advocacyof chronic disease

Strategies for engaging businesses for health Study marketing techniques and marketing data

derived from commercial companies on behaviourmodification

Create public forums that sustainably raiseawareness of issues relating to NCDs


21/22

*Surveillanc

e*

Mapping the

epidemic ofNCDs

*Manageme

nt*

Strengthen

health carefor people

with NCDs

*Prevention*Reducing the

level of

exposure to

risk factors

There is a clear vision on how to address NCDs

XYZ[\]New developments


22/22

Documents

Noncommunicable Diseases in India: Setting the Research Agenda