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Grand Challenges in Chronic Non-Communicable Diseases
Health Experts agree on roadmap for curbing global rise of chronic disease
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Several of the world's most eminent health scientists and organizations have published a landmark global consensus on the 20 foremost measures needed to curb humanity's most fatal diseases, their study and commentary featured in Nature magazine.
Known as chronic, non-communicable diseases, they are reaching world epidemic proportions and include cardiovascular diseases (mainly heart disease and stroke), several cancers, chronic respiratory conditions, and type 2 diabetes.
Researchers used the structured consensus-building "Delphi" technique to create the "Grand Challenges in Chronic Non-Communicable Diseases (CNCDs)" - a distillation of informed opinions drawn from 155 panel members across 50 nations, carefully selected following recommendations.
Study authors say the result is an authoritative list of the 20 most important challenges today to restraining and reversing these slow killer illnesses. The list is accompanied by recommended research priorities for meeting the Challenges, drawn from the study data and finalized by leading international health experts who guided the project (list appended).
Leading partners behind the project are the McLaughlin Rotman Center (MRC) for Global Health (University Health Network and University of Toronto), Toronto; the Oxford Health Alliance (OxHA), London; the UK Medical Research Council (UK MRC), London; the Canadian Institutes of Health Research (CIHR), Ottawa; and the US National Institutes of Health, Bethesda.
Grand Challenges in Chronic Non-Communicable Diseases
Goal: Raise public and political awareness
Grand Challenges
- Raise the political priority of non-communicable disease;
- Promote healthy lifestyle and consumption choices through effective education and public engagement;
- Package compelling and valid information to foster widespread, sustained and accurate media coverage and thereby improve awareness of economic, social and public health impacts.
Research Needed to Address Goals
- Study how to engage governments in partnerships for disease prevention;
- Develop research activities for health that bridge government departments (e.g. transport, civic planning, health, education and environment);
- Identify the reasons for low awareness and advocacy of chronic disease in societies;
- Study how to create public forums that sustainably raise awareness of CNCD issues.
Goal: Enhance economic, legal and environmental policies
Grand Challenges
- Study and address the impact of government spending and taxation on health;
- Develop and implement local, national and international policies and trade agreements, including regulatory restraints, to discourage the consumption of alcohol, tobacco and unhealthy foods;
- Study and address the impacts of poor health on economic output and productivity.
Grand Challenges
- Study and address the impact of government spending and taxation on health;
- Develop and implement local, national and international policies and trade agreements, including regulatory restraints, to discourage the consumption of alcohol, tobacco and unhealthy foods;
- Study and address the impacts of poor health on economic output and productivity.
Research Needed to Address Goals
- Evaluate the health impacts of agricultural policy interventions;
- Study the health and economic impacts of comprehensive community-based interventions;
- Create general population metrics and outcome indicators for policy and program surveillance;
- Quantify impact of CNCDs on domestic economies;
- Study the international ramifications of change of food and tobacco consumption;
- Probe motivations behind domestic expenditures, and how these affect lifestyle choices;
- Investigate the impact and effectiveness of food labeling legislation.
Goal: Modify risk factors
Grand Challenges
- Deploy universally measures proven to reduce tobacco use and boost resources to implement the WHO Framework Convention on Tobacco Control;
- Increase the availability and consumption of healthy food;
- Promote lifelong physical activity;
- Better understand environmental and cultural factors that change behaviour.
Research Needed to Address Goals
- Do prospective cohort studies to identify factors that reduce risk of developing CNCDs;
- Evaluate foetal and early life influences on chronic disease risk;
- Find and evaluate new or combined medical preparations to prevent cardiovascular disease and diabetes, or reduce their morbidities;
- Evaluate behavioural modifications to reduce risks;
- Establish metrics, and relationships between metrics, which are culturally and ethnically specific;
- Investigate cultural and ethnic variation in risk factors to refine behavioural interventions;
- Quantify personal risk related to phenotypes, genotypes and multiplicative risks;
- Study the interaction of environment and genes in risk factors and in outcomes;
- Develop new biomarkers and diagnostics for risk and for early disease detection.
Goal: Engage businesses and community
Grand Challenges
- Make business a key partner in promoting health and preventing disease;
- Develop and monitor codes of responsible conduct with the food, beverage and restaurant industries;
- Empower community resources such as voluntary and faith-based organizations.
Research Needed to Address Goals
- Study marketing techniques and marketing data derived from commercial companies regarding behaviour modification;
- Investigate mechanisms for consumers and the public to influence food industry positively;
- Research the impact of taste, flavour, packaging, labeling and advertising on choice and health;
- Create and evaluate community-based strategies to promote healthy living;
- Identify modes of effective public/private partnerships that support health;
- Develop better understanding of nutrient benefit in foods.
Goal: Mitigate health impacts of poverty and urbanization
Grand Challenges
- Study and address how poverty increases risk factors;
- Study and address the links between the built environment, urbanization and chronic non-communicable disease.
Research Needed to Address Goals
- Investigate the biological basis of health risks related to poverty;
- Examine the influence of poverty on the adoption of high risk behaviour;
- Identify negative effects of economic growth on health;
- Study how to work with planners, architects and city representatives to enhance the environment for healthier living.
Goal: Reorient health systems
Grand Challenges
- Allocate resources within health systems based on burden of disease;
- Move health professional training and practice towards prevention;
- Increase number and skills of professionals who prevent, treat and manage chronic non-communicable diseases, especially in developing countries;
- Build health systems that integrate screening and prevention within health delivery
Research Needed to Address Goals
- Develop strategies to integrate health system management of communicable and non-communicable disease;
- Form collaborations to find best practices in delivering affordable and equitable health care;
- Study how to provide more structured knowledge for health-promotion;
- Develop strategies to ensure that medical training and curricula focus on chronic non-communicable diseases;
- Develop and provide culturally specific and nationally appropriate resources for training of health-care workers;
- Study how best to ensure that disadvantaged communities have adequate resource allocations in health care and in preventative practice;
- Optimise use of electronic health records for predicting disease and measuring the effect of health interventions;
- Study how best to develop and establish real time surveillance tools;
- Discover and develop tools for screening and stratifying populations according to risk;
- Increase access to medications to prevent complications of chronic non-communicable disease.
* * * * *
Executive Committee
(* Denotes Nature commentary co-authors)
- Robert Beaglehole (*), former Director, Department for Health Promotion, Disease Prevention, Management and Surveillance, WHO
- John Bell (*), Regius Professor of Medicine, University of Oxford; Chair, Oxford Health Alliance
- Alan Bernstein (*), President, Canadian Institutes of Health Research
- Sir Leszek K Borysiewicz (*), Chief Executive, Medical Research Council
- Abdallah Daar (*), Senior Scientist and Co-director, Program on Life Sciences, Ethics and Policy, McLaughlin-Rotman Centre for Global Health; Professor of Public Health Sciences and of Surgery, University of Toronto
- Roger Glass (*), Director, Fogarty International Center, National Institutes of Health, USA
- Jeffrey Koplan (*), Vice President for Academic Health Affairs, Emory University
Scientific Board
- Lucas Adetokunbo, Former Director, WB/WHO/UNDP/UNICEF Special Programme on Tropical Diseases Research and Training, Nigeria
- Sir George Alleyne, Professor Emeritus, University of the West Indies
- Stephen Colagiuri (*), Professor of Metabolic Health, University of Sydney
- Diane Finegood (*), Scientific Director, Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes
- Ray Fitzpatrick, Faculty Fellow and Dean, Professor of Public Health and Primary Care, University of Oxford
- Julio Frenk, Former Secretary of Health, Mexico; currently Grupo Carso Health Institute, and the Bill and Melinda Gates Foundation
- Nirmal Ganguly (*), Director General, Indian Council of Medical Research
- Harold Jaffe, Professor of Public Health, University of Oxford
- Stephen Leeder, Director, Australian Health Policy Institute & University of Sydney
- Alan Lopez, Director, Population Health, University of Queensland
- Adel Mahmoud, President, Merck Vaccine Division
- David Matthews (*), Chairman, Oxford Centre for Diabetes, Endocrinology and Metabolism, Professor of Diabetic Medicine, University of Oxford
- Stig Pramming (*), Executive Director, The Oxford Health Alliance
- George Sarna (*), Associate Director, Research Management Group, Medical Research Council, UK
- Nizal Sarrafzadegan (*), Professor of Medicine, Cardiology Department, Isfahan University of Medical Sciences, and Isfahan Cardiovascular Research Center, Iran
- Peter Singer (*), Co-director, Program on Life Sciences, Ethics and Policy, McLaughlin-Rotman Centre for Global Health; Professor of Medicine, University of Toronto
- Lars Rebien Sorensen, Chief Executive, Novo Nordisk A/S
- Derek Yach (*), Director of Global Health Policy, PepsiCo
- Lap-Chee Tsui, Vice President, University of Hong Kong
- Richard Smith (*), Former Editor, British Medical Journal; Director, Ovations Chronic Disease Initiative.
* * * * *
For more information on The Grand Challenges project: www.oxha.org/initiatives/grand_challenges
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