By Dr. Chandrashekhar Potkar, chief medical officer, Emerging Markets, Pfizer Upjohn and Dr. Amrit Ray, global president, Research, Development & Medical, Pfizer Upjohn.
Every two seconds, someone dies prematurely from cardiovascular disease, cancer, diabetes, chronic respiratory disease, and other chronic conditions, collectively known as noncommunicable diseases (NCDs).1 In fact, NCDs are now the leading cause of death and morbidity globally, with 71% of all deaths attributable to these conditions.2 This high prevalence and the chronic nature of NCDs have a direct impact on economies, with the total global burden estimated to reach US$47 trillion between 2010 and 2030.3
Although many NCDs are caused by genetics, healthcare-systems factors, or influenced by social determinants, these chronic conditions are, in some part, self-driven. According to the World Bank, more than half of the NCD burden could be avoided through health promotion and prevention initiatives.4 Further, modifiable behaviors, such as tobacco use, physical inactivity, unhealthy diet, and the harmful use of alcohol increase the risk of NCDs.2
Despite the ubiquity of NCDs, our solutions cannot be “one size fits all.” In order to tip the scales on NCDs, we need to address the considerable variability that exists in the burden of NCDs across nations and in corresponding intervention strategies.
Global NCD stakeholders must take advantage of the data available to us and act. By understanding countries’ specific NCD burdens and their preparedness to combat NCDs, we can help countries develop appropriate national policy frameworks. Pfizer Upjohn developed a scientifically rigorous methodological approach – the Strategic segmentation for NCD country Action Plans, known affectionately as the “SNAP” framework – that segments countries based on key variables affecting their development of NCD action plans, using evidence from credible external sources, including the Global Burden of Disease (GBD) study,5 WHO country profiles,6 and World Bank statistics,7 as well as validation by local data.6 In low- to middle-income countries (LMICs), these variables include NCD burden and policy preparedness, whereas in high-income countries (HICs), variables are gross-national income (GNI) and disability-adjusted life years (DALYs).
Our SNAP framework supports the categorization of LMIC countries into four distinct NCD archetypes for action planning depending on the levels of burden and local policy preparedness: Advocacy (high burden, evolving preparedness); Focus (high burden, high preparedness); Leverage (low burden, high preparedness); and Observe (low burden, evolving preparedness). For example, Malaysia is an example of a “Focus” country — only about 37% of patients treated for hypertension have controlled their blood pressure.8 Armed with this insight, inter-sectoral stakeholders in Malaysia can focus on training primary care physicians to manage hypertension by increasing awareness of guideline recommendations to address translation gaps.
According to WHO data for HICs, 80% of deaths are attributable to NCDs. As an example, the NCD burden on average for Italy, the UK, and Australia is around 90% for each country.6 These HICs would therefore benefit from a solution-oriented strategy that accounts for the local NCD landscape and the diverse needs across markets. By concentrating main strategies on policies for healthy aging, improved adherence as well as combating diseases with the highest burden in these countries, patient outcomes can be improved.
More than 50% of countries lag behind the WHO’s Sustainable Development Goal (SDG) 3.4 to reduce premature mortality from NCDs by one-third by 2030 through prevention and treatment.1, 9 Inter-sectoral collaborators must use the data available to us to change these statistics by implementing customized, coordinated and integrated approaches that balance science with execution. We hope that the SNAP framework offers one tool to catalyze action on NCDs. By targeting disease-related factors and healthcare system–related factors, we can improve care over the long term.
For more information about SNAP and Pfizer Upjohn’s approach to target NCDs, please visit the Pfizer Upjohn website.
1 World Health Organization. Noncommunicable Diseases (NCDs) and Mental Health: Challenges and Solutions. Available at https://www.who.int/nmh/publications/ncd-infographic-2014.pdf (accessed January 8, 2020).
2 World Health Organization. Noncommunicable Diseases. 2018. Available at https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases (accessed January 8, 2020).
3 Bloom DE, Cafiero ET, Jané-Llopis E, et al. The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum; 2011.
4 The World Bank. Growing Danger of Noncommunicable Diseases. 2011. Available at http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/Peer-Reviewed-Publications/WBDeepeningCrisis.pdf (accessed January 8, 2020).
5 Global Burden of Disease. Lancet. Available at https://www.thelancet.com/gbd (accessed July 10, 2019).
6 World Health Organization. Noncommunicable Diseases Country Profiles 2018. 2018. Available at https://www.who.int/nmh/publications/ncd-profiles-2018/en/ (accessed January 8, 2020).
7 The World Bank. World Bank Country and Lending Groups. 2019. Available at https://datahelpdesk.worldbank.org/knowledgebase/articles/906519 (accessed January 8, 2020).
8 Ministry of Health Government of Malaysia. Clinical Practice Guideline on Management of Hypertension. 5th Edition. Kuala Lumpur 2018. Available at http://www.acadmed.org.my/view_file.cfm?fileid=894 (accessed July 10, 2019).
9 NCD Countdown 2030: Worldwide Trends in Non-communicable Disease Mortality and Progress Towards Sustainable Development Goal target 3.4. Lancet. 2018. Available at https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)31992-5.pdf (accessed January 17, 2020).