At the end of September this year in New York, the United Nations (UN) held a High-Level Meeting on Noncommunicable diseases (NCD). This followed from the first such meeting held in 2011. In 2011 this meeting was a landmark as it was the first time a health issue was brought to the UN’s attention in such a way after HIV/AIDS in 2001. David Beran, COHESION Project Principal Investigator, was present in New York and followed some of the discussions during the formal and informal sessions, which highlighted how COHESION could bring some lessons to the overall NCD debate.
Lesson 1: Focus on the global, but do not forget the local
The discussions in New York as well as discussions at the World Health Organization (WHO) focus on what needs to be done at a global level and often seem distant from the reality on the ground in the 3 countries and 6 communities where COHESION is working. At the end of the day global decisions and policies need to translate into tangible changes on the ground.
Lesson 2: One size does not fit all
The WHO and others have promoted the concept of “Best Buys” (see: http://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf;jsessionid=B754E5C569837C5F67A9ED4A21AC7B1E?sequence=1). These 88 interventions were assessed for cost effectiveness, feasibility, as well as non-financial considerations and address a variety of elements associated to the 4 risk factors and 4 diseases included in the WHO’s NCD Global Action Plan. These interventions have been “standardized” and although some, such as tobacco taxation, could be seen as universal, others need to be more tailored to the local reality and context.
Lesson 3: Avoiding the prevention versus care dichotomy
Discussions in New York seemed skewed towards prevention. Is this because this is “easier” to address from a policy perspective? Is it because the “Best Buys” for prevention are more standard than those for care? What COHESION has seen on the ground is that these two elements cannot be disassociated and what is needed is locally adapted responses for both prevention and care.
Lesson 4: People not policies
The ultimate goal of a policy is not the policy itself, but to impact people. This requires global guidance to be translated into national solutions that need to be implemented. To date this has not happened as the COHESION Project has witnessed first-hand in the 6 communities where it is working. Especially working for vulnerable populations there is the need to focus on their specific reality and find solutions that work for them.
Lesson 5: Bottom-up versus top-down the only way forward for NCDs
NCDs are rooted in the daily lives of people. Prevention of diabetes is not the same in Nepal or Peru. Managing hypertension in a bank manager in Maputo is not the same as care for a rural dwelling school teacher. Therefore, local solutions are required for these global challenges taking into account what people need and involving them in creating and designing the solutions.
Lesson 6: Partnership is not a word to be taken lightly
A buzzword in New York and frequently used in the statements from the UN was “partnership”. This was mainly around the topic of partnering with the private sector, but as COHESION has learnt partnership is not a word to be taken lightly and it takes time and investment to have true partnership. That said, when the right energy is devoted, partnerships can be powerful in addressing complex situations and overcoming challenges.
These lessons are further described in upcoming scientific papers that the COHESION Team has in the pipeline. The COHESION Team has submitted a paper on the analysis of the global policy environment for NCDs and a similar policy paper for Neglected Tropical Diseases (NTD) will also provide further lessons in addressing the health challenges that vulnerable populations face. Two in-depth analyses of the health system and the complexity of managing chronic diseases are also on their way. From a methodological perspective a paper accepted in BMJ Global Health on the COHESION approach to developing interventions will be of interest to many researchers. All these results from COHESION’s formative work and co-creation approaches provide insights and methods in dealing with the complexity of NCDs and NTDs in vulnerable populations thus contributing to the Sustainable Development Goals (SDGs).