Global research priorities in noncommunicable diseases
Date: Thursday 1 November 10.45–12.15
The need to reorient public health priorities worldwide is evidenced by the current prevailing global burden of disease, 56% of which can be attributable to noncommunicable diseases (NCDs). Despite this, NCDs have remained on the sidelines of mainstream public health action.
There are some indications of the beginnings of change in this arena with recent shifts in multilateral policies and allocation of seed resources, particularly in the area of tobacco control. This change creates a number of policy, legislative and institutional imperatives for countries, as well as the need for a global mechanism to pool resources and technical expertise.
Within countries, reorienting health systems, building the capacity of health professionals, upgrading infrastructure and ensuring availability of and access to essential drugs will have to be evidence-based, which underscores the need to determine priorities for research to support the envisaged public health transition. Most developing countries currently have a focus on risk factor and etiological research in relation to NCDs. There is, therefore, a need to move towards other areas in generating evidence relevant to the structuring of NCD public health programmes, such as surveillance and intervention research, in order to facilitate an assessment of the effectiveness of policies, disease trends and future health needs.
For epidemiological purposes, population-based NCD risk factor surveillance systems and registries for surveillance of cancers and stroke need to be established and maintained; management information systems need to be reconfigured and morbidity surveillance systems need to be re-cast. Epidemiological research to determine causal associations for risk factors that have implications for setting targets for preventive interventions also needs to be promoted. Depending on the stage at which public health action is being initiated, policy and operational research on risk mitigation in the diet, physical activity, tobacco and environmental pollution arena; and operational research in demonstration settings and/or programme evaluations' also need to be strengthened.
In addition, health policy and systems research of relevance to developing integrated models of service delivery are also a priority, as is research to address institutional impediments to the integration of NCDs across diseases, and in relation to other public health programmes. Integration of NCDs in public health must be leveraged as an opportunity to strengthen health systems and obviate some of the inadvertent weaknesses created in health systems as a result of the single disease vertical programmes of the past.