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HMG7120 Global Challenge - Non-Communicable Disease, Victoria University, Australia

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Introduction: Non- communicable diseases and mortality rate increase has been a growing concern for policy makers all over the world. The non- communicable diseases ( NCD) form from varied combinations of genetic, environmental, behavioural and physiological factors. The mortality rates are the highest in the low and the middle-income group companies. The objective of the policy associated with NCD is to try to ensure that there is significant reduction in the loss of lives due to premature death. There are many legislations that have been passed in order to ensure that diseases like AIDS , tuberculosis can be addressed at the right time, so that the loss of lives are minimal but this has not been possible in the case of the NCDs Limited resources and infrastructural problems in low income countries are a major problem in this regard. The primary non- communicable diseases that cause major risk, worldwide are cancer, diabetes, chronic respiratory ailments and cardiovascular diseases. The risk factor that are underlying these NCDs are unhealthy diet patterns, tobacco consumption, alcoholism, lack of physical activities. This shows that they are basic personal habits that cannot be addressed completely and this is where it becomes important, that measures are taken to address the issues.

Question 1: Evidence that underpins the NCD policy agenda

Answer: The growing rate of the NCDs, clearly is alarming and the NCD policy has also reflected that it is a problem for both developed and developing nations. It is important that there is revision of policies from time to time to understand the underpinning issues and make smaller changes in a as and when required basis on the basis of the current evidence and statistics that is placed.

Question 2: Lessons learnt in addressing NCDs over the last 10 years

Answer: The lessons that have been learnt while dealing with NCDs in the past years are as follows :

• The harm they cause are a major impediment to economic growth of families and hence nations and the economic burden of physical inactivity is huge (Ding et al ., 2016)

• They cause perpetual poverty and hinder growth and development in the lower economic group and will cause a loss of $47 trillion between 2011 and 2030 if they continue to rise.

• The NCDs are responsible for death in three out of five people globally

• It needs to be controlled especially the epidemic of diabetes that is claiming lives due to wrong life style choices

• Governments and global bodies need to come together to resolve the issues

• Lack of funding in poor countries lead to lack of infrastructure

• Lack of political stability and will often causes major trouble in implementation of these policies.

• There is lack of involvement of religious leaders that often affect this in a negative way

• Basic healthcare facilities available to the low income group is extremely minimal

• Lack of political will has been pivotal in the increase in the level of NCDs in the developed nations

• There is poor infrastructure in most countries to heal NCDs and that is the reason why it is important that care needs to be taken to resolve these

• Policy revision are essential on an interim basis both globally and nationally

Question 3: Key issues that need to be addressed

Answer: The key issues that need to be addressed are that control of the risk factors has become essential and there is a need to make the awareness regarding these diseases a major issue. Only through awareness campaigns, it is possible that it can be averted. There is need for policy revision is essential on an interim basis both globally and nationally. There is need to ensure that there is more funding available to the developing countries to build medical infrastructure

Question 4: Key global actors and leadership in NCD policy

Answer: The global players who are important in the case of NCD policy are healthcare organisations of the national level that is WHO is a major body along with United Nations and the government of each and every member country. The heads of trade bodies like World trade organisation are also leaders who influence the spread of the NCD in the form of wrong food packaged food being allowed to be sold in the third world countries. The political will is crucial and the world leaders need to unite along with health organisations to ensure that this is brought under control

Question 5: Key milestones in policy formulation and implementation

Answer: There are many milestones that have been achieved in the form of better awareness regarding the risks globally, along with that there is also much head way that has been achieved in the case of the issues like getting funding for research. Generic medicines are now available more easily and there has been some development of medical infrastructural facilities. There is effort taken to ensure that global bodies like United Nations, UNDP , WHO are now working in unison to resolve the NCD crisis globally. There is effort taken by individual government to meet bench mark set by the WHO to prevent these diseases from increasing.

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Question 6: Principles and Approaches used in NCD policy

Answer: In the less wealthy economies, the healthcare approach that has been taken up is the primary healthcare approach. The non - communicable diseases have started to spread like epidemics and that is why there is need to make healthcare assessment, awareness and treatment available at the basic fundamental level. NCDs hamper the socio- economic development of a country and that is why it is important that it is treated at the primary level healthcare facilities. However in the wealthier nations it needs to be incorporated in the regular medical plan , so that there is much better coverage (Narain, 2019).

Question 7: NCDs in the Sustainable Development Goals (SDGs)

Answer: The 2030 agenda for sustainable development have been adopted by the United Nations summit 2015 (Bennett et al ., 2018) This summit recognises NCDs as a major challenge. The international body has realised that the NCDs are going a long way in handling the issues associated with healthcare as it causes major impediments in development. The various sustainable golas that have been taken up are:

• Premature mortality rate that is caused by Non communicable diseases needs to be reduced by one third of what it is currently

• There is need that there is access to essential medicines at affordable rates to all and the non communicable diseases are severe diseases and that is the reason why it is important that medicines associated with these are available (Nugent et al ., 2018)

• There is need to try and achieve universal health coverage all over the world and trying to make it uniform gradually

• There is need to ensure that alcohol industry is more regulated and there is reduction in the harmful effect of these to a large extent

• Ensure that the implementation of the WHO Framework associated with Convention on Tobacco Control (FCTC) is made more strong and there is more realistic approaches taken in dealing with the tobacco addiction

• There should be enhanced effort on developing possibilities for research and development regarding medicines in this field

• Pollution levels need to be addressed, so that chronic respiratory failure is reduced.

Question 8: Global Targets

Answer: The World Health Organisation (WHO), along with other international healthcare regulating bodies have decided on some global targets that will help to provide guidelines towards a sustainable, evolved and uniform healthcare system. These targets being set will help the WHO to monitor , which regions need improvement and focus on the regions to ensure better health all over the world. There are 9 voluntary global targets for NCDs , that is to be achieved by 2025 , with the base line of 2010 (NCD targets 2013). These targets are as follows:

Target 1: Reduction in the mortality rate of the four major diseases , that is diabetes , cardio vascular ailment, cancer and chronic respiratory illness by approximately 25%

Target 2: Alcohol is having far-reaching negative effect and that is the reason why there is need to reduced alcohol circulation and use by 10%, especially in the tropical countries, with stringent focus on removing unregulated liquor. This is to be done in a national context

Target 3: There is need to reduce the poor physical activity level aspect and sedentary lifestyle by 10%. This is need to improve both diabetes risk and also to aid in curing cardio vascular diseases. People will be encouraged and incentivised to adopt a more active life style.

Target 4: The intake of sodium through salt intake needs to be reduced by 30%, as the fried and junk related food shall have to be made more and more redundant. The objective is to change all aspects of junk food consumption at least by 30%

Target 5: There is the need to ensure that there will be severe crackdown on the use of tobacco under people with age group of 15 years and more , this is required to try and give them a positive and healthy adolescence. The targeted figure is 30% , but it needs to be much higher in the African continent , where tobacco misuse is rampant

Target 6: There is need to ensure that there is a reduction in the 25% reduction in the raised blood pressure levels of the population globally, as raised blood pressure levels are causing much havoc on the health of the work force globally.

Target 7: The epidemic of obesity need to be addressed with focus on nutritional diet and more knowledge about better food choices. The fast food and sugary drink industry to be taxed at a higher level than present, so that they take up healthier choices and change their product line.

Target 8: There is the target of 50% that needs to be achieved in the case of counselling and drug therapy. There is also the need to control the glycaemic index as well. The counselling sessions are needed to address drug counselling and also to help in the obesity factor as well.

Target 9: There needs to be an increase in the affordable technologies and essential medicines that needs to be inculcated , so that it is easier to treat NCDs. There is need to make generic low price effective medicines made available everywhere. The target set of the availability is 80%

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Question 9: The role of global versus national policy and the importance of national policy

Answer: There is an important role that is played by global policy as well as national policy with regards to the healthcare related issues associated with Non communicable diseases. The importance in both the cases is different. The global policy provides the benchmark that needs to be attained in order to ensure that there are better healthcare practices all over the world. The national policy of dealing with NCDs is the frameworks that are providing the framework and the process that will help in achieving that format. The national policy is always built with consideration of the country and its infrastructural possibilities and that is why it is a much more realistic goal that can be met in the context of developing nations. The global players who are important in the case of NCD policy are healthcare organisations of the national level that is WHO is a major body along with United Nations and the government of each and every member country. The heads of trade bodies like World trade organisation are also leaders who influence the spread of the NCD in the form of wrong food packaged food being allowed to be sold in the third world countries. However the national policy is the direct reflection of the political will that will help in attaining the bench mark to a certain extent.

Question 10: Coordination and monitoring mechanisms

Answer: The United Nations high Level summit has put Non-communicable Diseases on a global agenda. It has set some standards that need to be adhered to. In the WHO 2008-2013 Action plan for Global strategy there was focus on prevention and control of various factors. There was an establishment of an UN decade of action that that had an action plan drawn up from 2012 to 2022 (Mungal-Singh, 2011). There was specific focus on reducing the death By NCD rate by 2%. Many other targets were set up to address the growing issue of high mortality. There came the need to also set up a monitoring unit and a high- level commission on accountability for action was set up. This commission had the responsibility to measure accountability for the actions of various bodies who were all supposed to adhere by the UN summit guidelines. This accountability team had representatives from all wakes of society like, government, civil society, multi- lateral institutions and the private sector. The accountability team had to submit a report to the UN General Assembly, after reviewing the situation. This is how the co-ordination and the monitoring activities are being undertaken and there are timely reviews made in order to ensure that monitoring is continuous.

Question 11: Key documents on NCD policy

Answer: The policy documents regarded in this respect are as follows :

• National drug policy

• Good governance and medicinal model framework policy document

• WHO guidelines for medicine donation to developing nations

• WHO guidelines associated with pharmaceutical pricing policies

• WHO guidelines on essential medicines

• Global action plan on NCDs

• Manual on developing tobacco and alcohol quitting help line policy

• Global status report on NCDs

• National primary healthcare policy of each specific nation

• Governmental policies, strategies and interventions that will ensure that there is effort on the fact that there is need for prevention of these diseases.

• Medicinal policy and its framework

These are the basic documents and these documents are associated with many governmental and international body reports on the progress that are needed to ensure that enough effort is being put to tackle NCDs

Question 12: Challenges in formation and implementation of NCD policies

Answer: There are many challenges that are present in the formulation and the implementation of NCD policies and they are highlighted as follows:

• The socio- economic and physical environments in low and middle income countries provide much lesser medical care and protection in diseases

• Lack of funding in poor countries lead to lack of infrastructure

• Lack of political stability and will often causes major trouble in implementation of these policies.

• There is lack of involvement of religious leaders that often affect this in a negative way

• Civil society is not that powerful that a healthy life style choice can be brought about by them.

• Basic healthcare facilities available to the low income group is extremely minimal (Riley et al ., 2016)

• The market is highly populous and there is hardly any control regarding the various food items that are made available to the mass in general and this is leading to urban obesity crisis and poor nutrition profiling.

• There is hardly any governmental actions on food labelling and almost no control over tobacco and adulterated country liquor in the low income group countries

• Sustainable health financing ventures are not well developed and there is lack of social health benefit schemes

• Disparity in the national and the local and regional health policies are a major impediment in this case as well.

• The first world countries are involved in the process of using surveillance in order to monitor and record the morbidity details in the case of NCDs , whereas even the record on the mortality is very poor in the case of low income group regions

• There is lack of evidence based tools and cost effective solutions to treatment

• Man made natural disasters often lead to chronic emergencies that associates with focus shifting to these factors and the NCDs are often neglected.

• Another major challenge is that there are no measuring or assessment oriented tools that are used to evaluate the condition.

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Question 13: Recommendations for the way forward

Answer: The recommendations that can be put forward to resolve the problems associated with the NCDs are as follows:

• Tobacco to be taxed at a higher rate

• There should be effort undertaken to ensure that there are better healthcare schemes available for vulnerable population

• The Ministry of trade should focus on the health standards of the products being sold in the market and there should be stress on proper labelling in all processed food , so that the obesity epidemic does not harshly affect citizens lives

• There is need to control the abusive sale of unregulated liquor

• There should be smoke free zones all over the place with minimal smoking zones to discourage smoking

• There is need to focus on responsible advertising and increase the awareness levels

• The Ministry of education needs to ensure that there is educational programmes that focus on healthier life style choices from elementary school

• The role of municipality is to spread locality specific awareness, so that the treatment can be taken up quickly

• There should be monitoring and assessment of all measures taken and audit needs to be conducted by proper authorities who need to compare it to international standards of care

• Better medical infrastructure needs to be built, so that more people can be trated under governmental health schemes

• There should be strong monitoring on processed food sold by multination and the salt and sugar along with trans fat options and saturated fat have to be excluded from the sold products , should be the governmental mandate

• Civil society needs to be less judgemental and more supportive of individuals who are under these problems

Conclusion: It can be concluded that NCDs are a major impediment towards a healthy world and it is essential that effort be taken to remove these issue as much as possible and there is the need to make sure that the priority of health is kept as an all-important aspect for the current times and the generations to come.

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