The Convergence of Infectious Diseases and Noncommunicable Diseases Proceedings of a Workshop (2019) / Chapter Skim
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9 Visionary Statements on Potential Priorities to Address the Convergence
9 Visionary Statements on Potential Priorities to Address the Convergence
Pages 105-122
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From page 105... ...
The workshop concluded with closing remarks from Peter Daszak, president of EcoHealth Alliance. ADAPTING PUBLIC HEALTH PRACTICE IN AFRICA TO A NEW UNDERSTANDING OF MICROBES AND HEALTH Jay Varma, senior advisor at the Africa Centres for Disease Control and Prevention, presented a visionary statement that focused on integrated approaches and building the needed infrastructure to adapt a public health approach in Africa to address infectious diseases and NCDs.
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From page 106... ...
Varma stated that discussions of diseases or health challenges with policy makers should be linked to the concepts of universal health care and health security. The classical divide pins universal health care to NCDs and health security to infectious diseases, he noted, but it is possible to demonstrate how both types of diseases apply to both concepts.
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From page 107... ...
Varma said that in the public health field, efforts are directed toward working from the bottom to the top of the pyramid, prioritizing interventions that can have an impact across the broadest population level while requiring the least amount of effort at the individual level. Applying the Public Health Pyramid to Integrating Infectious and Noncommunicable Disease Interventions Varma used the public health pyramid to suggest ways to integrate interventions against both infectious diseases and NCDs.
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From page 108... ...
At the level of long-lasting protective interventions, Varma suggested deploying vaccines that prevent cancer. He noted that one of the greatest strides at the intersection of chronic diseases and infectious diseases was the discovery that infectious diseases cause cancer.
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From page 109... ...
The Public Health Foundation of India aims to address the diversity of public health challenges that India faces across the spectrum of infectious diseases and NCDs -- thus, convergence is a lived reality for Reddy. He reflected on how the message about the need for convergence could be communicated to the world at large.
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From page 110... ...
These pathogenic pathways can trigger inflammation, which itself can become a systemic phenomenon that causes vascular damage, among other consequences. Reddy suggested that it is no longer tenable to use Koch's postulates as the necessary criteria for linking a microbial assault with vascular damage and other noncommunicable conditions, given the discovery, for example, of common pathways of inflammation in thrombogenesis that are triggered by microbial infections.
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From page 111... ...
Health professionals will need keen cultural understanding and the ability to collaborate, Reddy said, even when they are developing depth in one area of research in which their expertise will qualify them as leaders. He mentioned the potential effect of dedicated funding streams that could be established by national or international funding agencies to bring together postdoctoral students from different disciplines to jointly address multidisciplinary research challenges and find solutions.
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From page 112... ...
Large international funding agencies are now focusing on capacity building, health systems, and primary health care. Potential Priorities for Convergent Action In summary, Reddy outlined his five priorities for spurring continuous change and convergent actions: 1.
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From page 113... ...
During this century, global health will need to gain momentum from shared values, equity, universal health coverage, and ensuring planetary health for our shared common future, he noted. To date, he stated: Research has only been sampling limited sections of the global human fam ily, primarily in high-income [settings]
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From page 114... ...
García emphasized prevention and strengthening both day-to-day and specialized services at all levels of care, from the community to specialized hospitals. Research Support for the Study of Convergence García's first priority is to continue supporting research on the convergence of infectious disease and NCDs that takes into consideration life course, gender, ethnicity, and diverse environments.
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From page 115... ...
A shift in thinking will be needed to bring research into policies for prevention, surveillance and detection, control, and treatment. Funders tend to prefer randomized controlled trials, which are beneficial, but she said qualitative research and descriptive epidemiology within prespecified conceptual models warrant prioritization as well.
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From page 116... ...
Potential Priority Policy Changes García's final priority is to promote policy changes directed toward the integration of public health activities and health services for infectious diseases and NCDs as part of universal health coverage. The phrase associated burden is more apt than dual burden, she said, and the disease approach should be replaced with a person-centered approach supported by comprehensive health strategies.
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From page 117... ...
It is relatively easy to pass declarations, but he noted the execution is not commensurate because supposedly binding commitments do not have tangible effects. Reddy commented that the message communicated to policy makers could be that we do not have the luxury of dealing with infectious disease and NCD issues sequentially, particularly in a country like India.
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From page 118... ...
Varma commented on the power of generating public outrage in driving change. He suggested framing chronic diseases as a product of genetic fatalism or being "born that way," or "being stuck in lifestyle choices." If people believe that having a chronic condition is beyond their own control, as infectious diseases are, then he suggested they are more likely to demand that the government take action to protect them.
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From page 119... ...
Discussion of exposomes and social determinants of health involves complex societal issues that are beyond the capacity of many governments to address, especially in systems plagued by corruption and resource constraints, said García. Although microbiomes seem complicated, they are less complex to address than changing entrenched social determinants, such as poverty.
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From page 120... ...
Varma admitted that the public health sphere often tries to avoid messages that appear overtly political, to the extent possible, but he said, "It is not so much to avoid the discomfort but to find a way to thread the needle a little more." He explained that his own public health strategy when communicating with policy makers is to avoid talking about the benefits of health interventions and to focus on security from threats, opportunities to make or save money, and justice in alleviating inequities. Rather than avoiding discomfort, he clarified that he tries to frame the issues in ways that appeal to people across the spectrum, from genetic fatalists to those who attribute all outcomes to individual-level decisions.
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From page 121... ...
He emphasized the importance of communication and engaging with communities and civil society to work toward rectifying the low expectations people have with respect to government-provided health services. Varma pointed to this issue as a root cause of infectious disease outbreaks, such as Ebola virus disease.
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From page 122... ...
This might involve borrowing language from the effective global health security agenda, he noted. For example, the concept of "NCD security" could be used to frame the threats related to political instability and security issues that arise in situations where an entire country or population has a large chronic disease burden that is compounded by poverty and hunger.
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