The Convergence of Infectious Diseases and Noncommunicable Diseases Proceedings of a Workshop (2019) / Chapter Skim
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6 Confronting "The Blind People and the Elephant" Metaphor to Bridge the Silos
6 Confronting "The Blind People and the Elephant" Metaphor to Bridge the Silos
Pages 65-76
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From page 65... ...
This session was moderated by Bridget Kelly, principal consultant of Burke Kelly Consulting. The panelists were Gene Bukhman, director of the Program in Global Noncommunicable Disease and Social Change at Harvard Medical School; Rachel Nugent, vice president of the Chronic Noncommunicable Diseases Global Initiative at RTI International; Nelson Sewankambo, president of the African Medical Schools Association; and Dennis Carroll, director of the Emerging Threats Division at the U.S.
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From page 66... ...
in the former Soviet Union. He cited professional differentiation as one of the reasons that practitioners tend to view themselves as either in the infectious disease camp or in the NCD camp.
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From page 67... ...
He remarked, "We shouldn't lose sight of those distinctions or lose sight of the focus on equity that came naturally to us in the infectious disease world." Understanding the Economics of the Convergence Rachel Nugent, vice president of the Chronic Noncommunicable Diseases Global Initiative at RTI International, shared her experiences from working in the NCD space from a global policy and health economics perspective. Health economics seeks to address the questions of value for money and how to improve that value related to health and health care, but what compelled her to work in NCDs was the lack of action and investment relative to the amount of evidence available.
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From page 68... ...
Almost all the interviewees thought that it would be cost-effective or cost saving to integrate NCDs in the populations with a need for NCD care (e.g., an identified burden of heart disease, stroke, or potentially cancer)
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From page 69... ...
The Implications of a Collision Between Emerging Infectious Diseases and Noncommunicable Diseases Dennis Carroll, director of the Emerging Threats Division at USAID, provided comments that reflected the evolution of his own understanding about infectious diseases and the larger ecology in which they reside.
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From page 70... ...
In the process of trying to position this work in a more forward-leaning way, it becomes evident that the dynamics that will potentiate and exacerbate emerging infectious diseases will also contribute to another series of events, through which populations that are already challenged by emerging infectious diseases will become increasingly challenged by NCDs. This epidemiological collision is significant in Carroll's work, because the populations that are most vulnerable to emerging infections tend to be the populations living with preexisting NCDs.
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From page 71... ...
, rheumatic heart disease, or type 1 diabetes -- but may be more consistent with the implicit ethical paradigm within which the global health infectious disease world has traditionally operated. Defining NCDs too narrowly may lead to missed opportunities in national conversations that strive to forge links between infectious diseases and NCDs as conventionally construed, continued Bukhman.
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From page 72... ...
These cognitive barriers can influence how these problems are understood, she said, which can hamper efforts to deal with them effectively. Sewankambo said that the terms infectious diseases and noncommunicable diseases are so deeply engrained in the common vernacular of health professionals and in the medical education system that they are substantial barriers.
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From page 73... ...
The transition will continue to be difficult without such a resource that maps the larger ecosystem of converging NCDs and infectious diseases, he said. Nugent replied that such an evidence base already exists in the second and third editions of the Disease Control Priorities, which provides an extensive body of evidence on cost-effectiveness, including high-priority packages of care for low-resource countries with cost estimates (Jamison et al., 2018)
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From page 74... ...
Syra Madad, senior director at NYC Health + Hospitals, commented on the blurring line between health care delivery and public health within health systems, although they are separate entities. Health care delivery focuses on individual patients, but policy and guidance are often provided by public health and not well translated at the health care delivery level; this is particularly evident in infectious disease outbreaks, she said.
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From page 75... ...
It is helpful to think about convergence in terms of future proofing health and health care delivery as well as health proofing the future. "We have to somehow converge in terms of the science of primary prevention and work out how to slowly close the tap, instead of just working out how to plug the leaks in the bucket," she said.
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From page 76... ...
Public engagement also contributes to helping people understand how they can prevent health challenges at an earlier stage. Nugent suggested finding concrete ways to bring convergence to upstream factors that drive delivery -- for example, engaging with governments and donors to address siloed budget lines and considering ways to address siloed training of practitioners.
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