PSI’s Commitment to Addressing the NCD Crisis

By Cat Normile, Non-Communicable Diseases Project Manager, PSI and Emilee Kaufman, Corporate Partnerships & Philanthropy, PSI

At last year’s United Nations (UN) General Assembly, Population Services International (PSI) committed to investing sustainably together to detect and treat three priority non-communicable diseases (NCDs): diabetes, hypertension and cervical cancer.

As a result, the organization created the position of Non-Communicable Diseases Project Manager, tasked with identifying strategic investments in early detection and treatment of NCDs across PSI’s network. We sat down with Cat Normile, who joined PSI six months ago, to discuss what we need to do about NCDs right now.

According to the World Health Organization (WHO), NCDs account for 40 million deaths every year – 70% of all deaths globally. More than three quarters of NCD deaths occur in low- and middle-income countries. Considering these staggering statistics, why isn’t there more attention and energy around the global NCD response?

The reasons are complex and more numerous than I can list here, but I’ll name a few:

NCDs are a relatively new area in global health, so we’re still trying to identify best practices for interventions and clear return on investment, while simultaneously building up a currently meager evidence base. To compound the issue, global health funding remains siloed, impeding efforts to integrate NCDs with other health areas and potentially complementary interventions. Traditional donors have existing priorities, and as development assistance for health has plateaued, alternative sources of funding for new health areas like NCDs must be explored.

NCDs suffer from an identity crisis. The name itself, “non-communicable diseases,” has inspired comments in the global health journals and plagued passionate advocates who struggle to form cohesive messaging. There’s no universally agreed definition: it’s a group of usually chronic conditions that aren’t transmitted between people, except perhaps genetically. Disability is often included, as is road safety and mental health. It is both vague and diffuse, so it’s hard to wrap your head around the concept.

NCDs are often asymptomatic conditions that progress slowly and tend to afflict people later in life, and the impact of an intervention can be difficult to quantify. The “double burden” of communicable and non-communicable diseases in low- and middle-income countries is acknowledged more and more at a global level, but it’s still hard to drive action and urgency around the issue. Health systems in low- and middle-income countries are often designed to address acute illness. Integrating care for diseases that cannot be cured but must instead be managed is a significant challenge.

What strategies must we consider to address NCDs?

The most interesting thing about working in NCDs is that they are so wide reaching. Not only in terms of the people they affect – people of all socioeconomic backgrounds, genders, ages, geographies – but in the variety of development, cultural, and political areas they intersect. To address NCDs, we must think beyond health care to food security; access to education; gender equality; sustainable cities; air pollution and other environmental factors; and employment and economic prosperity. These are all global development priorities whose progress is greatly hindered by NCDs.

What can we do to encourage more sustainable investments in NCDs?

NCDs are at the forefront of emerging trends in global health. The challenges discussed above and many others have inspired innovation in program design and funding, and impassioned global and local advocates to raise the profile of the NCD agenda. Collaboration across sectors is increasingly the norm, as evidenced by growing private sector engagement and the development sector’s more eager embrace of their involvement.

There are also great minds talking about NCDs in new ways. One thing everyone agrees on is that NCDs cost a lot and affect national economies. Framing NCDs in terms of return on investment or within the context of global health security makes for compelling arguments for greater contributions of national and development assistance resources.

Finally, there are great companies and organizations prioritizing NCDs. My position is an excellent example of this. It exists because two institutions came together with the common goal of having impact on a major global health crisis. PSI, in its new Global Strategy, singles out NCDs as one of five priority health areas on which to focus and drive attention and a corporate partner in the NCD space is investing in PSI’s capacity to be a leader in this field.

PSI doesn’t shy away from working with corporate partners. Your position is indeed proof. What else does PSI embrace about these private sector partners?

PSI works with over a dozen corporate partners across multiple health areas. The partnerships are developed with a clear purpose, shared vision and mutual benefit – something much easier said than done. Pharmaceutical industry partners greatly complement our work in NCDs. Not only do they have the financial capital necessary to help create and implement our programs, but they also offer us a wealth of technical expertise to assist in program design and execution. In return, these private sector partners are able to gain valuable insights into new markets, see their products from a new perspective, and as a result increase their competitive advantage.

What’s next for NCDs?

Trial and error. But that’s exciting!

We’re building new partnerships and exploring novel and efficient ways to integrate health services. We’re experimenting with new metrics for NCDs, and have worked closely with our Program Analytics team to develop what we believe is the first Disability-Adjusted Life Year model for hypertension, allowing us to visualize our impact.

I hope to see a seismic shift from today’s rhetoric of “Look at the problem” to “Look at all we’ve done and the impact we’ve had.” At the recent United Nations General Assembly, unrest among the NCD community was evident; we’ve established the need, now it’s time to mitigate the problem. Organizations working on the ground, like PSI, with support from forward thinking partners will be leading the way.