GSO Commentary — GSO NCD Colloquium Series : Three Main Principles

The 2012 GSO Colloquium Series started with a Launch Event on 10 January for the adoption of a Statement of Principles on NCDs, based on multi-stakeholder collaboration. Subsequently, the GSO has facilitated other Colloquiums Events for a better understanding of specific issues related to NCDs. Drawing from the results of these events, the GSO has identified three main principles and a composite of proposed illustrative elements for their implementation.

The Basic Message: We have to integrate NCDs and communicable diseases in “solution-finding” processes. The solution lies with individuals, the private sector, NGOs, governments and international organizations working together. A multi-sectoral and multi-stakeholder approach is essential because NCDs’ roots lie with non-medical causes. Everybody is concerned: NCDs confront all countries and communities, developed and developing equally.

I. The Three Main Principles

A. From a disease-centered to a person-centered model

We believe in a systemic social and healthcare approach where people as individuals are the center of the model. We should leverage Existing Platforms (such as HIV/AIDs, Primary Care, Maternal Health), and refocus the health care system towards the establishment of integrated services, both vertically and horizontally. More detail on implementation here.

B. Equitable access to health care is a human right

We believe that access to health care is a human right. A “second class” health care system is not acceptable. To make this possible we need to mobilize a strong political commitment from our governments at all levels in support of multi-sectoral and multi-stakeholder cooperation. We seek social and political acceptance of health care in all sectors, working together with healthcare professionals and all stakeholders to promote wellness as well as the prevention, treatment and care of NCDs.  More detail on implementation here.

C. All stakeholders -going beyond their respective roles

We believe that all stakeholders should go beyond their respective roles in a collaborative framework oriented to equitable access. These stakeholders should include governments, NGOs, the private sector, academia and communities. The multi-stakeholder concept should lead to concrete action with different partners working collaboratively towards improved patient outcomes, healthy lifestyles and overall wellbeing.  More detail on implementation here.

II. Illustrative Elements for Implementation of the Three Principles

A. From a disease-centered to a person-centered model

Colloquium participants identified the following elements for implementation of this basic principle:

  • NCDs should stand for “New Challenging Diseases” to reflect the need for a different approach to NCDs taking us beyond disease management in traditional health care systems.
  • Mental health needs to be an integral part. By 2030, depression will be the number 1 non-communicable disease. Furthermore, its interactions with other NCDs call for a more integrated and holistic health care approach that includes mental health.
  • Horizontal integration: Primary health care systems need to be incentivized to focus on prevention and wellness, while also integrating chronic rather than merely episodic treatment and care
    • o Adequate training for prevention and early detection by health care professionals and the added value of community healthcare workers and other, non-health-related networks should be a priority.
    • o Early detection is crucial because of the long-term implications of treatment and care and the escalating severity of NCDs in the absence of early detection.
    • o Sufficient human resources, infrastructure and supplies should be directed to early detection programmes, including evidence-based screening for certain diseases (diabetes, hypertension, breast and cervical cancers).
  • Patient empowerment (combining education and accountability) is an important element of this new systemic approach, Such empowerment enhances patient acceptance and adherence to long-term treatment programmes.
    • Both time and skills should be devoted to supporting individuals with information about prevention and wellness strategies.
    • Health literacy for the individual should also be part of any treatment programme, using community-based health workers, and such technological innovations as mobile phone apps and smart cards.
    • Appropriate care for chronic conditions needs to be emphasized and should integrate the individual patient’s point of view
  • Vertical integration
    • Consistent messaging is important for the holistic approach to person-centered health and well-being.
    • Innovative treatment and care models for chronic conditions should also be a part of a vertically integrated health care system for NCDs.


B. Equitable access to health is a human right

Colloquium participants identified the following concerns for the implementation of this basic principle:

  • Access to health literacy, medicines, health technologies and infrastructure remains a challenge: all over the world, many people do not have access to appropriate health information, affordable medicines, health technologies or the infrastructure needed for the prevention, care and treatment of NCDs.
  • The role of government is crucial here, to create and maintain the policy framework for an integrated healthcare system and to facilitate the multi-sectoral engagement of non-health sectors to support wellness as well as prevention, treatment and care.
    • An efficient system should have a well-aligned and sustainable financing mechanism, incorporating an insurance scheme, whether through public or private systems.
    • It should be results oriented with incentives based on measurable outcomes at all levels, including prevention, treatment and care.
    • There should also be incentives for healthy lifestyles at all levels.
    • The policy framework should define the roles of health care professionals and other key stakeholders in non-health sectors.
  • Accessibility depends on availability and affordability.
    • Health and wellness systems should be available and accessible for everyone, both in terms of cost and geography.
    • Treatment and care for both physical and mental health conditions should be there when needed. This, too, should overcome barriers to access, whether geographical, cultural or operational.
    • Critical elements for ensuring equitable access include the availability of adequate resources for and attention to adequate deployment and use of medicines and technology, along with effective monitoring and appropriate training of their use.
    • Other critical elements involve the accessibility, availability and affordability of the conditions for healthy lifestyles and wellness, including appropriate nutrition, physical activity, and tobacco and alcohol control.
  • Health products, services and infrastructure should be oriented to responding to a life cycle approach, including both physical and mental wellbeing.
    • This should include access by all stakeholders to the results of research in healing and cures.
    • Information sources should be available at a technical and user-friendly level, to deliver education about NCDs to individual patients, health care professionals and all other stakeholders.


C. All stakeholders – going beyond their respective roles

Colloquium participants identified the following elements for the implementation of this basic principle:

  • Everyone is an ambassador – spreading out the message of holistic and person-centered care to others (children to their families to their communities).
  • A multi-sectoral and multi-stakeholder approach requires identifying the right forum or platform to mobilize expertise from all sectors for multi-sectoral action.
    • It should include schools, families, the workplace, communities and government services.
  • Community and government services should be directed to building trust through inclusive inter-sectoral dialogue and collaboration.
    • Stakeholders should be encouraged to join multi-stakeholder NCD Working Groups.
    • Governments should encourage multi-stakeholder dialogue and not just separate dialogues with each group.
    • Particular attention should be given to overcoming the pariah image of business by highlighting the benefits of business representatives sitting down with governments, health professionals and NGOs.
  • The inclusive approach should also concentrate on encouraging innovative approaches for multi-sectoral action.
    • Collaborative mapping and data gathering from all sources can help to identify win-win scenarios.
  • Opportunities should be created for all to be involved in integrating a healthy schools strategy into the educational curriculum and all school programmes.
    • Child safety and development should be broadened to include lessons for lifelong practices on the risk factors of tobacco, alcohol, diet and physical activity.
    • Education of individuals, families and health professionals on diet and lifestyle is crucial.
    • Schools can and should operate as a social hub for community-based, multi-stakeholder engagement.
  • The workplace is a pertinent setting for addressing all risk factors associated with NCDs, including mental health and stress.
    • Workplace practices should be encouraged to incorporate prevention, early detection and care in the overall work setting.
    • Extending healthy workplace-oriented practices from big companies with the resources to other workplace settings should be encouraged.