Slowing the NCD “Epidemic” K.M.Venkat Narayan, Emory University Stakeholder’s Meeting Harvard School of Public Health 10 December, 2015

Need cohort data in LMICs Lack of data on “incidence” for NCDs in LMICs is problematic Phenotypes may be different Risk factor effect may differ, other risk factors may be relevant Window for intervention not always clear Huge opportunities for developing Low-cost data systems Imaginative methods to estimate incidence indirectly

NCDs – Common Myths? Due to Almost everything is due to “obesity” aging of populations urbanization macro-economic changes socio-economic factors Almost everything is due to “obesity” Major opportunities to Use demographic, econometric methods to understand macro-level influences on NCDs

Slowing the “epidemic” versus slowing the impact of the epidemic In high-income countries major improvements in DM complications CVD death rates Cancer death rates Disability rates All of these require screening and early application & evaluation of effective interventions (pharmacology, technology, low-cost work-force, integrated care) at health system and policy levels Methods To measure quality of care at population level To implement and test multi-pronged approaches to improve quality of health-care

Primary Prevention Tobacco control Lifestyles (Diet & Activity) Huge gap in data and methods on multi-level interventions Single item dietary approaches are problematic and lack RCT evidence Soda tax – reduces consumption of soda, may increase juice substitution, impact on health outcomes needed Only diet intervention to show benefit is the Mediterranean diet Weight-loss and lifestyle interventions among people with impaired glucose tolerance and diabetes have benefits Few good data on how to change activity/sedentary behavior Vaccines We are not paying enough attention to these

Closing thoughts Stop thinking of HIC interventions as different from LMIC interventions Stop “Exporting” failures Stop offering “Simplistic” solutions to complex problems Instead Carefully implement proven interventions Lower cost of interventions Simplify delivery of interventions Build research base and capacity in LMICs Develop innovative methods for implementation science, borrowing from other disciplines (e.g., business, economics, demography)