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

2. 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

3. 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

4. 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

5. 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

6. 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)