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Translation of Research Findings for Translation of Research Findings for Prevention and Control of NCDs Prevention and Control of NCDs

Shanthi MendisShanthi MendisChronic Disease Prevention and Management Chronic Disease Prevention and Management

World Health Organization World Health Organization

Translation of Research Findings for Translation of Research Findings for Prevention and Control of NCDs Prevention and Control of NCDs

Shanthi MendisShanthi MendisChronic Disease Prevention and Management Chronic Disease Prevention and Management

World Health Organization World Health Organization

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Translation of Research Findings (Evidence) Translation of Research Findings (Evidence) into national NCD policies and programs in into national NCD policies and programs in

low- and- middle- income countries low- and- middle- income countries

Translation of Research Findings (Evidence) Translation of Research Findings (Evidence) into national NCD policies and programs in into national NCD policies and programs in

low- and- middle- income countries low- and- middle- income countries

Does evidence exist to inform NCD policies?

How can evidence be translated into policies?

Global mortalityMajor NCDs = Heart disease, Stroke, Cancer, Diabetes, asthma

Cardiovascular diseases 30%

Cancer 13% Other NCDs, Other NCDs, injuries injuries & mental health& mental health18% 18%

CommunicableCommunicable maternalmaternal infant 30% infant 30%

Asthma/COPDAsthma/COPD7%7%

DiabetesDiabetes 2%2%

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What research findings do we have ?What research findings do we have ?What research findings do we have ?What research findings do we have ?

Research has found the causes of major NCDs.

Research findings on effective interventions that protect the population from NCDs address people with NCDs or at high risk

These interventions have been effectively implemented in developed countries to reverse NCD trends.

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What are the evidence informed NCD Policies ?What are the evidence informed NCD Policies ?What are the evidence informed NCD Policies ?What are the evidence informed NCD Policies ?

Promote physical Activity

Promote fruits/vegetables intake

Reduce salt and fat intake

Control tobacco

Early detection and management

National NCDPolicies

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Potential Impact of evidence based NCD policies Potential Impact of evidence based NCD policies

Potential Impact of evidence based NCD policies Potential Impact of evidence based NCD policies

Reduce recurrent heart attacks and strokes 75% Reduce mortality from heart disease 50% Reduce mortality from cancer, asthma, COPD Reduce health care costs Reduce social and macroeconomic costs

Wider determinants of NCD Wider determinants of NCD Wider determinants of NCD Wider determinants of NCD

Housing

Housing Employment

Employment

Education & health

literacy

Education & health

literacy

Environment

For healthy living

Protection of Health

Primary health care

Social determinants

policies and programs policies and programs

Projected Mortality Trends 2000-2030Projected Mortality Trends 2000-2030

Projected global deaths (2004-2030) Global Burden of Disease 2004 data

0

2

4

6

8

10

12

2000 2005 2010 2015 2020 2025 2030

Dea

ths

(mill

ion

s)

Cancers

Stroke

Road trafficaccidents

HIV/AIDSTB

Malaria

Acute respiratoryinfections

Ischaemic HD

Perinatal

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Gap in Knowledge Translation Gap in Knowledge Translation Gap in Knowledge Translation Gap in Knowledge Translation

What are the challenges for evidence informed policy making?

What factors affect the policy environment ?

How can policy making be made more open to the influence of evidence ?

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Challenges Challenges Challenges Challenges

Intersectoral nature of NCD policies Associated with the pressures of globalization Constraints to knowledge translation

control tobacco e.g. increase in tobacco tax

reduce salt/fat intake e.g. agreement with food industry

promote healthy eating e.g. regulate fast food chains

increase fruits/vegetable intake e.g. agriculture subsidies

Per capita expenditure on health (International dollars )

Per capita expenditure on health (International dollars )

Less than 50 $

50 – 99

100-499

500-999

1000-1999

>2000

33 2572241918

Expenditure Number of countries

LMIC < 5% of GDP on health aim at 10-15%

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Evidence informed policy making Evidence informed policy making Evidence informed policy making Evidence informed policy making

Clear stages in decision making

Formal mechanisms for consultation

Open processPlayers known

Constraints identified

Policy process

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Political, Social, Economic and other Factors that influence Political, Social, Economic and other Factors that influence policy making policy making

Political, Social, Economic and other Factors that influence Political, Social, Economic and other Factors that influence policy making policy making

Agenda of donors

Resource constraints

Competing interests and priorities

Governments that encourage policy debate

PartnershipsNetworks

GovernanceLegislation, mandatory regulations

The Need for Partnerships and Governance The Need for Partnerships and Governance The Need for Partnerships and Governance The Need for Partnerships and Governance

Food labelling

Partnership with industry to reduce salt in processed food

Governance e.g. mandatory regulations or supervisory bodies

Partnerships are keyPartnerships are keyPartnerships are keyPartnerships are key

Causes/solutions often outside health systems Need to look across society for the solutions Work intersectorally across ministries Alliances and coalitions, public/private

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Evidence informed NCD policiesEvidence informed NCD policiesEvidence informed NCD policiesEvidence informed NCD policies

e.g. Loose networksLobbying NGO or civil society groupsMediaProfessional associationsCommunity organizations

ResearchersResearchers Technocrats and civilTechnocrats and civilServants Servants

EvidenceEvidencemakersmakers

Need for Need for

KnowledgeKnowledge brokersbrokers PolicyPolicymakersmakers

Support evidence informed policy making Support evidence informed policy making

Improve Health Literacy - Improve Health Literacy - Helping People to:

New ways to engage people so that they can influence policy –

Empowerment of the community Empowerment of the community Empowerment of the community Empowerment of the community

• RadioRadio• InternetInternet• MobilesMobiles• Interactive TVInteractive TV

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How can networks Influence policy process ?How can networks Influence policy process ?How can networks Influence policy process ?How can networks Influence policy process ?

Policy Process Media and Civil Society networks

Agenda setting Advocacy

Policy formulation Collaborate in discussion

Implementation Enhance policy communication

Evaluation Collect evidence on problems

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Need to Strengthen Country Capacity Need to Strengthen Country Capacity For Broader Intersectoral Approaches to Research and Knowledge For Broader Intersectoral Approaches to Research and Knowledge

Translation that goes beyond the health sectorTranslation that goes beyond the health sector

Need to Strengthen Country Capacity Need to Strengthen Country Capacity For Broader Intersectoral Approaches to Research and Knowledge For Broader Intersectoral Approaches to Research and Knowledge

Translation that goes beyond the health sectorTranslation that goes beyond the health sector

Source: Potter and Brough (2004).Source: Potter and Brough (2004).

Structures, systems rolesStructures, systems roles

Staff and infrastructureStaff and infrastructure

SkillsSkills

ToolsTools

Enable Enable effective effective use of…use of…

Enable Enable effective effective use of…use of…

Enable Enable effective effective use of…use of…

Require…Require…

Require…Require…

Require…Require…

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World Health Organization Tools for translation of World Health Organization Tools for translation of evidence into policies evidence into policies

World Health Organization Tools for translation of World Health Organization Tools for translation of evidence into policies evidence into policies

Action Plan for Prevention and Control of NCD Framework Convention on Tobacco Control Global Strategy for Diet, Physical activity and Health

Primary Care Package of Essential NCD interventions

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Conclusions Conclusions Conclusions Conclusions

Requirements for prevention and control of NCDs

Broader intersectoral approaches to research Translation of research findings into policies Recognition of the widespread failure to

implement evidence-based Health Interventions

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Conclusions Conclusions Conclusions Conclusions For prevention and control of NCDs we need To find better ways for evidence informed policy making Partnerships to support intersectoral policies Networks to link researchers and technocrats Strong role of the State and better governance Knowledge translation that goes beyond the health sector

Health in all Policies