{"id":10462,"date":"2011-08-10T09:52:28","date_gmt":"2011-08-10T08:52:28","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=10462"},"modified":"2011-08-11T08:58:13","modified_gmt":"2011-08-11T07:58:13","slug":"tracey-koehlmoos-institute-of-medicines-workshop-on-country-level-decision-making-for-ncds","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2011\/08\/10\/tracey-koehlmoos-institute-of-medicines-workshop-on-country-level-decision-making-for-ncds\/","title":{"rendered":"Tracey Koehlmoos: Institute of Medicine’s workshop on country level decision making for NCDs"},"content":{"rendered":"

\"TraceyIn a previous blog<\/a>\u00a0I mentioned that I attended the Institute of Medicine\u2019s workshop on country level decision making for control of chronic diseases, which was held on 19-21 July at the House of Sweden in Washington, DC.\u00a0 However, I had promised more details of the meeting and then promptly disappeared for two weeks of vacation (which I will tell you about if you read to the end).<\/p>\n

The workshop was held to identify the requirements needed to create tools for country led planning for implementing chronic disease control programmes, with an eye on the important elements of effectiveness, efficiency, and equity.\u00a0 The meeting and resulting work\u00a0are timed to precede the United Nations General Assembly’s high level meeting on non-communicable disease control and prevention, to be held in New York on 19-20 September 2011.<\/p>\n

The 100+ attendees included policy makers from developing countries, agenda setters in non-communicable diseases (NCDs), public and private sector leaders, scientists working in NCDs, economists, and a handful of others. It was a good mix of people, some familiar faces from the NHLBI-UnitedHealth Group network of centres were there,\u00a0and there were also many who were\u00a0there for the first time\u00a0to tackle\u00a0this common challenge. For example, the newly rebranded FHI360 (the non-governmental organisation formerly known as Family Health International along with its new acquisition,\u00a0AED) has thrown\u00a0its hat into the global health NCD area. Although best known for\u00a0its work on family planning and HIV, the sheer global reach of\u00a0its operation is promising, especially perhaps for countries that are not yet engaged in the NCD discussion.<\/p>\n

The workshop was built around four case studies that were commissioned by the Institute of Medicine\u00a0in Grenada, Kenya, Rwanda, and Bangladesh. On the first day, a health ministry representative from each country presented on the progress and needs for NCD care within\u00a0their country and also on how decisions were made within\u00a0each health sector. I was impressed by the various levels of progress within\u00a0each country as well as the needs for NCD care. I\u00a0was particularly\u00a0haunted by one of the health ministry\u00a0representatives stating the urgent need for health economists who understood the national context and the issues around NCD planning and implementation \u2014 and who would be available and willing to come and help.<\/p>\n

On the second day the authors of a case study presented on data availability and gaps\u00a0in NCD control and prevention. (This is why I was there, talking about the Bangladesh case study.) More than just talking about demographic and health surveys or WHO-STEPS surveys, the authors also talked about barriers in data collection,\u00a0for example,\u00a0asking women if they used tobacco, or not feeling that field workers had the capacity to undertake blood pressure readings, or political barriers in which NCDs as a public health issue pale in comparison to the urgency of the ambitious objectives set by the Millennium Development Goals. The afternoon featured presentations about costing and economic modelling for NCDs. A day talking about data and economic modelling might sound dry but the material was accompanied by a lively discussion about the appropriateness of models and tools\u00a0and also on the best way for developing countries to apply these tools in their setting.<\/p>\n

The third day of the meeting focused on global support for country level planning in low and middle income countries. It featured talks by Derek Yach from Pepsico, Johanna Ralston from the NCD Alliance,\u00a0and Montserrat Meiro-Lorenzo from the World Bank. Derek challenged us to think about how the world will change on 21 September after the UN meeting. Where are we going? How are we going to get there? But it was Montserrat who had me sitting on the edge of my seat while she spoke passionately about how policy makers live in the\u00a0present (and increasing spending on health for NCDs may not appeal to them now when cost effectiveness may tell them it is best to do nothing). She\u00a0said that there are lost opportunities and challenges at three levels: 1) the service provision level;\u00a0 2) the policy level, which goes well beyond health policy so that it includes urban planning, tobacco farming, taxes, indoor air pollution, and public transportation; and 3) the accountability of the government. There was a lively discussion around the development of NCD SWAT teams or experts available to provide high level technical support to countries taking action on NCDs. Examples of such expertise would include health systems, economics, and medical support. However, looking beyond health, this team would have to be able to help bridge the multisectoral gaps\u00a0between urban planning, agriculture, and road traffic.<\/p>\n

The development of a website housing the webcasts as well as the conference report is in progress. I will provide those links in the comments to this blog when those items become available. The case studies are not available for circulation yet either\u2014but I will let you know the details when the situation changes. I feel strongly that a case study looking at burden, policies, and programmes is an important first step in designing strategies for NCDs in developing countries. These four case studies will hopefully serve as a model.<\/p>\n

As for the vacation, you might be thinking, what does this have to do with NCDs? I won\u2019t regale you with tales of beaches, hiking, and sunburn, but rather I wanted to provide a perennial update on electronic cigarettes (e-cigarettes).\u00a0 In December 2010, the US Food and Drug Administration lost an appeal to have e-cigarettes branded a drug delivery device.\u00a0 Since April 2011 efforts have been under way to regulate e-cigarettes<\/a> as a tobacco product under the federal Tobacco Control Act; however, the success of that implementation is unclear to me. This summer my boys were exposed to radio commercials and television commercials for e-cigarettes while in the US.\u00a0 At least we did not see kiosks selling e-cigarettes in shopping malls like we had previously, but I only made one trip to a mall while in the US.<\/p>\n

In other tobacco news, when I returned with the boys to Jakarta for the start of the school year, one of them dutifully pointed out that the Marlboro Man is back. After a year’s hiatus during which we were treated to first white, then black, horses on Marlboro advertisements, everyone\u2019s favorite tobacco promoting cowboy has been resurrected on billboards around Jakarta. Indonesia remains one of the few countries<\/a> not to have ratified the Framework Convention on Tobacco Control.<\/p>\n

Tracey Koehlmoos<\/strong> is programme head for health and family planning systems at ICDDR,B and adjunct professor at the James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

In a previous blog\u00a0I mentioned that I attended the Institute of Medicine\u2019s workshop on country level decision making for control of chronic diseases, which was held on 19-21 July at […]<\/p>\n

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