{"id":47759,"date":"2020-06-11T19:01:45","date_gmt":"2020-06-11T18:01:45","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47759"},"modified":"2020-06-12T08:46:30","modified_gmt":"2020-06-12T07:46:30","slug":"lets-envisage-a-new-better-normal-for-all-non-communicable-diseases","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/06\/11\/lets-envisage-a-new-better-normal-for-all-non-communicable-diseases\/","title":{"rendered":"Let\u2019s envisage a new, better normal for all non communicable diseases"},"content":{"rendered":"<p><span style=\"font-weight: 400\">The covid-19 pandemic has seen<\/span> <span style=\"font-weight: 400\">unprecedented action by governments to restrict the movement of most of the world\u2019s population from international travel and access to non-essential services and public spaces. While covid-19 is rightly at the forefront of our minds, we want to shine a spotlight on the biggest killers of the 21<\/span><span style=\"font-weight: 400\">st<\/span><span style=\"font-weight: 400\"> century\u2014non-communicable diseases (NCDs).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">NCDs are the <\/span><a href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(18)32203-7\/fulltext\"><span style=\"font-weight: 400\">leading cause of premature mortality globally<\/span><\/a><span style=\"font-weight: 400\"> and result in vast health, social and economic costs. The major NCDs, including diabetes, heart diseases and non alcoholic fatty liver disease (NAFLD), share many common risk factors, including sedentary lifestyles and poor diets, among others. These contributors disproportionately impact the poor in many countries, as covid-19 now does. Notably, several NCDs are also known risk factors for covid-19, highlighting the indirect health implications of these diseases.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">As covid-19 infection rates fall, discussions will turn to the way societies will function in the medium to long term, what is being termed &#8220;the new normal.&#8221; This presents a once-in-a-generation opportunity to put public health at the centre of societies and to shape and deliver holistic responses to the major health challenges of the 21<\/span><span style=\"font-weight: 400\">st<\/span><span style=\"font-weight: 400\"> century, from covid-19 to NCDs such as NAFLD, obesity, diabetes, cardiovascular disease and mental health.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Addressing NCDs, such as NAFLD, is not only about reducing the prevalence of disease, but also building resilience and reducing vulnerability so as to ensure healthier, more sustainable, and more prosperous societies. Fortunately, we know a great deal about what needs to be done, for example, from <\/span><a href=\"https:\/\/www.isglobal.org\/en\/-\/movilidad-y-covid-19-como-debemos-redisenar-el-transporte-para-un-nuevo-futuro-\"><span style=\"font-weight: 400\">reengineering transport systems so that cities are more walkable and bikeable and public green spaces more accessible<\/span><\/a><span style=\"font-weight: 400\">, to transforming food systems so they deliver healthy affordable diets to all.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">These efforts are not only about improving health, but about social justice. During the current crisis, politicians have championed that we are all in this together, but it is very clear that the lived reality varies widely within society. Not everybody has the luxury of an indoor bike, access to private outdoor areas or the privilege of large living spaces\u2014let alone access to adequate healthcare, economic security, or safe housing. One of the consequences has been a drastic reduction in physical activity, which has implications for physical and mental wellbeing. In many countries, <\/span><a href=\"https:\/\/www.bmj.com\/content\/364\/bmj.l251\"><span style=\"font-weight: 400\">NCDs often follow a social gradient<\/span><\/a><span style=\"font-weight: 400\">,<\/span><span style=\"font-weight: 400\"> disproportionately impacting those of lower social-economic status. A dramatic reduction and delaying of primary care health-seeking, cancer and diabetes screening attendance and secondary prevention adherence for chronic disease observed in many societies during covid-19 may further accelerate health inequities. With this opportunity to envisage a new future, we must put equity at the heart of our responses, ensuring that whatever action is taken reduces, rather than compounds, existing inequities. This starts with engaging and empowering affected communities to drive the process.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The <\/span><a href=\"https:\/\/sustainabledevelopment.un.org\/?menu=1300\"><span style=\"font-weight: 400\">Sustainable Development Goals (SDGs)<\/span><\/a><span style=\"font-weight: 400\"> provide a foundation for action, from health (SDG3), food and nutrition (SDG2) and sustainable cities (SDG11) to climate action (SDG13) and inequality (SDG10). To be successful, we need to combine these agendas to comprehend the complex systems and trade-offs in policy decisions. This calls for new, more collaborative ways of working, including uniting diverse groups of activities, from health and climate change to new economies, in order to innovate solutions and amplify their collective voices.\u00a0 While the SDGs are adopted by countries, change can start at the city level. This has already begun. Examples of this during the covid-19 pandemic include <\/span><a href=\"https:\/\/www.neweurope.eu\/article\/milan-announces-plan-to-permanently-reduce-car-use-after-lockdown\/\"><span style=\"font-weight: 400\">Milan announcing an ambitious plan to reduce car<\/span><\/a><span style=\"font-weight: 400\"> use by expanding bike infrastructure and improving walkability. Other cities such as Berlin have introduced temporary bike lanes, while <\/span><a href=\"https:\/\/www.driving.co.uk\/news\/covid-19-cars-banned-roads-safer-exercise\/\"><span style=\"font-weight: 400\">London, Manchester, and Brighton<\/span><\/a><span style=\"font-weight: 400\"> plan to introduce restrictions on cars to make exercising safer. Such approaches not only enable people to be more active, but make public transport safer for those who require it, while also lowering noise and air pollution levels, benefitting human health and the planet.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">We suggest the biggest enemy in the battle against NCDs is inaction. More than five years ago, WHO termed the scale of the problem posed by NCDs and the weak international response a \u201cglobal scandal,\u201d leading some to ask <\/span><a href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(15)01178-2\/fulltext\"><span style=\"font-weight: 400\">\u201cwhere is the anger and the activism\u201d?<\/span><\/a><span style=\"font-weight: 400\"> So, what has happened in the past five years to shift the dial? With politicians and the general public acutely aware of the importance of public health due to the current pandemic, now is the time to move from inaction to long-lasting action. We urge politicians to engage with their constituents and stakeholders from across sectors and disciplines to come together to find common solutions to multiple challenges at once. We must strive for a &#8220;new normal&#8221; that is a &#8220;better normal,&#8221; one in which our towns and cities become the foundation upon which healthier and more sustainable societies are built.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Jeffrey V Lazarus<\/strong>\u00a0is head of the health systems team at the Barcelona Institute for Global Health (ISGlobal) and an Associate Professor at the Faculty of Medicine, University of Barcelona, Barcelona, Spain and vice-chair of the EASL International Liver Foundation. <\/span><a href=\"https:\/\/twitter.com\/JVLazarus\"><span style=\"font-weight: 400\">@JVLazarus<\/span><\/a><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Henry Mark,<\/strong>\u00a0EASL International Liver Foundation, Geneva, Switzerland. @<\/span><a href=\"https:\/\/twitter.com\/HenryEMark\"><span style=\"font-weight: 400\">HenryEMark<\/span><\/a><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Terry T.-K. Huang<\/strong> is Professor and Chair of the Department of Health Policy and Management, Director of the Center for Systems and Community Design, and Co-Director of the NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, USA.<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Alessandro Demaio<\/strong>, fellow at Melbourne School of Population\u00a0&amp;\u00a0Global Health, University of Melbourne, Australia and CEO of VicHealth.\u00a0<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Competing interests<\/strong>: Jeffrey V Lazarus reports research grants from Genfit, Gilead and Intercept, outside of the work discussed here.\u00a0\u00a0Henry Mark, Terry T-K Huang and Alessandro Demaio have read and understood BMJ policy on competing interests. They declare no competing interests relevant to this article.<\/span><\/em><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The covid-19 pandemic has seen unprecedented action by governments to restrict the movement of most of the world\u2019s population from international travel and access to non-essential services and public spaces. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/06\/11\/lets-envisage-a-new-better-normal-for-all-non-communicable-diseases\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":45634,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-47759","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Let\u2019s envisage a new, better normal for all non communicable diseases - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/06\/11\/lets-envisage-a-new-better-normal-for-all-non-communicable-diseases\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Let\u2019s envisage a new, better normal for all non communicable diseases - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The covid-19 pandemic has seen unprecedented action by governments to restrict the movement of most of the world\u2019s population from international travel and access to non-essential services and public spaces. 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