Mobilising society to implement solutions for non-communicable diseases

Akselrod, Svetlana; Bloomfield, Ashley; Marmot, Michael; Moran, Andrew E.; Nishtar, Sania; Placella, Erika

doi:10.1136/bmj.l360

Cited by 11 publications

(5 citation statements)

References 6 publications

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“…5,6 In Mexico, while no reliable national estimates prior to Seguro Popular are available, an initial assessment of this policy found increasing coverage of childhood cancer care with an estimated survival of 50% for ALL. 7 As Mexico's current government restructures the health system 8,9 and integration of non-communicable diseases to universal health coverage -frameworks are considered for other countries, 10 a comprehensive assessment of the health outcomes achieved under Mexico's financing policy for high-cost cancer treatments is warranted.…”

Section: Introductionmentioning

confidence: 99%

Acute Lymphoblastic Leukaemia Survival in Children Covered by Seguro Popular in Mexico: A National Comprehensive Analysis 2005–2017

Muñoz-Aguirre

Huerta-Gutiérrez

Zamora

et al. 2021

Health Systems & Reform

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The aim of the study was to measure survival of children with acute lymphoblastic leukemia (ALL) under Mexico's public health insurance for the population treated under Seguro Popular. A retrospective cohort study using claims data from Mexico's Seguro Popular program, covering cancer treatment from 2005 to 2015 was conducted. Overall 5-year national and state-specific survival for children with ALL across Mexico who initiated cancer treatment under this program was estimated. From 2005 to 2015, 8,977 children with ALL initiated treatment under Seguro Popular. Under this financing scheme, the annual number of treated children doubled from 535 in 2005 to 1,070 in 2015. The estimates for 5-year overall survival of 61.8% (95%CI 60.8, 62.9) remained constant over time. We observed wide gaps in riskstandardized 5-year overall survival among states ranging from 74.7% to 43.7%. We found a higher risk of mortality for children who received treatment in a non-pediatric specialty hospital (Hazards Ratio, HR = 1.18; 95%CI 1.09, 1.26), facilities without a pediatric oncology/hematology specialist (HR = 2.17; 95%CI 1.62, 2.90), and hospitals with low patient volume (HR = 1.22; 95%CI 1.13, 1.32). In a decade Mexico's Seguro Popular doubled access to ALL treatment for covered children and by 2015 financed the vast majority of estimated ALL cases for that population. While some progress in ALL survival may have been achieved, nationwide 5-year overall survival did not improve over time and did not achieve levels found in comparable countries. Our results provide lessons for Mexico's evolving health system and for countries moving toward universal health coverage.

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Section: Introductionmentioning

confidence: 99%

Acute Lymphoblastic Leukaemia Survival in Children Covered by Seguro Popular in Mexico: A National Comprehensive Analysis 2005–2017

Muñoz-Aguirre

Huerta-Gutiérrez

Zamora

et al. 2021

Health Systems & Reform

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“…27 This dearth has been recognised at the national level as it severely constrains Pakistan's capacity to effectively address the NCD epidemic. [28][29][30][31][32] Additionally, the focus on NCD research funding to LMICs like Pakistan in the last three to four decades has been very low compared with the size of the problem. 33 Limited funding opportunities are available within universities and through the Higher Education Commission, Pakistan Science Foundation and the Ministry of Science and Technology at the national level.…”

Section: Discussionmentioning

confidence: 99%

“…Besides lack of stable governance with consistent focus, limited resources, weak health systems and poor national capacity, a critical missing piece in the national NCD response in Pakistan is a skilled research workforce 27. This dearth has been recognised at the national level as it severely constrains Pakistan’s capacity to effectively address the NCD epidemic 28–32. Additionally, the focus on NCD research funding to LMICs like Pakistan in the last three to four decades has been very low compared with the size of the problem 33.…”

Section: Discussionmentioning

confidence: 99%

Opportunities and challenges to non-communicable disease (NCD) research and training in Pakistan: a qualitative study from Pakistan

et al. 2022

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IntroductionMost of the global non-communicable disease (NCD)-related death burden is borne by low and middle-income countries (LMICs). In LMICs like Pakistan, however, a major gap in responding to NCDs is a lack of high-quality research leading to policy development and implementation of NCDs. To assess institutional opportunities and constraints to NCD research and training we conducted a situational analysis for NCD research and training at Aga Khan University Pakistan.MethodsWe conducted a descriptive exploratory study using grounded theory as a qualitative approach: semistructured interviews of 16 NCD stakeholders (three excluded) and two focus group discussions with postgraduate and undergraduate trainees were conducted. A simple thematic analysis was done where themes were identified, and then recurring ideas were critically placed in their specific themes and refined based on the consensus of the investigators.ResultsThe major themes derived were priority research areas in NCDs; methods to improve NCD research integration; barriers to NCD research in LMICs like Pakistan; design of NCD research programme and career paths; and NCD prevention at mass level, policy and link to the government. In general, participants opined that while there was an appetite for NCD research and training, but few high-quality research training programmes in NCDs existed, such programmes needed to be established. The ideal NCD research and training programmes would have in-built protected time, career guidance and dedicated mentorship. Most participants identified cardiovascular diseases as a priority thematic area and health information technology and data science as key methodological approaches to be introduced into research training.ConclusionWe conclude from this qualitative study on NCD research and training that high-quality research training programmes for NCDs are rare. Such programmes need to be established with in-built protected time, career guidance and mentorship for the trainees to improve their research capacity in Pakistan.

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“…Advancements have been made in this regard, particularly for goal setting in [ 12 , 14 , 15 ]. Policy making must also consider their local priorities and include population strategies to confront non-communicable diseases [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Control of Glucose, Blood Pressure, and Cholesterol among Adults with Diabetes: The Brazilian National Health Survey

Reis

Duncan

Szwarcwald

et al. 2021

JCM

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ABC (glucose, blood pressure and LDL-cholesterol) goals are basic standards of diabetes care. We aimed to assess ABC control and related factors in a representative sample of Brazilian adults with diabetes. We analyzed 465 adults with known diabetes in the Brazilian National Health Survey. The targets used were <7% for glycated hemoglobin (A1C); <140/90 mmHg for blood pressure; and <100 mg/dL for LDL-C, with stricter targets for the latter two for those with high cardiovascular (CVD) risk. Individual goals were attained by 46% (95% CI, 40.3–51.6%) for A1C, 51.4% (95% CI, 45.7–57.1%) for blood pressure, and 40% (95% CI, 34.5–45.6%) for LDL-C. The achievement of all three goals was attained by 12.5% (95% CI, 8.9–16.2%). Those with high CVD risk attained blood pressure and LDL-C goals less frequently. A1C control improved with increasing age and worsened with greater duration of diabetes. Achievement of at least two ABC goals decreased with increasing BMI and greater duration of diabetes. In sum, about half of those with known diabetes achieved each ABC goal and only a small fraction achieved all three goals. Better access and adherence to treatment and strategies to personalize goals according to specific priorities are of the essence.

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Mobilising society to implement solutions for non-communicable diseases

Abstract: A BMJ series helps map the way towards better health and wellbeing for all

Cited by 11 publications

References 6 publications

Acute Lymphoblastic Leukaemia Survival in Children Covered by Seguro Popular in Mexico: A National Comprehensive Analysis 2005–2017

Acute Lymphoblastic Leukaemia Survival in Children Covered by Seguro Popular in Mexico: A National Comprehensive Analysis 2005–2017

Opportunities and challenges to non-communicable disease (NCD) research and training in Pakistan: a qualitative study from Pakistan

Control of Glucose, Blood Pressure, and Cholesterol among Adults with Diabetes: The Brazilian National Health Survey

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