Responding to sustained poor outcomes in the management of non-communicable diseases (NCDs): an “incident control” approach is needed to improve and protect population health

Abstract

In 2017 Public Health England were asked to assist with investigating why 1-year cancer survival rates appeared lower than expected in a local area. We identified 50 premature deaths that surveillance data suggested we would not expect. These deaths highlighted a gap in recognising and responding to this kind of systematic non communicable disease (NCD) outcome variation. We hypothesise that the lack of a universally agreed systematic response to variations is not only counter-intuitive, but wholly unacceptable where non-communicable diseases (NCDs) rather than infectious diseases have become the leading causes of illness and death worldwide. In the United Kingdom (UK) alone over 89% of mortality in 2014 was attributable to NCDs. We argue that a new approach is urgently needed to turn the curve on NCD outcome variation to protect and improve the public’s health. We set out a definition of an NCD “incident” and propose a phased approach that could be used to respond to local variation in NCD outcomes. Establishing parity of response for local variations in NCD outcomes and CD control is critically important. Although evidence shows that prevention and early intervention will make the biggest difference to NCD incidence, collective local whole health economy response, exploiting the wealth of surveillance data in real time, needs to be at the heart of responding to variations in NCD outcomes at a population level. We argue that local and national public health agencies should mandate a standardised ‘incident’ response to significant changes in outcomes from NCD to mitigate and reduce the loss of quality life.

Twin epidemics of covid-19 and non-communicable disease

“…Rigorous, community based detection and follow-up of patients with hypertension, for example, reduce both morbidity and inequalities in stroke mortality 10. Some argue for parity between measures to reduce local variation in NCDs and measures to control infectious disease 11. Excess rates of some NCDs could be notifiable for example.…”

“…Excess rates of some NCDs could be notifiable for example. Local and national public health agencies should develop a standardised incident response to clusters of premature NCDs, equivalent to that used for local outbreaks of infectious diseases 11…”

Improving Global Healthcare and Reducing Costs Using Second-Generation Artificial Intelligence-Based Digital Pills: A Market Disruptor

“…It leads to improved global health, for example, by improving response and patient adherence to anti-diabetics, anti-hypertensive, and secondary prevention drugs in patients with cardiovascular diseases. Better responses also reduce the loss of working days, further contributing to the global economy [ 71 , 72 , 73 ]. By focusing on clinical outcomes and the reduction of side effects, second-generation AI systems are likely to increase their adoption by patients and clinicians, supporting prolonged adherence to and sustainable effects from chronic drugs.…”

COVID-19: transferring learning from the pandemic response to non-communicable disease control

“…There is resonance and immediate applicability of the learning from the strategic response to the pandemic (specifically in relation to the structures, systems and processes that have been put in place) that could be applied elsewhere, such as public health management of NCDs. There is an urgent need for action in this area as the non-COVID-19 health burdens, 4 particularly due to cancer 5 and mental ill-health, 6 have been grossly exacerbated. In part, this has resulted from the need to pivot resources to COVID-19 response efforts which, in the UK, caused a hiatus in elective care 7 and a temporary suspension of usual screening programmes which was coupled with sudden and dramatic changes in health-seeking behaviours.…”

“…The management of NCDs has shown sustained and persistently poor outcomes. Indeed, the ‘strategy paradox’ 4 was described where despite successive plans developed globally and nationally to tackle major NCDs, they continually fail to address or respond to locally changing patterns of disease. 14 The COVID-19 pandemic response describes a new way of working, where form follows function.…”