WONCA Statement on NCDs and Primary Health Care to WHO

WONCA launched a NCD statement during the 2023 World Council Meeting in Sydney, Australia, with former Member at large and WHO Liaison, Prof Val Vass, presenting the statement on the second day of activities. The statement not only emphasises the critical role of Primary Health Care (PHC) Teams in addressing noncommunicable diseases (NCDs), but also stresses early detection and addresses risk factors, aligning with WONCA's commitment to reduce premature NCD deaths per the 2030 Sustainable Development Goal.

 

WONCA's NCD Commitment Recognised by WHO Leader, Dr Bente Mikkelsen

In response to WONCA's NCD statement unveiled at the 2023 World Council Meeting, Dr. Bente Mikkelsen, Director of the Division of Noncommunicable Diseases at WHO, expressed immense gratitude for the collaboration. She acknowledged WONCA's crucial role in the fight against noncommunicable diseases (NCDs) and emphasised the importance of addressing statistics related to Noncommunicable Diseases.

Dr. Mikkelsen highlighted the alarming global burden of NCDs, constituting 74% of all deaths, particularly affecting low and middle-income countries. She applauded WONCA's focus on primary and secondary prevention, especially targeting tobacco, alcohol, obesity, and hypertension. Dr. Mikkelsen conveyed optimism that these efforts could align with the 2030 Sustainable Development Goal, aiming to reduce premature mortality by 30%, underscoring the potential impact with WONCA's support.

Dr. Mikkelsen stressed the interconnectedness of NCDs, health care disruption during crises, and the need for universal health coverage. She commended the role of Primary Health Care (PHC) Teams, including family doctors, in delivering essential interventions, and urged continued support for healthcare workers emphasising the importance of investing in health education, competency-based training, and multidisciplinary teams.

Finally, she encouraged embracing innovative service delivery models and underscored the critical role of partnership in implementing solutions, expressing delight at WONCA's collaborative efforts and congratulating the organisation on the impactful statement launch.

WONCA Statement on Non Communicable Diseases (NCDs) and Primary Health Care (PHC) to WHO

Noncommunicable diseases (NCDs)—primarily heart disease, stroke, cancer, diabetes and chronic respiratory diseases—cause nearly three-quarters of deaths in the world. Their drivers are social, environmental, commercial and genetic, and their presence is global. Every year 17 million people under the age of 70 die of NCDs, and 86% of them live in low- and middle-income countries (LMICs). Many of these early deaths are evitable. Critical is early detection and management of NCDs, e.g. Half of all people with hypertension do not know it. Addressing major risk factors that can lead to them—tobacco use, unhealthy diet, harmful use of alcohol, physical inactivity and air pollution—could prevent or delay significant ill health and a large number of deaths from many NCDs. All these conditions can be detected and, in most cases, managed at primary care level. In addition, since multimorbidity increases a generalist primary care holistic approach is crucial to achieve the 2030 Sustainable Development Goal (SDG) target on reducing premature NCD deaths by a third. Primary Health Care (PHC) Teams provide the necessary technical expertise through community based, patient-centred, multiprofessional, coordinated and continuous preventative care. This can reduce mortality, disability and health inequity at a lower per capita cost than other health care systems.1 Continuity of care with a Family Medicine doctor reduces hospitalisations, emergency departments visits, and treatment duplications.2 Multi professional PHC teams enable equity of access to preventative care and offer holistic person centred delivery to address the complex co-morbidities intrinsic to NCD management. Emerging evidence from LMICs confirms that, for meeting local needs, clearly defined delivery frameworks for achievable interventions, accompanied by appropriate resourcing, are essential.3,4,5 Adapting to local contexts requires the strong leadership and expertise which Family Doctors are trained to provide through:

(i) Proactivity (prevention and promotion) by:
• Developing strong partnerships with citizens and patients to empower the self-care and health literacy needed for successful health promotion and disease prevention.
• Addessing local social determinants of health to prevent NCD development .
• Incorporating social prescribing into service delivery so that patients are referred to range of local, non-clinical services to support their health and wellbeing.

(ii) Reactivity (Patient management) by:
• Managing complex patients multimorbidity and assessing risk.
• Coordinating the care provided by multi professional PHC teams.
• Personalising multiple disease guidelines to safely address the individual needs of NCD patients.
• Overseeing the responsibilities in PHC teams to ensure the most cost-efficient NCDs health care.
• Balancing overuse of tests and treatments to make shared medical decisions with patients.
• Adapting post pandemic to improve the quality and safety of telehealth services for patients.

WONCA is committed to building partnerships with WHO to provide technical expertise globally to lead NCD challenges and advocate with governments to build strong PHC models in national health systems. The 132 WONCA member organisations offer opportunities to train family doctors to lead PHC training for NCD initiatives in country. WONCA working parties and special interest groups offer expertise for research projects. Expertise which is essential to ensure we meet the 2030 SDG NCD targets and address the current inequities in NCD management worldwide.


Download the statement as PDF document

References

References:
1. Starfield B, Shi L, J Contribution of Primary Care to Health Systems https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690145/
2. Hetlevik Ø, Holmås TH, Monstad K. Continuity of care, measurement and association with hospital admission and mortality: a registry-based longitudinal cohort study. BMJ Open. 2021 Dec 2;11(12):e051958. doi: 10.1136/bmjopen-2021-051958.
3. Varghese C, Nongkynrih B, Mikkelsen B. Learning by Doing: Accelerate Towards the NCD Target in SDG Through Primary Healthcare Comment on "Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare". Int J Health Policy Manag. 2022 May 1;11(5):708-710. doi: 10.34172/ijhpm.2021.96
4. Shiroya V, Shawa N, Matanje B, Haloka J, Safary E, Nkhweliwa C, Mueller O, Phiri S, Neuhann F, Deckert A. Reorienting Primary Health Care Services for Non-Communicable Diseases: A Comparative Preparedness Assessment of Two Healthcare Networks in Malawi and Zambia. Int J Environ Res Public Health. 2021 May 10;18(9):5044. doi: 10.3390/ijerph18095044.
5. Muratalieva E, Nendaz M, Beran D. Strategies to address non-communicable diseases in the Commonwealth of Independent States countries: a scoping review. Prim Health Care Res Dev. 2022 Nov 15;23:e73. doi: 10.1017/S1463423622000639.
6. Invisible Numbers: The True Extent of Noncommunicable Diseases and What to Do about Them. WHO, 2022. https://apps.who.int/iris/rest/bitstreams/1466662/retrieve
7. WHO NCD Factsheet. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases