Optimal Strategy for Screening in LMIC

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Disease Screening in Public Health

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University of Geneva

Disease Screening in Public Health

57 notes

Current and future public health is characterized by the increase of chronic and degenerative diseases, corresponding to the worldwide ageing of the population. The increasing prevalence of these conditions together with the long incubation period of the chronic diseases and the continual technological innovations, offer new opportunities to develop strategies for early diagnosis. Public Health has an important mandate to critically assess the promises and the pitfalls of disease screening strategies. This MOOC will help you understand important concepts for screening programs that will be explored through a series of examples that are the most relevant to public health today. We will conclude with expert interviews that explore future topics that will be important for screening. By the end of this MOOC, students should have the competency needed to be involved in the scientific field of screening, and understand the public health perspective in screening programs. This MOOC has been designed by the University of Geneva and the University of Lausanne. This MOOC has been prepared under the auspices of the Ecole romande de santé publique (www.ersp.ch) by Prof. Fred Paccaud, MD, MSc, Head of the Institute of Social and Preventive Medicine in Lausanne (www.iumsp.ch), in collaboration with Professor Antoine Flahault, MD, PhD, head of the Institute of Global Health, Geneva (https://www.unige.ch/medecine/isg/en/) and Prof. Gillian Bartlett-Esquilant (McGill University, Quebec/ Institute of Social and Preventive Medicine, Lausanne).

À partir de la leçon

Screening in Low and Middle-Income Countries and Migrants

The globalization of non-communicable diseases is a major challenge in low and middle income countries (LMIC). At the same time, migration is occurring between these countries and high income countries. Screening for cardiovascular diseases and for cancer in low and middle income countries will be presented and discussed. In addition, the special consideration of screening of migrants from these countries will be addressed. This module is given by: Professor Pascal Bovet from the Division of Chronic Diseases at the Institute of Social and Preventive Medicine in Lausanne; Dr. Catherine Sauvaget from the International Agency for Research on Cancer (IARC) in Lyon, France; and Professor Patrick Bodenmann from the Polimedical University Clinic and head of the Centre for Vulnerable Populations. A quiz will complete this module.

Module 7 Introduction_new video3:59

Screening of Noncommunicable Disease in LMIC5:59

Optimal Strategy for Screening in LMIC11:09

Cardiovascular Disease (CVD) Screening in LMIC10:45

Focus on Hypertension for CVD Screening in LMIC11:49

Cancer Screening in LMIC8:11

Rencontrer les enseignants

Antoine Flahault
Professor of Public Health and Director of the Institute of Global Health (Faculty of Medicine, University of Geneva) and co-Director of Centre Virchow-Villermé (Université Paris Descartes)
University of Geneva and Université Paris Descartes – Sorbonne Paris Cité
Fred Paccaud (In Partnership with UNIGE)
Professor of epidemiology and public health and Director of the Institute of social and preventive medicine
Lausanne University Hospital
Gillian Bartlett-Esquilant
Professor of Epidemiology and Research and Graduate Program Director and Associate Chair for the Department of Family Medicine at McGill University.
University of Lausannne and McGill University

[MUSIC]

The general trend about how to go about non-communicable disease,

has evolved dramatically over the last 15 years.

This slides here shows the first global strategy that was issued

by the World Health Organization in 2000, and gave a vision on how to

address the non-communicable disease along three pillars.

So the lesson was decrease risk factor through population-wide

intervention and healthcare, to address patients, or persons,

with cardiovascular disease or risk factor, who need to be treated.

They after, they have been sending out documents and events that have changed

the landscape for non-communicable disease prevention and control.

I mentioned just two here.

There was a meeting in 2011 in New York.

It was called the UN High level Meeting on Non-communicable Disease Prevention and

Control, which was held at the General Assembly in New York in September 2011,

and from that meeting, a document came out which is called

the UN Political Declaration on Non-Communicable Disease.

This document is extremely important.

It was the second time that the United Nations would address

non-communicable disease, recognizing that non-communicable

disease were both critically-important health problem.

As well as a critically-important development problem for all countries,

and particularly, low and middle-income countries.

This declaration sets the stage and the steps that need to be taken.

Now, this is the first time that these strategies have been identified and

formulated not only by experts, by medical experts, but also by heads of governments.

And that makes a big change, because this approach to

non-communicable disease now is not just an idea of some specialist,

but it's a politically-agreed movement worldwide.

And that event in 2011, had some follow-up that was scheduled,

inclusive different step to ensure that implementation is being done,

in all countries over time.

And one of these outcome was another meeting in 2014,

that was organized to evaluate progress done since 2011.

And to show further steps that would be needed until the objective of

a 25% reduction of noncommunicable disease is achieved in 2025.

This 2014 UN outcome document basically reiterated what was said in 2011.

And again, it shows and documents the different intervention

that countries need to implement, if the goal of a reduction

of non-communicable disease is to be achieved in 2025.

And let's just me show in this slide,

that several documents have been issued since 2000 up to now.

And different steps are already scheduled up to the year 2025, and even 2030.

So this is just to say that the global agenda and the global policy for

non-communicable disease, is very well organized and

includes very clear steps that countries are now expected

to achieve and to deliver a certain number of outcomes.

Among these outcomes and expectations, and that comes again, from the United Nations

decision, and in particular, the one from the World Health Organization.

There are nine global targets that have been established,

and that countries have to address by 2025.

One is a 25% decrease of noncommunicable disease by 2025,

and there are eight other targets.

And in the context of that module here, which is on high-reach strategies,

several of this nine targets, are related to high-risk strategies.

One is a 25% relative reduction of the prevalence of

hypertension by 2020, compared to 2010.

And this is mainly related to high-reach strategies, also not only, because

decrease of salt and population wide strategies also have a role.

But still, this is mainly a high-reach strategy that will achieve that goal.

And there are also a goal of having 80% availability of

affordable basic technologies and medication,

that need to be available in non-communicable disease,

in relation to non-communicable disease.

And also the goal of having at least 50% of people who are eligible for

treatment for noncommunicable disease that get that treatment.

So these 9 goals are well-defined, they have been agreed by all countries,

so they are agreeable to both experts and political authorities.

And countries are expected to give, to feedback results

about how they implement these strategies nationally.

And they have to feedback this information to the United Nations, through the general

assemblies, and also through reports that will be published every five years.

And along these nine targets,

there have been 25 indicators that have been developed.

And in relation to the high-reach strategy that is the topic of this session.

One of the targets is about raised blood pressure, and

countries are expected to report back to the United Nations,

actually to the World Health Organization, on a regular basis up to 2025,

about prevalence of high blood pressure, in both adults and children.

Countries are also expected to report about raised total cholesterol.

And also a few other things, inclusive are some indicators related

to national system response, like what is the availability of

different technologies and medicine at country level?

So the beauty of that whole process to address non-communicable disease,

has been that a certain number of particularly cost-effective intervention

to reduce non-communicable disease, have been defined and identified.

And this intervention are called best buys.

They are called Best Buys.

It's the World Health Organization but also by other institutions,

like the World Bank and other similar organizations.

What is interesting with this intervention is that there are only a few.

And they are very well defined, they are those that are most cost-effective, they

are affordable, they are scalable, and that can be implemented by all countries.

There are some intervention that are population-wide,

like taxes on tobacco, taxes on alcohol, reducing salt intake in diet,

through manipulating manufactured foods, reducing trans fat, and so long.

There are not so many, there are around 10 or 12 of such intervention,

that countries are expected to implement.

And there are also high-risk strategies, that is strategies to address

non-communicable disease at the individual level.

And there are not many, but one of them is to provide multi-drug therapy for

people at medium or high risk for cardiovascular disease.

Another one is to provide aspirin to people who have had a heart attack.

There are also one or two other interventions for cancer, but

this will be the topic of another modules and I will not detail this here.

So in conclusion, I would say in this introductory sessions of

noncommunicable disease in low and middle-income countries,

that these disease, noncommunicable disease,

are now recognized as being priority health and

economic issues, in Low and middle-income countries.

That global health policy to address this non-communicable disease,

have been developed, and are being implemented by all countries worldwide.

We also can recognize that best buy intervention, that is

intervention that are most cost-effective to address non-communicable diseases,

have been identified, and countries are expected to implement them.

There is a global action plan that has been developed by

the World Health Organization,

and all countries have agreed to implement that plan between 2013 and

2020, in order to achieve the targets that have

been set by the World Health Organization.

And finally, and not least, this whole global policy program at world level,

for non-communicable disease, has a clear follow-up.

There are several occasions where countries will meet at the United Nations

and the World Health Organization. And will have to report back about progress,

about non-communicable disease prevention and control.

And this, altogether,

gives good hope that noncommunicable disease will be addressed and

some reduction will be achieved within the five or next ten years.

[MUSIC]

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