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Commissioners and participants of the opening meeting of the Lancet Commission on Reframing NCDs and Injuries for the Poorest Billion

After 5 years, the landmark report of The Lancet Commission on Reframing NCDs and Injuries (NCDI) for the Poorest Billion has now been published and was launched at a virtual global event on September 15th 2020.

In 2015 a global commission of experts came together and divided into working groups focussed on understanding 4 key issues;

1. The nature of the burden
2. What can be done about the burden
3. How to finance solutions
4. How to integrate NCDs and injuries of poverty into global health governance

Sixteen low- and lower-middle-income countries have also conducted National NCDI Poverty Commissions, seven of which have already been published and their initial reports launched.

Key Findings

• The commission found that 90% of the world’s poorest live in rural areas of Sub-Saharan Africa and South Asia and that 80% of these people are younger than 40 years of age.
• Significantly, they found that key global initiatives, including the UN Millennium Development Goals, the Sustainable Development Goals and the World Health Organization’s 4 (diseases) x 4 (risk factors) Global NCD Action Plan agenda do not adequately address the actual NCDI burden among the world’s poorest billion.
• Moreover, even after the addition of mental and substance abuse disorders and air pollution to the 4 x 4 model in 2018, the report determined that existing frameworks still fail to address more than half of the NCDI poverty burden identified.

Relevance to rheumatic heart disease (RHD)

• The Lancet NCDI commission report highlights RHD as a one of several severe NCDs that disproportionately affect the poorest billion.
• RHD has been identified as being one of 52 causes which account for 75% of the NCDI burden “among the poorest billion between the ages of 5 and 40 years”.
• Similarly, RHD was identified as being one of 40 causes accounting “for 75% of the NCDI burden in those aged over 40 years”.
• Importantly, the report has been informed by the lived experiences/stories of young people living with NCDs including a 14-year-old Nepalese girl, a 17-year-old Nepalese boy, a 40-year-old Malawian woman, and an 18-year-old Ethiopian boy, all with RHD.
• The commission report suggests that in many health systems, an early priority in Universal Health Coverage (UHC) expansion could be to develop Integrated Care Teams (ICTs) that address, for example, severe chronic NCDs including advanced rheumatic heart disease.
• The report discusses ways in which sentinel conditions such as RHD, which are responsible for a large amount of lifetime health loss in the absence of treatment, could be leveraged by exploring how prioritised NCDI interventions map onto potential ICTs within existing health service delivery platforms.
• Secondary prophylaxis with penicillin for rheumatic fever or established RHD, as well as treatment of acute pharyngitis to prevent rheumatic fever, were both scored as having very high equity and very high cost effectiveness in terms of NCDI interventions – the highest possible rating.
• Secondary prophylaxis with penicillin for rheumatic fever or established rheumatic heart disease was identified as a priority intervention at the nexus of chronic care and first-level (district) hospitals by National NCDI Poverty Commissions.
• Treatment of acute pharyngitis in children to prevent rheumatic fever was identified as a priority intervention at the nexus of prevention and the health center by National NCDI Poverty Commissions.

Key Outcomes

The Lancet Commission report provides the clearest picture yet of the burden of NCDIs among the world’s poorest and most vulnerable people and calls for urgent action to address it. The report argues that the current global NCD agenda does not address the needs, perspectives, and rights of the world’s poorest and for this reason, the NCD agenda must be expanded as a matter of justice and equity. The Commission hopes to bring attention to “life-saving and cost-effective solutions for NCDIs of poverty that can be delivered as part of a comprehensive commitment to UHC”. They also plan to “launch the NCDI Poverty Network to mobilize greater funding and political commitment for the health of the poorest billion”.

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