Global & Disaster Medicine

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Noncommunicable diseases in Rwanda

CDC

Making some noise about noncommunicable diseases in Rwanda

Posted on August 28, 2017 by Kristy Joseph, MA, CDC Global NCD Branch

We weren’t sure what to expect when the Rwanda Biomedical Center requested a training for their noncommunicable disease (NCD) program managers. We had never delivered this particular curriculum before, but after three months of preparation, our journey from Atlanta began. After landing in the capital Kigali, we faced a bumpy three-hour drive into the mountains to the remote northern district of Musanze. We finally arrived, exhausted but excited. What followed was four days of learning and a wealth of opportunities to address the growing crisis of NCDs in Rwanda.

A creeping global crisis

NCDs cause about two out of three deaths globally, and are a creeping crisis in low- and middle-income countries (LMICs). In Africa, NCDs are estimated to become the most common cause of death by 2030. NCDs are particularly challenging because unlike infectious diseases, patients often need long-term health care. While many NCDs are preventable by reducing four main behavioral risk factors (tobacco use, physical inactivity, excessive use of alcohol, and unhealthy diet), these very same risk factors become more common as countries like Rwanda urbanize. The soaring burden and costs of NCDs in LMICS resonate globally by weakening economies and health systems, leaving countries unprepared to deal with pandemic threats that can easily spread across borders.

 

Preparing for the future

Despite these looming threats, “the NCD movement is too quiet, too pedestrian, and too polite to make the impact it deserves,” according to Richard Horton, Editor-in-Chief of The Lancet. Yet the Rwandan Ministry of Health (MOH) is not staying silent: they set an ambitious national goal to reduce 80% of premature deaths caused by NCDs or by injuries in people under 40 years old by the year 2020, known as “80x40x20”. To achieve this goal, Rwanda is making moves to expand access to medical care, focus on the most prevalent diseases, and deliver medical services more efficiently.

“The NCD movement is too quiet, too pedestrian, and too polite to make the impact it deserves.” –Richard Horton, Editor-in-Chief, The Lancet

The Rwanda Biomedical Center (RBC) partners with the MOH to promote quality, affordable, and sustainable population health care services through innovative, evidence-based interventions and practices. The RBC requested NCD training for their 12 public health professionals responsible for the day-to-day implementation, management, and monitoring and evaluation of NCD prevention and control programs. While this staff is devoted to working on NCDs, few had prior NCD experience. In December 2016, the CDC Global Noncommunicable Diseases Branch piloted a four-day course to meet their needs.

The training focused on public health core competencies, including leadership, interdisciplinary partnerships, data analysis, program planning, and creating evidence-based interventions. Mastering these areas is especially important to tackle the complexities of NCD management and risk factors.

The right stuff

A compelling training helps equip public health workers with the right tools and knowledge so they can make data-based decisions and communicate to target populations. The best trainings illustrate key points using real-world examples that participants can relate to. While driving in Rwanda, we noticed bicyclists hanging on to the back of moving trucks. We shared with the RBC staff this observation of risky road behavior to justify the need for coalition building and data to support road safety initiatives. We saw their eyes light up with ideas as we explained CDC’s Health Impact Pyramid (pictured to the right) and emphasized the importance of population-level interventions. We hoped to motivate them to act and inspire them to advocate for the resources and support they need to be successful.

What next?

As a result of the training, we are identifying more activities that foster NCD prevention in Rwanda. The RBC has already begun implementing some ideas from the course, such as creating disease-specific fact sheets. In addition to expanding our collaboration with Rwanda, our branch plans to hit the road with this course and train public health staff in additional countries in 2017. The only way to address the NCD epidemic is to keep making noise!

“This training changed our perspective and approach to tackling the NCD burden.”
-Samuel Rwunganira, Epidemiologist

The Global NCD Branch would like to acknowledge these individuals for their contributions to the NCD Program Managers Training course. From the Global NCD Branch: Brian Robie (retired), Lauren Billick, Sheryl Pouech, and Jami Husain. We would also like to thank Dileep Bal (independent contractor), Denise Duran (Division of Cancer Prevention and Control), Sheryl Pouech (Office of Public Health Preparedness and Response), and the National Public Health Institute team (Workforce Institute and Development Branch, Division of Global Health Protection).            

Posted on August 28, 2017 by Kristy Joseph, MA, CDC Global NCD Branch

 


Reducing speed to save lives by Dr Margaret Chan, WHO Director-General, and Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases (NCDs)

WHO

Reducing speed to save lives

Dr Margaret Chan, WHO Director-General, and
Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases (NCDs)

Commentary 
9 May 2017

We can save so many lives around the world if we just slow down. Each year, more than 1.25 million people – many of them young people – die in automobile crashes. And a large proportion of these deaths are preventable: about one third are due to vehicles traveling at excessive speeds. In low- and middle-income countries, that figure is closer to half.

Dr Margaret Chan

Dr Margaret Chan, the Director-General of WHO
WHO

Regardless of where one lives, speeding is a lethal problem. Studies show that on most roads, in most countries, 40–50% of all cars travel above the posted speed limit. And whether or not a car is speeding can be the difference between life and death. For example, someone who is hit by a vehicle traveling at 50 miles (80 kilometers) per hour has a 3 times higher risk of dying than if they had been hit by a vehicle moving at 30 miles (48 kilometers) per hour.

This means that just setting urban speed limits at 30 miles per hour or less, and allowing local authorities to reduce speed limits further around schools and other areas with high pedestrian traffic, would save many lives. It is encouraging that 47 countries around the world are already implementing these commonsense practices. But we must do far more to expand the reach of such measures, and to ensure that more governments adopt them.

Success through a comprehensive approach

Not surprisingly, countries that have embraced a comprehensive approach to road safety, such as the Netherlands, Switzerland, and the United Kingdom, have had the most success in reducing their rates of death and injury from automobile accidents. These countries have made it a high priority to reduce rates of speeding, and they have taken steps to improve the safety of their roads, vehicles, drivers, and all others who use roads, including pedestrians and motorcyclists.

For example, proactive countries have built their roads to include features that calm traffic, such as roundabouts. They have also established speed limits tailored to local road conditions, while stepping up enforcement to deter traffic violations. And they have begun to require that all new cars include life-saving technologies such as autonomous emergency braking.

Safer streets, healthier cities

Municipal leaders worldwide – from Addis Ababa to Mumbai to Bangkok – have played a key role in implementing these measures, which are not just saving lives, but also making their cities healthier in other ways. Safer streets encourage more people to walk and cycle, helping to reduce air pollution, which has been linked to chronic respiratory disease, cancer, and other noncommunicable diseases.

To build on these achievements, Bloomberg Philanthropies, the World Health Organization, and other partners are working with municipal leaders to help them gather the data needed to identify problem areas more effectively. They can then determine where to target their limited resources to make the biggest improvements. We are also providing support for local authorities to stage public-awareness campaigns that will help build grassroots support for new road-safety legislation and stronger penalties.

Improving road safety is one of the biggest opportunities we have to save lives around the world. And the good news is that, starting with the solutions outlined above, we already know how to do it.

Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases (NCDs)

Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases (NCDs)

The fourth annual United Nations Global Road Safety Week, May 8-14, provides a chance to draw more attention to these solutions. Over the course of the week, community events are being held in cities around the world, to help raise awareness of the problem and advance more solutions. These events will take many forms: street traffic will be slowed down, campaigns will be launched in many schools, and roundtable discussions will be held to explore how we can ensure that smart policies continue to spread.

All of these events and initiatives will bring together local and national leaders in government, civil society, business, law enforcement, and other sectors. To learn more about the week’s events, and how every community can take steps to reduce speeding, we encourage readers to visit the Road Safety Week website.

A world in which far fewer lives are lost to automobile accidents is possible and entirely within our reach. It is up to all of us to make it a reality.


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