Operationalising dementia prevention as a measurable NCD priority.

There is considerable research around the morbidity and mortality related to noncommunicable diseases (NCDs), particularly cardiovascular disease and diabetes, among people living with HIV/AIDS (PLWHA) in resource-richer settings. Less is known about the burden and appropriate management of NCDs, particularly 'other' NCDs including cancer, renal, pulmonary, neurocognitive and mental health conditions, among older PLWHA in resource-limited settings (RLSs). We undertook a literature review of these other NCDs to explore what is currently known about them and identify areas of further research. Systematic literature review of published manuscripts and selected conference abstracts and reports. Although there is growing recognition of the importance of these NCDs among the aging population of PLWHA in RLSs, significant gaps remain in understanding the epidemiology and risk factors among older PLWHA in these settings. Even more concerning is the limited available evidence for effective and feasible approaches to prevention, screening and treatment of these conditions. The burden of these NCDs is related to both the aging of the population of PLWHA and an increased risk due to HIV infection, other comorbidities associated with HIV infection or transmission risk and underlying risk factors in the general community. Results from resource-richer settings and RLSs highlight malignancies, neurocognitive and mental health as well as renal disease as the most significant challenges currently and likely to increase in the future. Although some lessons can be taken from the growing experience with NCDs in older PLWHA in resource-richer settings, additional research is needed to better understand their risk and impact and identify optimal models of care to effectively address this challenge in the areas where the majority of older PLWHA will be receiving care.

Depression and anxiety are among the most common mental health conditions globally that impact the lifestyle of affected individuals. Mental conditions and chronic diseases are linked to each other bidirectionally. Depression and anxiety with comorbid chronic conditions are often neglected or under-screened and possess challenges in treatment. This study aimed to know the frequency and determinants of depression and anxiety along with the severity level among common chronic communicable and non-communicable diseases. We enrolled 200 healthy controls and 800 cases with equal number (n = 400) of patients with communicable and non-communicable diseases. Depression and anxiety were screened through Hamilton's rating scale for depression and anxiety separately. We also measured the determinants of severe depression among patients with chronic diseases. Data was analyzed through SPSS version 23. We found higher frequency of depression (31% vs 11%; p=<0.001) and anxiety (13.25% vs 6%; p = 0.021) among cases as compared to healthy controls respectively. We found higher levels of depression among participants with non-communicable diseases as compared to communicable diseases (37.25% vs 24.75%; p < 0.05) respectively. Moreover, there was a higher frequency of anxiety in participants with communicable diseases as compared to those with non-communicable diseases, but the difference was non-significant (14% vs 12.5% p = 0.081). Among non-communicable diseases the highest percentage was found among individuals with cancer (67%), followed by diabetes (38%), cardiovascular diseases (33%) and respiratory disorders (11%). Among participants with communicable diseases, the highest percentage of depression was found in patients with Tuberculosis (29%) followed by HIV/AIDS (28%), Long COVID-19 (25%) and Hepatitis B/C (17%). There is a significantly higher percentage of depression and anxiety among participants with chronic diseases. It calls for a comprehensive approach to patient care that incorporates mental health as a fundamental aspect of the treatment and management of chronic diseases. Understanding the predictors of severe depression across different chronic conditions helps in stratifying patients who may benefit most from integrated psychiatric and psychological interventions.

Uganda faces a complex policy landscape as it simultaneously addresses infectious diseases and noncommunicable diseases (NCDs). The health system has been overwhelmed by the growing burden of NCDs across all socioeconomic strata. In this study, we sought to understand the policy context around NCDs in Uganda, the roles of actors both within and external to the government, and the factors shaping the development and implementation of NCD policies and programs in Uganda. We conducted in-depth interviews with 30 policy actors from the Ugandan Ministry of Health (MOH), nongovernmental organizations, and academia to understand the roles of different actors in the Ugandan NCD space, the programs and policy measures in discussion, and how to bridge any identified gaps. A thematic data analysis was conducted. All national actors viewed funding constraints as a critical barrier to developing and executing an NCD strategic plan and as a barrier to leading and coordinating NCD prevention and control efforts in Uganda. The crowding of nongovernment actors was found to fragment NCD efforts, particularly due to the weak implementation of a framework for action among NCD actors. Relatedly, limited recruitment of technical experts on NCDs within the MOH was viewed to further diminish the government's role in leading policy and program formulation and implementation. Though recent MOH efforts have aimed at addressing these concerns, some skepticism remains about the government's commitment to increase budgetary allocations for NCDs and to address the technical and human resources gaps needed to achieve NCD policy aims in Uganda. This study highlights the immediate need to mobilize more resources, reduce fragmented efforts in the NCD space, and prioritize investment in NCD prevention and management in Uganda.

ROAD SAFETY: A MAJOR PUBLIC HEALTH ISSUE

A World with Fewer People with Diabetes Noncommunicable Diseases

We appreciate the feedback and responses generated since the publication of our paper of September 13, 2005 [1]. It clearly fulfils our aim of initiating a debate around the core issue expressed in our work—mainly how the targets expressed in the Millennium Development Goals (MDGs) may have the unintended consequence of relegating mental health and noncommunicable diseases in general from the vision of policy makers. Using evidence on mental health in developing countries, we argued in our paper that addressing mental health problems is an integral part of health system interventions aimed at achieving some of the key MDGs, a view supported by the responses to our paper. However, we should clarify that within the MDGs there is not a “millennium mental health development goal” as suggested by Kasi et al [2]. Sachs and Sachs state that “the reason that the MDGs do not explicitly address noncommunicable diseases such as cardiovascular or psychiatric is because the MDGs focus on the gap in health status of rich and poor countries, a gap mainly accounted for by infectious diseases, malnutrition, and unsafe childbirth. The goals were crafted to address these large gaps rather than to solve all pressing health problems” [3] We think this assertion deserves their reassessment. It is a common view to assume that the developing world suffers mainly from infectious diseases. In fact, noncommunicable diseases kill people at economically and socially productive ages and kill them mostly in the developing world: 80% of chronic disease deaths occur in low- and middle-income countries [4]. Another misconception is that the epidemic of noncommunicable diseases is still to come. That is no longer true: it is here already [5–7]. We need an informed debate about the health interventions needed to tackle the burden of disease in the developing world, and one that goes beyond the MDGs as they are currently configured. We are delighted to learn that the Sachs are “exploring ways to integrate mental health care within the health systems,” and agree that development and public health communities—including mental health professionals—need to work together to ensure that the MDGs can be achieved. Explicitly tackling these mental health gaps, in parallel with achieving the existing MDGs, would be a major achievement, resulting in significant improvement in mental health around the world.

The central place of psychiatry in health care worldwide.

Background:Patients with non-communicable diseases are vulnerable to disasters. This is a systematic review describing the impact of disasters on non-communicable diseases.Methods:A systematic review was conducted using PRISMA standards. Relevant articles published from 1997 to 2019 collected by searching the Scopus, PubMed, Science Direct, databases. We specifically examined reports describing NCDs and including the key words “non-communicable disease and Disasters”. NCDs included cardiovascular, respiratory, diabetes, cancer and mental health diseases.Results:Of the 663 studies identified, only 48 articles met all the eligibility criteria. Most studies have shown the impact of all natural disasters on non-communicable diseases (39.8% n=19). The largest study was the effect of earthquakes on non-communicable diseases (29.2% n=14). For the NCDs targeted by this research, most of the included studies were a combination of four diseases: cardiovascular disease, respiratory disease, diabetes and cancer (44% n=21). Followed by cardiovascular disease (14.6% n=7), chronic respiratory disease (12.5% n=6), diabetes and cancer (6.2% n=3) and mental health (12.5% n=6).Conclusion:The incidence of disasters affects the management of treatment and care for patients with NCDs. Specific measures include a multi-part approach to ensuring that patients with non-communicable diseases have access to life-saving services during and after disasters. The approach of the health system should be expanded from traditional approaches to disasters and requires comprehensive planning of health care by policy makers and health professionals to develop effective strategies to enable patients to access medical, therapeutic and diagnostic services in natural disasters.

Noncommunicable diseases (NCDs) are leading causes of death globally and in Nigeria they account for 29% of total deaths. Nigeria's health system is decentralized. Fragmentation in governance in federalised countries with decentralised health systems is a well-recognised challenge to coherent national health policymaking. The policy response to the rising NCD burden therefore requires strategic intent by national and sub-national governments. This study aimed to understand the implementation of NCD policies in Nigeria, the role of decentralisation of those policies, and to consider the implications for achieving national NCD targets. We conducted a policy analysis combined with key informant interviews to determine to what extent NCD policies and strategies align with Nigeria's decentralised health system; and the structure and process within which implementation occurs across the various tiers of government. Four inter-related findings emerged: NCD national policies are 'top down' in focus and lack attention to decentralisation to subnational and frontline care delivery levels of the health system; there are defective coordination mechanisms for NCD programmes which are underpinned by weak regional organisational structures; financing for NCDs are administratively burdensome and fragmented; and frontline NCD service delivery for NCDs are not effectively being integrated with other essential PHC services. Despite considerable progress being made with development of national NCD policies, greater attention on their implementation at subnational levels is needed to achieve more effective service delivery and progress against national NCD targets. We recommend strengthening subnational coordination mechanisms, greater accountability frameworks, increased and more efficient funding, and greater attention to integrated PHC service delivery models. The use of an effective bottom-up approach, with consideration for decentralization, should also be engaged at all stages of policy formulation.

Noncommunicable diseases (NCDs) cause more than half of all deaths in low- and middle-income countries, claiming an estimated 29 million lives each year (of 36 million NCD deaths worldwide).1 About 30% of these deaths occur before the age of 60. Death and disability due to NCDs are rising in all regions of the world but most rapidly in sub-Saharan Africa, where the projected increases in NCDs will outpace reductions in infectious diseases (contributing to a rising “double-burden” of disease).2 In sub-Saharan Africa, women aged 15–49 are already dying from NCDs at a rate four times higher than women living in high-income countries.1 This burden of premature mortality and disability poses a threat to human, social and economic development. More than half of all tuberculosis deaths in India are attributed to tobacco, and over a quarter of new tuberculosis cases in countries with the highest burden are attributed to tobacco use and diabetes.3 Where public health systems are weak, payment for care can trap poor households in cycles of debt and illness. In India, for example, treatment for diabetes costs an affected person on average 15–25% of household earnings.4 A World Bank study showed that cardiovascular disease leads to catastrophic expenditure for 25% of Indian families and drives 10% of families into poverty.5 People with NCDs are also more likely to miss work, become unemployed or retire early.6 In view of such evidence, the World Economic Forum has ranked NCDs as among the top global threats to economic development.7 Scientists agree that a comprehensive package of primary prevention, health-care interventions and improved surveillance can substantially reduce the burden of NCDs.8,9 Building on this evidence, the 193 WHO Member States adopted a global strategy for the prevention and control of NCDs at the World Health Assembly in 2000. Subsequently, WHO has adopted the Framework Convention on Tobacco Control, the Global Strategy on Diet, Physical Activity and Health, and the Global Strategy to Reduce the Harmful Use of Alcohol. Tools are thus in place to reduce the burden of NCDs, enshrined in WHO’s 2008–2013 Action Plan for the implementation of the global strategy.10 Reducing the burden of NCDs is no longer just a technical issue, but a political problem.11 Health ministers and policy-makers in developing countries are aware of the burden and the existence of cost-effective interventions. Yet, thus far, donors and the international development community have been slow to respond, in part because NCDs are not among the Millennium Development Goals. Despite repeated donor commitments such as the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action, NCDs receive less than 3% of development assistance for health even though they cause more than one-third of all premature deaths.12 WHO’s Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases provides the roadmap for change.13 Since its adoption in 2008, a global movement has begun to emerge around its shared goals, led by leaders from developing countries. For example, the Doha Declaration on Noncommunicable Diseases and Injuries called for the integration of NCD prevention and control into the global development agenda. Discussions during the United Nations Economic and Social Council meeting in July 2009 led to a United Nations General Assembly Resolution in May 2010, requesting the United Nations convene a high-level meeting in September 2011 with the participation of heads of state and government.14 Just as the HIV/AIDS high-level meeting in 2001 marked a turning point in the HIV epidemic,15 this meeting provides an opportunity to raise the priority given to NCDs within the global development agenda. Preparations for the high-level meeting have already begun through regional consultations in all six WHO regions. These consultations have resulted in declarations or outcome documents that identify priorities for action against NCDs and outline the expectations of Member States. Based on the regional consultations, some of these expectations include: a greater commitment from policy-makers to NCD prevention; more effective mechanisms and monitoring of intersectoral action; greater accountability of non-health sectors; and scaling-up of WHO’s Action Plan. Ultimately the outcomes of the high-level meeting will depend on the expressed priorities of Member States. At the very least, the meeting should increase awareness of NCDs among policy-makers and achieve higher levels of political commitment. The involvement of the health profession is crucial to ensure that countries prepare well for the high-level meeting and focus their discussions on intensifying preventive action against NCDs and strengthening health-care interventions. If the health profession provides leadership and support to global and national initiatives to address NCDs, their active involvement will play a pivotal role in altering the course of the epidemic and averting millions of premature deaths.

Non-Communicable Diseases (NCDs) continue to increase globally, including where recorded among prison populations. Pakistan, like many low- and middle-income countries is facing significant health system challenges. Little is known about NCDs in its prison population. A scoping review mapped and described what is known about factors impacting on NCDs in the prison population of Pakistan. Objective: To describe factors impacting Non-Communicable Diseases (NCDs) in the prison population of Pakistan and to inform policy and improve prison conditions, nutrition, and healthcare for effective NCD management and care. Methods: A comprehensive search was conducted on Web of Science, PubMed and EMBASE, restricted to publications from 2000 to 2023. Eight studies fulfilled the eligibility criteria. Records were independently screened, charted and content analysis was undertaken. Results: Six themes were generated; Nutritional and dietary provisions, Physical activity and body mass index; Substance use and dependence; Hypertension and diabetes; Access to medical care and Mental health. Prior and detention related risk and lifestyle factors underpin the chronic ill health of people living in prison. These include prior history of smoking and alcohol use, and situational aspects of prison conditions causing environmental stress, malnutrition and sedentarism. Where reported, hypertension, obesity and depression were high among people in prison. Conclusions: Prisons are fundamental to the domestic NCD response. Prisons in Pakistan require dedicated resourcing to improve basic conditions, nutrition and healthcare allocations for all people living in prisons. The review highlights the need for prison-based NCD screening, diagnosis, treatment and care in Pakistan, in close alliance with specialist care in hospitals. Further health research is warranted to examine the effectiveness of NCD policies and practices in place in contemporary prison systems in Pakistan.

Because of the urbanization, demographic transition and influence of globalization, the lifestyle of people in many of the low and middle income countries (LMIC) is changing; heading to unhealthy dietary habit, physical inactivity and use of cigarette and alcohol.The lifestyle changes on the background of earlier malnutrition, inevitably leads to central obesity.This with the stressful situation caused by the competitive environment catalyzes the surge of Non Communicable Diseases (NCDs).Reports showed that the burden of NCDs in LMICs is on the rise.As a result, NCDs are responsible for two-thirds of the world's deaths-80% in low-and middle-income countries.In sub-Saharan Africa, NCDs contribute a third of the disability-adjusted life year burden.However, resources allocated to prevent and treat NCDs in LMICs are none or little (1).Until recently, communicable diseases remained the sole priority for health policy though they do not constitute the major contributor to the burden of disease in terms of disability-adjusted life years or mortality in any region of the world apart from sub-Saharan Africa (2, 3).Though essential to reduce the future disease burden, prevention interventions will do little for those people who have already developed NCDs, and who are essentially being used to validate investments that will come too late to help them.While working on limiting the number of future NCD patients, an important duty is to ensure that people with NCDs receive quality care today.Investing to improve primary care to shoulder NCD services-the main entry point to health services for most people in resource-limited settingshas the potential to overcome some of these problems (4).From the successful experience gained in delivering interventions for communicable diseases such as HIV, tuberculosis

BackgroundThere is a significant treatment gap in provision of effective treatment for people with mental disorders globally. In some Low and Middle Income Countries (LMICs) this gap is 90% or more in terms of untreated cases. Clinical practice guidelines (CPGs) are one tool to improve health care provision. The aim of this review is to examine studies of the effectiveness of evidence-based CPG implementation across physical and mental health care, to inform mental healthcare provision in low and middle income countries (LMICs), and to identify transferable lessons from other non-communicable diseases to mental health.MethodsA systematic literature review employing narrative synthesis and utilising the tools developed by the Cochrane Effective Practice and Organisation of Care (EPOC) group was conducted. Experimental studies of CPG implementation relating to non-communicable diseases, including mental disorders, in LMICs were retrieved and synthesised.ResultsFew (six) studies were identified. Four cluster randomised controlled trials (RCTs) related to the introduction of CPGs for non-communicable diseases in physical health; one cluster-RCT included CPGs for both a non-communicable disease in physical health and mental health, and one uncontrolled before and after study described the introduction of a CPG for mental health. All of the included studies adopted multi-faceted CPG implementation strategies and used education as part of this strategy. Components of the multi-faceted strategies were sometimes poorly described. Results of the studies included generally show statistically significant improvement on some, but not all, outcomes.ConclusionEvidence for the effectiveness of interventions to improve uptake of, and compliance with, evidence-based CPGs in LMICs for mental disorders and for other non-communicable diseases is at present limited. The sparse literature does, however, suggest that multifaceted CPG implementation strategies that involve an educational component may be an effective way of improving guideline adherence and therefore of improving clinical outcomes. Further work is needed to examine cost-effectiveness of CPG implementation strategies in LMICs and to draw conclusions on the transferability of implementation experience in physical health care to mental health practice settings. Strategies to ensure that CPGs are developed with clear guidance for implementation, and with explicit, methods to evaluate them should be a priority for mental health researchers and for international agencies.

This paper examines the ongoing efforts within the United Nations (UN) to establish modalities and criteria for the participation of indigenous institutions in the UN Organization, particularly in the General Assembly, Economic and Social Council, and treaty bodies. It highlights that this consideration, anticipated for the UN's 70th General Assembly and potentially reaching a decision in September 2017, marks a significant shift, challenging over 370 years of a modern state system that has largely denied the political legitimacy of Fourth World nations. The UN Declaration on the Rights of Indigenous Peoples (UNDRIP) and the 2014 World Conference on Indigenous Peoples (WCIP) have provided crucial principles, such as the right to free, prior, and informed consent, mandating indigenous participation in decisions affecting their rights. The paper traces the historical exclusion of indigenous nations from international discourse, from the 17th century dominance of nations and empires to their subordination within the modern state system. It distinguishes between the organic definition of "nation" and the artificial construct of "state" as defined by the 1648 Treaty of Westphalia. Despite the historical denials, as exemplified by the Haudenosaunee's repeated attempts to gain admission to the League of Nations and later the UN, the current consultations by the UN General Assembly President signify a potential breakthrough. The paper summarizes the diverse views from states, nations, and NGOs on eligibility criteria and accreditation processes, noting significant divergences but also areas of convergence. It concludes that while the full resolution of indigenous participation is a long-term endeavor, the current movement signifies a crucial step towards Fourth World nations gaining a rightful seat at the international decision-making table.

This chapter deals with developments towards the recognition of the right to an effective remedy as lay down in international instruments, with emphasis on the normative content of this right. Special attention will be given to the United Nations (UN) Basic Principles and Guidelines on the Right to a Remedy and Reparation for the Victims of Gross Violations of International Human Rights Law and Serious Violations of International Humanitarian Law , adopted in their final form by the UN General Assembly in 2005 and marking a milestone in the lengthy process towards the framing of victim-orientated policies and practices. The International law commission Articles on State Responsibility were referred to as setting out legal consequences in terms of obligations of a State to stop wrongs attributable to that State and to repair the harm done to injured parties. Keywords: International Human Rights Law; International Humanitarian Law; International Instruments; State responsibility; United Nations (UN) general assembly