Acting Early on NCDs: Research and action for digitally-enabled health systems

The mounting burden of NCDs

Non-communicable diseases (NCDs) have emerged as the leading cause of death globally, accounting for 74% of deaths worldwide and claiming the lives of 41 million individuals annually.¹ The rise in non-communicable diseases (NCDs) is driven by a complex interplay of factors, including urbanisation, the globalisation of unhealthy lifestyles, population aging, and social determinants such as poverty, education, and access to healthcare, which contribute to the increasing prevalence of risk factors like unhealthy diets, physical inactivity, tobacco use, and alcohol consumption.^1,2  Furthermore, air pollution and climate change, to which health systems contribute, are risk factors for many NCDs.³ The chronic nature of these diseases impairs quality of life across multiple dimensions and often creates long-term needs for treatment and care.^2,4 Beyond the human toll, NCDs place an enormous financial strain on governments⁴ and threaten the sustainability and resilience of health systems.³

The World Health Organization (WHO) has called for urgent government action to mitigate the burden of NCDs amid these escalating pressures. Despite the high burden of NCDs, it is estimated that 80% of cases are preventable,⁵ meaning that most premature deaths could be avoided or delayed. This demands a multifaceted approach that extends beyond the delivery of healthcare. It is paramount to address the social, commercial and environmental determinants of health, and enact public health initiatives promoting active lifestyles, healthy dietary choices, and habits from early ages through multi-sectoral action. These interventions form the foundation of a proactive strategy for primary prevention aimed at preventing the onset of diseases.

The healthcare delivery system also plays a crucial role in the primary prevention of NCDs through an array of strategies including education and counselling, behavioural interventions and pharmaceutical care, underpinned by risk assessment and targeted screening for risk factors. For those already with active disease, early detection and swift referral into appropriate treatment pathways is needed to alleviate symptoms and improve prognosis. The more equitably, efficiently, and responsively health systems do so, the greater the potential benefits in terms of patients' health outcomes and experience, quality of life and ability to work. NCDs typically require lower-intensity care if caught earlier, which draws on fewer health system resources and produces less emissions than in more advanced stages. Achieving gains in these areas requires health systems to create the right conditions for healthcare providers to act early.

PHSSR's work to strengthen health systems

The Partnership for Health System Sustainability and Resilience (PHSSR) is a non-profit, multi-sector, global collaboration of which the London School of Economics (LSE) is a founding member. Its goal is to improve global health by building more sustainable and resilient health systems for the future. In 2023, PHSSR released a Global Summary Report, with research insights from 18 countries. It identified shared challenges facing health systems globally. The forthcoming Abu Dhabi Global Healthcare Week (13 to 15 May 2024) will see the PHSSR 3rd Summit: Working together to strengthen health systems take place. This summit promises an excellent opportunity for solution-focused dialogue between experts from around the world on how to address these common challenges.

These findings have informed PHSSR's next chapter of research: The PHSSR Policy Roadmaps. PHSSR research findings have underlined the need for more effective, earlier detection and intervention on NCDs, and "Acting Early on NCDs" will be the focus of the first Policy Roadmaps. Research teams in seven countries will employ a new research framework to assess their countries' health systems capabilities across seven domains: governance, financing, workforce, medicines and technologies, service delivery, population health and environmental sustainability.

Incorporating diverse stakeholder perspectives and insights, the resulting reports will assess each country's strengths, weaknesses, opportunities and challenges in relation to acting early. Building on this analysis they will provide policy makers and implementers with a clear, country-specific, evidence-informed set of actions for strengthening their health system and fostering sustainability over the long term.

Health system digitalisation as an enabler of early intervention

Among the areas of focus in the Policy Roadmaps will be the use of digital technologies. Advances in the use of data and digital technologies have the potential to support comprehensive and personalised approaches to early detection and intervention of NCDs. In practice, centralised and integrated digital health and data infrastructure can help forecast future health system and workforce needs, while also enabling healthcare professionals to identify individual risk.⁶ Interoperability of health data formats (structural), languages (semantic), and sociopolitical facilitators (organisational/legal) will be key for the successful implementation of digital technologies in health systems. Digital health tools, when properly implemented, also have the potential to empower patients to actively participate in their own healthcare and enable early detection and intervention for NCDs, for example with the support of mobile health applications and remote monitoring devices.⁷

Investing for sustainable health systems

Although there are upfront costs associated with developing a digital infrastructure that is interoperable and integrated within the health system, its effective implementation can help health systems in making the shift towards earlier detection and intervention. Earlier intervention benefits patients first and foremost. Over time, it is cost-effective and generates a significant return on investment when compared to treating advanced-stage NCDs.^8,9 Furthermore, healthier populations are more productive and able to contribute to overall economic growth, while also reducing the burden on health systems.

Digitalisation is underpinned by collaboration between policy makers, healthcare providers, technology innovators and users. Some examples include:

Estonia: A combination of genomic and health data in the national health information system is used to provide personal risk calculations for selected complex diseases. Clinical decision support systems are used to automatically visualise the disease risks and provide suggestions to reduce this risk towards disease prevention or improved, personalised patient treatments.³

Japan: Health Japan 21 aims to promote overall health, for example, through early detection and intervention of chronic diseases. The central government supports local governments by allocating financial resources and leading activities focussing on areas such as the extension of healthy life expectancy, reduction of health inequalities, increased early detection and intervention on NCDs, and improvements in social and lifestyle behaviours. Analysis completed in 2022 found improved healthy life expectancy, decreased age-adjusted mortality rate for cerebrovascular disease, and decreased age-adjusted mortality rate for cancer among those younger than 75 years of age. Social marketing methods are employed to share useful messages about behaviour modification and health guidance to specific population segments (e.g. male/female, young/elderly) through Internet of Things (IoT) technologies, also known as "smart objects".¹⁰

France: NEPHROLOR is a regional network that has developed a comprehensive strategy for acting early on and managing chronic kidney disease. Some key components include patient education programmes, early diagnosis and treatment measures, online patient monitoring thorough data collection and sharing, and patient reported quality/satisfaction evaluation questionnaires.¹¹

UAE: Healthcare providers in Abu Dhabi have introduced patient portals, allowing patients to access their medical records, book appointments, and communicate with healthcare providers online. These portals seamlessly integrate with mobile health apps, further facilitating appointment bookings, lab result access, and health information dissemination. Designed to boost patient engagement, these tools are especially vital for those with chronic conditions. Many Abu Dhabi healthcare institutions employ remote monitoring, either self-reported through health apps and portals or via monitoring devices integrated within these apps or portals. The continuous tracking of vital signs and health metrics fosters proactive healthcare management.¹²

The third PHSSR Summit will take place on 14 May 2024 at Abu Dhabi Global Healthcare Week and will discuss the links between health system strengthening and proactive NCD management, including the role of digital technology facilitating early detection and intervention.

For more information on this and the upcoming PHSSR Policy Roadmaps, contact Mikaela Esquivel (m.esquivel@lse.ac.uk)

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