In today’s world, non-communicable diseases (NCDs), such as cancer, heart and respiratory disease, diabetes, hypertension and Alzheimer’s—to name just a few—have quietly emerged as a pandemic of silent killers to collectively become the leading cause of death worldwide. Overall, according to the World Health Organization (WHO), NCDs are responsible for more than 38 million deaths a year—more than all other causes combined.
Addressing Non-communicable Diseases With an Interdisciplinary Network
A group of Yale School of Medicine and School of Public Health faculty have joined together to form a transdisciplinary, collaborative network that addresses the global burden of NCDs. The Yale Network for Global NCDs (known as NGN, “engine”)—founded in 2015 by Nicola Hawley, PhD, department of chronic disease epidemiology; Evelyn Hsieh Donroe, MD, PhD, section of rheumatology, allergy & immunology; Kasia Lipska, MD, MHS, section of endocrinology & metabolism; Christine Ngaruiya, MD, MSc, DTMH, department of emergency medicine; Tracy Rabin, MD, SM, section of general internal medicine; and Jeremy Schwartz, MD, section of general internal medicine—brings together faculty involved in NCD research, advocacy, policy, implementation science, education, and ethics.
“We believe that we can have a greater impact working together, rather than in our isolated silos,” said Schwartz.
“Our goal is to foster dialogue and collaborations among faculty across campus regarding the global NCD crisis, thereby creating opportunities for students, and increasing partnerships with communities and institutions outside of Yale focused on NCDs,” added Hsieh.
“Furthermore, many of the issues that we struggle with globally are also issues highly relevant to our community right here at home,” said Lipska. “One example from diabetes care is access to affordable insulin, an issue that Yale NGN has taken up as one of its causes.”
Recognizing the Economic Cost of Non-communicable Diseases
Ngaruiya says the vast majority of deaths from NCDs take place in low- to middle-income countries, and if drastic countermeasures aren’t taken then advances recently made to counter other public health challenges, such as the effects of communicable diseases, may be forfeited. She says in addition to the tragic personal loss, the economic loss to countries and the world overall is sure to be staggering. The United Nations has estimated that the cumulative loss NCDs pose to the global economy could surpass $47 trillion by 2030 if it doesn’t soon become a top priority for countries worldwide to tackle.
“Most NCDs affect people under the age of 60, nearly all of whom are still economically active,” said Ngaruiya. “Losing those in societies who are still making a significant contribution is simply not something most economies can afford.”
Focusing on Non-communicable Diseases in Kenya
Since its inception, NGN members have co-authored multiple publications and embarked upon a number of successful collaborations that have engaged other faculty and trainees from the Yale community.
Ngaruiya was recently among a team of 25 researchers, in collaboration with the Kenya Ministry of Health, to publish a series of 10 research papers based on a national survey on NCD risk factors in Kenya. Conducted in 2015, the survey used the WHO STEPwise approach, a tool to help countries collect, analyze, and disseminate information on NCDs.
The survey, recommended by WHO for member nations, was the first to focus on NCDs in Kenya. Ngaruiya was the sole senior faculty contributor from the United States, co-authoring four of the 10 research papers.
Gladwell Gathecha, an executive from the Division of NCD in the Ministry of Health in Kenya, said undertaking the STEPS survey was a critical milestone for Kenya and forms an important part of the government’s efforts to address the increasing burden of the NCD and injuries epidemic currently affecting this nation.
“The survey paves the way for the establishment of an NCD surveillance platform that collects baseline indicators on determinants of NCD and their risk factors for policy and planning purposes,” said Gathecha. “The collaborative efforts toward publishing the findings played an integral part in ensuring effective translation of evidence to policy and achievement of a wider audience reach.”
Catherine Kyobutungi, executive director of the African Population and Health Research Center (APHRC), agrees with Gathecha, stating that the survey was a critical first step in understanding the magnitude of NCDs in the country, providing guidance on what Kenya needs to prioritize in NCD prevention.
“We are pleased to have participated in publishing academic papers from the first-ever national STEPS survey in Kenya,” said Kyobutungi. “Kenya has been a leader in developing comprehensive NCD prevention policies and strategies in the region, and the results from the STEPS survey provide a baseline on which we can assess progress a few years from now.”
Kyobutungi said publishing these papers ensures that the world is more aware of the challenge posed by NCDs and will help ensure that organizations, such as APHRC, respond with the urgency needed to tackle the epidemic.
“It was an honor and a privilege to be able to work with Kenya’s ministry of health and other prominent public health leaders on this critically important research study,” said Ngaruiya. “It’s only through close partnership and collaborative networking with leading organizations and experts around the world to produce studies like this that meaningful strides can be made toward forging an effective global response to the dire threat posed by NCDs.”
Understanding Why Non-communicable Diseases Are Often Overlooked
Ngaruiya says that in societies today the dangers posed by NCDs are often overlooked or not considered as great a priority as communicable diseases, such as HIV, hepatitis, or the flu, which typically get more attention from policy makers, public health officials, and the general public.
She says the reason for this is that NCDs are inherently chronic, so the effects of interventions targeting them require a prolonged period of time before tangible positive outcomes can be seen. In many instances, even when interventions are successful, they still don’t make the diseases go away.
“There is no such thing as a quick fix for treating NCDs, and continuous investment is necessary to make a meaningful long-term positive impact,” said Ngaruiya. “All these factors make it especially challenging to convince others to consider it a priority and to commit to the cause.”
Ngaruiya says another unique challenge posed by NCDs is that because such diseases are so slow to develop, they often go unnoticed until complications arise, and it is too late or extremely costly to administer effective treatment.
Also, societal trends further complicate and compound the challenges posed by NCDs. In particular, urbanization significantly contributes to the growth of NCDs. This trend contributes to the rise in NCDs because people are exposed more frequently to richer, potentially unhealthy food and diets, and have fewer opportunities for exercise and physical activity. These lifestyle changes are made worse by increased exposure to pollution in cities and harmful work environments, all of which expedite progression to the development of NCDs.
Collaborating Across the Globe to Tackle Non-communicable Diseases
In 2016, NGN hosted a cross-campus symposium on global NCDs and has sponsored multiple on-campus seminars and talks. The group successfully competed for the first round of Yale Institute for Global Health-Hecht Global Health Faculty Network Awards and embarked upon a multi-dimensional, mixed methods study of self-care for hypertension and diabetes in rural Nakaseke District, Kampala. This project represents a collaboration with faculty at Makerere University College of Health Sciences and the African Community Center for Social Sustainability (ACCESS), which builds upon the ongoing Ugandan partnerships of NGN members Schwartz and Rabin through the Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD).
As part of their faculty network award, NGN members traveled together to Uganda to visit with their collaborators, Isaac Ssinabulya, MD, and Robert Kalyesubula, MBChB, and NGN fellows Sarah Moor (Downs International Health Student Travel Fellow ’19 and YSM ‘22) and Andrew Tusubira, MPH, leaders of the field work for their study. The group spent its first day together in Nakaseke, hosted by ACCESS, and made site visits to the three health facilities where their research study is taking place. They then spent two days at the UINCD office in Kampala, again along with their Ugandan counterparts, delving into the primary data that the NGN fellows had spent the previous months collecting.
Reflecting upon this experience, Ngaruiya said, “It was so important for those members of NGN who have not worked before in Uganda, or even just a rural district such as Nakaseke, to see these places firsthand, meet health facility staff and leadership, and have the opportunity to ask questions and learn from them. It really enriched our understanding and interpretation of the data and the importance of the work going forward.”
Other projects led by Yale NGN faculty engage communities in China, Kenya, the Pacific Islands, Peru, and New Haven.
Originally published Sept. 13, 2019 and Feb. 12, 2019; updated October 25, 2022.