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Non-Communicable Diseases in Humanitarian Settings
The Harvard Humanitarian Initiative’s (HHI) program on Non-Communicable Diseases (NCDs) in Humanitarian Settings seeks to address the growing burden of chronic disease in fragile states in order to improve humanitarian action and join international efforts to prevent, control and ultimately reduce the burden of NCDs, in particular in the world’s most vulnerable populations.
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"Non-communicable diseases represent a new frontier in the fight to improve global health. […] They are now responsible for more deaths than all other causes combined."
UN Secretary General Report
May 19, 2011
Global Burden of NCDs
The heavy burden of chronic, non-communicable diseases (NCDs) globally is striking. According to the WHO, an estimated 36 million deaths were thought to be due to NCDs in 2008, accounting for 63% of the deaths that occurred globally. This number is projected to increase to 55 million by 2030 with the most rapid rise expected to occur in developing countries (1, 2). The diseases that make the largest contribution to the morbidity and mortality of NCDs are cardiovascular disease, cancer, chronic respiratory diseases and diabetes.
Not only are low- and middle-income countries (LMICs) disproportionately affected by NCDs, but also suffer the largest burden of humanitarian crises (6, 7). The UNHCR Global Trends Report estimates that a staggering 65.3 million people were displaced from their homes as refugees or internally displaced persons (IDPs) in 2015 - the highest level ever recorded (6). Individuals with NCDs are more vulnerable in crisis situations, emergencies exacerbate NCDs and there is invariably a healthcare gap for those with chronic disease during and following emergencies (7, 8). Moreover, emergencies are increasingly becoming protracted with the average length of conflict-induced displacement being 17 years (6, 9), which results in significant health ramifications.
NCDs in Humanitarian Crises
Despite these massive global changes, the problem of NCDs in humanitarian emergencies and conflict settings has largely been neglected. The international community is increasingly challenged with how to manage NCDs in such settings (7, 10). There is a lack of evidence-based guidelines for the management of NCDs in fragile states (7, 11) and it is unclear what interventions are effective and feasible (12). Increased advocacy, education and awareness around NCDs is needed to rally the global community to action. The burden of disease in emergencies needs to be further evaluated (8). Given largely fragmented NCD care in fragile states, improving coordination and collaboration between humanitarian agencies, academia and governments is crucial to build capacity, monitor and evaluate the delivery of NCD care. Moreover, access to essential medications, such as insulin, must be improved and the impact of NCD preventive activities and preparedness for crisis further addressed (7).
The impressive progress that has been made in the management of communicable diseases demonstrates that large-scale change is achievable with global collaboration, research and advocacy. Therefore, at present the HHI working-group is establishing and strengthening relationships and collaborations with other non-governmental organizations (NGOs), agencies, and academic centers and gathering information and ideas from the global community on how the Harvard community can contribute to this area with the expertise and resources that are available here in Boston. The HHI working group hopes to host an international conference on the topic here in Boston in 2017.
Resources and Publications
Slama S et al. Care of non-communicable diseases in emergencies. Lancet 388: 2350, 2016
Demaio A et al. Non-communicable diseases in emergencies: A call to action. PLoS Curr 2013
Jobanputra K et al. Three steps to improve management of noncommunicable diseases in humanitarian crises. PLoS Med 13:e1002180, 2016
Beran D et al. Improving global access to medicines for non-communicable diseases. Lancet 2: e561, 2014
Tonelli M et al. Modifying the Interagency Emergency Health Kit to include treatment for non-communicable diseases in natural disasters and complex emergencies. BMJ Global Health 2016
Affiliated Faculty and Collaborators
Brigham and Women's Hospital
Michael VanRooyen, MD, MPH
Gregg Greenough, MD, MPH
Marie McDonnell, MD
Massachusetts General Hospital
James Meigs, MD
University of Southern California
Parveen Parmar, MD, MPH
International Rescue Committee
Emmanuel d'Harcourt, MD, MPH
Ruwan Ratnayake, MHS, FETP
Lillian Kiapi, MD, MPH
University of Geneva
David Beran, MSc, PhD
Médecins Sans Frontières
Kiran Jobanputra, MD
James Smith, MD
London School of Hygiene and Tropical Medicine
Bayard Roberts, PhD, MSc, MA, BA
Pablo Perel, MD, MSc, PhD
World Health Organization
Alessandro R. Demaio, MCCS, MPH, PhD
Copenhagen School of Global Health
Siri Tellier, MPH