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N o n - c ommu n i c a b l e d i s e a s e s a n d d i s a b i l i t i e s Health systems: Priorities for investment and the creation of systems to enable patients to self-manage effectively. With earlier diagnosis and better treatment, HIV/AIDS is now becoming a chronic disease and there must be integrated systems responsive to all chronic conditions, such as tuberculosis and HIV, as well as the NCDs. This represents a positive approach, especially for poor countries with limited resources. In a recent analysis, Atun et al. (2014) propose five areas in which synergies could be created for treating NCDs (see Box: ‘Health systems: Priorities for investment’). Conclusion With increasing age and susceptibility to NCDs, which is also due to increased exposure to predisposing risk factors, there is also an increase in disability, which is the key linking factor responsible for reduction in productivity in the elderly and, therefore, productive ageing. Disability-induced impairment to productivity may be due to the ageing process, NCDs and the combination of them both. The reduction in productivity is made worse in the case of the LMICs by the inability to produce and adapt the essential services and systems necessary to prevent and treat NCDs. The extent of NCD-induced disability may be modulated by the social and physical environment as well as by appropriate health systems. The prevention of NCDs must take place throughout the life course. Special attention must be paid to adapting and reinforcing the health systems to seek synergies of approach to NCDs and other chronic conditions, and to deal with their comorbidities, which are inevitable in elderly individuals with NCDs. References Atun, R., Jaffar, S., Nishtar, S. et al., 2013. ‘Improving responsiveness of health systems to non-communicable diseases’. The Lancet, 381, pp. 690–696. Butler, R. N. and Gleason, H. P., 1985. Productive Ageing: Enhancing Vitality in Later Life. New York: Springer. Darnton-Hill, I., Nishida, C. and James, W. P. T., 2004. ‘A life course approach to diet, nutrition and the prevention of chronic diseases’. Public Health Nutrition, 7, pp. 101–121. Fortin, M., Bravo, G., Hudon, C., Vanasse, A. and Lapointe, L., 2005. ‘Prevalence of multimorbidity among adults seen in family practice’. Annals of Family Medicine, 3, pp. 223–228. Godfrey, K. M., Gluckman, P. D., and Hanson, M. A., 2010. ‘Developmental origins of metabolic disease: Life course and intergenerational perspectives’. Trends in Endocrinology and Metabolism, 21 (4), pp. 199–205. Handa, S. and Neitzert, M., 1998. ‘Chronic illness and retirement in Jamaica’. LMSS Working Paper No 131. World Bank. Hanson, M., 2011. ‘Developmental origins of non-communicable disease: Population and public health implications’. American Journal of Clinical Nutrition, 94 (6), pp. S1754–S1758. Holmerova, I., Ferreira, M., Wija, P. et al., 2013. Productive Ageing: Conditions and Opportunities. Prague: Faculty of Humanities, Charles University Prague. Lloyd-Sherlock, P., McKee, M., Ebrahim, S. et al., 2012. ‘Population ageing and health’. The Lancet, 379 (9823), pp. 1295–1296. Lozano, R., Naghavi, M., Foreman, K. et al., 2012. ‘Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010’. The Lancet, 380, pp. 2095–2128. Murray, C. J. L., Vos, T., Lozano, R. et al., 2010. ‘Disability-adjusted life years (DALYS) for 291 diseases and injuries in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010’. The Lancet, 380, pp. 2197–2223. Nolte, E. and McKee, M., 2008. Caring for People with Chronic Conditions – A health system perspective. New York: John Wiley and Sons. Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W. and Ferri, C. P., 2013. ‘The global prevalence of dementia: a systematic review and meta-analysis’. Alzheimers and Dementia, 9 (1), pp. 63–75. Robinson, M., Novelli, W., Pearson, C. and Norris, L., 2007. Global Health and Global Aging. New York: Springer. 76 Commonwealth Health Partnerships 2015 SIR GEORGE ALLEYNE is director emeritus of the Pan American Health Organization, where he served as director from 1995 to 2003; chancellor and emeritus professor of the University of the West Indies, where he first graduated in medicine in 1957; and adjunct professor at the Johns Hopkins Bloomberg School of Public Health. He completed his postgraduate training in internal medicine in the UK, and did further postgraduate work there and in the USA. Alleyne has been closely engaged with Commonwealth health issues, including the profile of NCDs in the developing world. He has received numerous awards in recognition of his work, including national honours from many countries of the Americas. In 1990 he was made Knight Bachelor by Her Majesty Queen Elizabeth II for his services to medicine and in 2001 he was awarded the Order of the Caribbean Community. 1. Multisectoral platforms based on national AIDS commissions and country co-ordinating mechanisms create synergies with NCDs at no additional cost 2. Integrated monitoring and evaluation systems, especially in LMICs benefiting from large investments for HIV and tuberculosis programmes. Integrated information systems bring together individual-level socioeconomic, behavioral, clinical and service utilisation data that is crucial in building individual risk profiles and establishing targeted responses 3. Structural integration of service delivery at the community and primary care levels can establish a single point of entry to manage multiple diseases including NCDs 4. Procurement and supply chain management systems are crucial in ensuring timely forecasting purchasing and distribution of health products, especially for chronic illnesses 5. Financing for UHC, and expanding health insurance coverage for the poor to improve access to health services, including those for NCDs 6. Demand generation and treatment management through community-based approaches. Such approaches, established mainly through HIV-related investments, offer powerful platforms that combine risk identification, demand, mobilisation, and management of NCDs and multi-morbidity


Commonwealth Health Partnerships 2015
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