How evidence can guide NCD policy decisions and program implementation

Noncommunicable diseases (NCDs) are one of the most significant challenges facing countries worldwide in the twenty-first century. The rapid growth in prevalence of diverse conditions such as heart disease, stroke, type two diabetes, cancer, respiratory disorders, and mental ill health is a significant part of this challenge and NCDs are now the major causes of death and disability in many countries, including low- and middle- income countries and small island developing states. In addition to health impacts, NCDs are responsible for large and growing costs to national economies.

Tackling NCDs in United Kingdom Overseas Territories (UKOTs)

Like governments across the globe, the 14 United Kingdom Overseas Territories (UKOTs) are grappling with how to address the rising burden of NCDs, rising health care costs, and the economic squeeze on budgets due to the COVID-19 pandemic. These highly diverse territories range from some of the world’s smallest and most remote islands to sizable communities adjacent to populous and highly developed countries, and from some that are largely dependent on overseas development aid to others that are among the world’s wealthiest communities. NCDs are a common denominator across the UKOTs and all territories are seeking to develop their policy frameworks and health systems to address these health conditions.

To address this, RTI’s Center for Global Noncommunicable Diseases contributed to a seminar series organized by the United Kingdom Government Department of Health, Office for Health and Disparities to share and discuss examples of how economic evidence can guide health policy decisions and implementation in the UKOTs. Below we include two examples from the seminar.

Identifying the Benefits of Tobacco Taxation in Saint Helena to Prevent and Reduce NCDs

In the seminar, Dr. Angie Jackson-Morris presented a UKOT example from her work with the Government of Saint Helena which used economic modeling to show the benefits of increasing tobacco taxation. Increasing tobacco taxation is globally recognized as one of the most powerful measures to reduce the burden of tobacco-attributable diseases, and consequently was an objective in Saint Helena’s national Health Promotion Strategic Framework.

Before enacting and implementing the NCD policy, the Island’s decision makers wanted to know the expected impacts on tobacco consumption, health gains for the island population, and excise duty revenue. The analysis used local health and economic data within a globally validated model and identified a set of options for decision makers to consider. Decision makers  appreciated the local angle of the analysis that focused on St Helena’s population and economy. They also liked the menu of intervention options they could choose from to balance between economic and health benefits.

Hear Angie discuss the process of developing and considering the evidence in the embedded video below.

Advocating for NCD Priorities in Jamaica

RTI’s Center for Global NCDs has worked with several island states to support their NCD planning using investment cases – analyses that are specific to a particular country or issue context and assess the health and economic costs and benefits of implementing a range of evidence-based interventions. In this seminar, Brian Hutchinson presented on how the investment case has advanced NCD priorities in Jamaica. Jamaica’s Ministry of Health has used an NCD investment case to advocate for NCD health priorities, advance policies and interventions, and build an NCD coalition among government institutions.

For example, investment case findings are being used to build the case for a new tobacco control bill that is currently before a Joint Select Committee of Parliament. The investment case consisted of two parts: an institutional context analysis (ICA) and an economic analysis. Through key informant interviews with diverse government and civil society stakeholders, the ICA sought to uncover drivers of the existing status quo around NCD funding and prioritization and the feasibility of specific changes to the status quo. The economic analysis assessed the health and economic burden of NCDs and mental disorders, and the extent to which scaling NCD care (e.g. effective coverage of treatment for hypertension) or enacting population-level policies (e.g. front-of-pack nutrition labeling) can reduce that burden.

Hear Brian and Sheryl Dennis Wright from the Pan American Health Organization describe more about how the Jamaica investment case is being used in the links below.

Ensuring NCD Policies and Programs are Implementable

Economic evaluations can provide certain types of information to guide policy planning – particularly which policies will be cost-effective and how best to balance health and economic considerations. Complementary implementation research can provide further insight to guide planning and implementation. These include assessments to identify whether specific services and health systems more generally have the capacity to implement a proposed policy or program. This can enable more realistic implementation and budget planning and increase the likelihood that the proposed policies or programs will be effectively implemented with the necessary capacities and stakeholder receptivity. Other highly practical analyses that can make national NCD planning more implementable include costing and financing analyses to inform accurate budgeting and foster confidence that plans are achievable; and integration analyses to identify whether NCD care could be effectively implemented as part of existing services or programs.

RTI’s Center for Global NCDs conducts a wide range of policy analyses and economic evaluations of health programs and policies. Its portfolio includes investment cases for the prevention and control of NCDs and mental disorders, tobacco control, road-traffic safety, household and ambient air pollution, and implementation research in diabetes prevention and management, mental health, and obesity.

To learn more about the investment cases and linking them to effective implementation of NCD policies and interventions, read our series of papers—‘Implementability’ matters: using implementation research steps to guide and support non-communicable disease national planning in low-income and middle-income countries | BMJ Global Health and Tailored support for national NCD policy and programme implementation: an over-looked priority

Learn more about RTI’s capabilities in implementation science for NCDs