Addressing risk factors in the community: ‘Invest in health, not disease’

As the acute phase of an emergency (during which provision of essential treatment is the priority) gives way to a protracted crisis, the longer-term challenges of living with and preventing NCDs need to be addressed – involving people living with NCDs, their families and local communities.

What? A policy ask

We call on governments and humanitarian actors systematically to plan for and resource NCD prevention before and during humanitarian crisis.

Why? The rationale

Current responses to humanitarian crises are often siloed, fragmented, short term, and strongly medicalised rather than community based. Other priorities may appear more pressing, particularly when coupled with a shortage of human and financial resources. Addressing the risk factors (poor nutrition, lack of exercise, smoking, alcohol and stress) using models of preventive action in humanitarian settings have not, to date, been a focus for researchers and humanitarian agencies. However, prevention and planning save lives during and beyond the acute phase of a crisis.

Success would be defined as NCD prevention being better resourced and fully embedded in regional preparedness plans, ensuring that those at risk of NCDs are included in an emergency response and mitigating the impact of a humanitarian emergency on the longer-term health of the population.

We need to create a strong basis that ‘allows communities to be resilient and with the ability to withstand shocks’ (Bootcamp participant).

Discussion

The policy ask was welcomed by the experts but acknowledged as ‘ambitious’ because prevention is seldom prioritised enough, even in non-emergency settings – but ‘realising this in emergency settings could be leapfrogging, doing the completely unexpected!’ (Bente Mikkelsen, WHO). Prevention is possible in protracted crisis/refugee settings – for example through improved nutrition, psychosocial and peer support.

Although humanitarian funding is seldom available for prevention in general (‘we are not peace-builders – we come in when things go wrong’ – Panu Saaristo, IFRC), there needs to be a continuum between emergency response and longer-term preventive initiatives. Development stakeholders, and particularly donors, also need to be convinced of the benefits of engaging with and financing this agenda.

“A complete ‘change of mindset’ is needed!”

Bootcamp participant

Several other actions were discussed that could maximise the potential for prevention of NCDs in humanitarian emergencies, including:

taking a community-led and people-centred approach to promoting and implementing NCD interventions;
investing in the generation of evidence from the implementation of non-medicalised interventions to address NCD risk factors; and
creating a global platform for multisector coordination to ensure a comprehensive response to NCDs that includes prevention.

“We need community input as to what will really work!”

Bootcamp participant

How? Campaign ideas

Building on the presence of Bootcamp participants from Kenya, the below campaign actions would aim at high-level civil servants in the Ministry of Health in Kenya, with advocacy efforts led by the Kenya Red Cross. However, the central campaign idea, to demonstrate the high cost in lost productivity and human lives if NCDs are not prevented, would be readily adaptable to other contexts. ‘The government needs to invest in NCDs and create a platform where communities are resilient’ or in short: ‘Invest in health, not disease!’

Specific ideas for campaign actions included;

Set up site visits for government officials during natural disasters for example flooding, so that they can hear the stories first-hand of people living with NCDs and the challenges they face in these situations.
Mobilise community voices – the network of ‘change agents’: community leaders, politicians, health workers, religious leaders – to advocate for NCD prevention and preparedness.
Build an investment case with research, showing that preventive efforts work and documenting the cost-effectiveness of different prevention packages versus treatment.