David Luu 1

Dr David Luu, a French medical expert specialising in paediatric heart surgery, has worked around the world – including in many post-disaster or humanitarian crisis contexts – for close to 20 years. He has seen the impacts of non-communicable diseases (NCDs) on populations everywhere and hopes to see partnerships move the cause of NCDs forward.

He spoke recently with the Defeat-NCD Partnership about his own history, and his goals relating to NCDs.

“I wanted to be a surgeon and a doctor from a very young age,” said Dr Luu.

When he was 21 years old, he went on a mission to Burkina Faso where he realised that congenital heart disease was one the leading birth defects as about 100,000 children born have the disease.

He has also organised missions to support the coordination of health care delivery in Haiti. About 600 children are born with congenital heart disease in Haiti per year – and without treatment it becomes the equivalent of a chronic disease – which affects the family, the society and the community. Dr Luu said that if you can detect it early enough, you can repair it successfully so that it becomes like an infectious disease – with antibiotics you can cure it.

In countries without universal health coverage, the burden of NCDs can be impossible for families to support: “If you look at a lot of different countries in Africa or South-East Asia, there are children who don’t have any chance to get treated. When they do, it costs a lot of money, it cost a lot of time for the parents, and sometimes it’s not socially accepted by the community. It can become such a burden, not only for the child but for everybody surrounding them. By saving one life you can improve the health of a whole population. That’s what I’ve become obsessed with now, the road I’m on.”

When he met Dr Mukesh Kapila, the Chief Executive of the Defeat-NCD Partnership, in Istanbul in 2016, the first thing they discussed was the link between NCDs and humanitarian disaster, and why cardiovascular disease should be included in the agenda for the World Humanitarian Summit.

According to Dr Luu, while the outbreaks and epidemics of NCDs are not caused by crises, they are massively augmented during a crisis.

“Let’s say you have a chronic disease that requires treatment. A disease that requires a certain lifestyle,” he said. “Now your life is completely destroyed and you have this massive change in your habits. You lose your ability to have proper treatment and follow-up. How can you address this issue?”

He added that people usually think that cardiovascular diseases are for the developed world, “for the really rich guys that are eating well and smoking cigarettes”. The reality is that it is everywhere – in every family, in every company, in every government, every day.

“If you look at the global data, NCDs are more deadly than everything else combined – not bigger than cholera, or bigger than war, bigger than everything else combined,” said Dr Luu. The WHO says that NCDs cause 71% of deaths. “We need to focus on something that kills that much, and we should focus on innovation that saves lives. That’s really my mission right now,” he said.

And how would that be done?

“It needs to be addressed at the highest level first,” said Dr Luu. “If you take one region in one country, and bring in the best stakeholders, focused on solving this problem for two million people in this one region, then in five years you could solve it.” He went on to say that organisations working on NCDs should leverage what those working on HIV and malaria have done.

Creating momentum requires partnership.

“If we don’t integrate the global vision of health we will always face barriers. We will always compete with other investments, so I think the approach has to bring people together. Equipment and infrastructure can only be addressed through private companies. Governments need to provide what the private sector cannot. You need finance innovation, from people who can develop new systems of finance, and that would be a win-win for everybody – for the funders, for the payers [for healthcare] and for the providers. Everybody should have access to health facilities within a 5 km range, and you can only do that if you provide digital transformation strategies and ensure implementation. NCDs should also have champions, ambassadors and advocates who promote the cause, prove that it can be done, and that it can be scaled.”

Dr Luu believes the multi-stakeholder approach should integrate, first of all, a population-centric programme. How to implement this programme, and who is going to perform these tasks, is as important as the policies themselves. The contributions of the governments, the NGOs, even the private sector, need to be integrated into the community.

“For the ideal round-table that I see, you have a banker, you have a governor, the head of state, scientists, anthropologists, sociologists, researchers, community people, patients, NGOs and civil society, even religious leaders should have a role,” said Dr Luu. “In countries where they believe in traditional medicine, how do you integrate that? We see that in Senegal, in Haiti, in many countries in the world. So how do you make sure that they are around the table, in the conversation, to make sure that universal health coverage works for them as well? I think in five years, a great foundation can be laid down.”

“I think we’re living in very exciting times right now,” Dr Luu continued. “If you want to address space travel, there is a way forward. If you want to use a car without gas, there is a way. If you want to see somebody from the other side of the planet, you can call and see them now. Twenty years ago these options did not exist. If the momentum and motivation are big enough, nothing is going to be able to stop progress. Of course we need the political will. If politicians decide to implement solutions for NCDs, and monitor progress, it will be done – it has been done, in a lot of different countries, so I’m really optimistic that a lot can be accomplished in the next five years. But we need to prove the added value of universal health coverage, showing why we should invest in universal health coverage when agriculture, building roads, energy and education need funding too. Why target non-communicable diseases instead of anything else? That’s where showing added value through scientific and economic proof is fundamental, so we need to keep talking about economic growth and social development productivity as part of the public health narrative.”

For Dr Luu, the fact that this kind of coverage can be difficult to implement is not a reason to forgo it.

“Heart surgery requires a lot of people, and a lot of infrastructure. I need at least five to 10 people around me, I need facilities, and paediatric surgery is even more complex. So what we realised is few countries in the world, especially in emerging economies, have access to those heart facilities. And even if they have access to the facilities, they don’t have access to the costly devices, and they don’t have access to the fully trained and skilled health care professionals and teams, so the need is just huge. But if you have this kind of facility, and you can perform paediatric heart surgery, you can perform everything. So the barrier to entry to perform surgery is very high, but once this facility is available everyone can come and get treated for everything. And that’s the beauty of it – if you start from the most difficult, you make sure that the easiest is simply accessible.”