A report by The Economist Intelligence Unit for The Defeat-NCD Partnership
28 June 2021
Progress towards reducing premature deaths from non-communicable diseases (NCDs) has been made across the globe, but not at the pace required to meet the UN Sustainable Development Goals (SDGs) for 2030. Developments made to NCD services are unequal across regions and income groups, thus exacerbating inequalities. NCDs are known to cluster in poorer areas, where there is unequal access to healthcare. A body of fairly recent science exploring COVID-19 suggests that more severe cases are seen in people with pre-existing illness. It is therefore impossible to ignore the possibility that NCDs and COVID-19 are inextricably linked.
COVID-19 has rendered those populations affected significantly by NCDs even more vulnerable to ill health, making the pandemic a wakeup call for strengthened NCD services. This report arrives at the following policy actions to drive scalable solutions that both mitigate COVID-19 and address underlying NCD population morbidity in low- and middle-income countries (LMICs):
There is a causal relationship between underlying NCDs and COVID-19 fatality. Our analysis revealed that factors strongly influencing this relationship include age, gender, smoking and healthcare expenditure. Once these factors are accounted for, our modelling suggests that a 10% reduction in NCD mortality, through better access to healthcare, would have reduced COVID-19 fatality by 20% in LMICs. In an LMIC of average population size, reducing the NCD mortality by a third (to meet SDG3) would have averted 36,000 deaths from COVID-19.
COVID-19 has severely disrupted NCD services, leaving a backlog of patients who require care and support. The excess deaths due to COVID-19 service disruptions are currently unknown in most LMICs and need to be better understood. Despite this, it is likely that routine service disruptions will leave a long tail of NCD morbidity and mortality once the spread of COVID-19 has receded. The already under-resourced healthcare systems of LMICs will struggle to grapple with this. NCD care must be integrated into COVID-19 mitigation to help manage the backlog of patients unable to access care during lockdowns.
Funding for NCDs in LMICs is insufficient, yet during COVID-19, LMICs received a radical increase in funding to tackle COVID-19 response. COVID-19 funding should also be sensitive to NCD morbidity, to allow integrated care. This could start with guidelines on and delivery of screen- ing programmes for NCDs during COVID-19 vaccination programmes. COVID-19 vaccination centres provide a prime opportunity to engage with hard-to-reach populations. Funding an increase of community health workers could enable the delivery of NCD health advice to patients in conjunction with administering COVID-19 vaccinations.
Telehealth and mobile health programmes could be another cost effective way to improve access to basic NCD care. Telehealth could further increase the reach of community health workers and enable digital access to information on managing common NCDs such as diabetes and obesity. Guidelines on the use of digital health need to be developed and proposed as an option for accessing healthcare in LMICs. Traditional options need to remain for older people and those with no access to technology.
Underinvestment in public health systems across the world hinders both chronic NCD prevention and epidemic preparedness. COVID-19 mitigation strategies that simultaneously address NCDs in LMICs must be put in place alongside improvements to universal health coverage to ensure long-term sustainability.