Why is it important to work on NCD intervention with older people in particular?
The first reason is that NCDs occur more in older people, especially with complications. If you have hypertension when in your 40s, then the complications come only in your 50s and 60s. If there are no complications yet, you can prevent them occurring through these interventions. So NCDs by their nature increase with age – you have more NCDs when you are older. The second reason why we need to work with older people is that many of them do not take proper care of themselves. They may not have the energy to eat well, they may feel lonely and when you are lonely, you stop eating and stop being physically active. All those kind of things are related to wellbeing, so if you can prevent loneliness and prevent people from not eating, you can avoid all these NCDs. That is why we need to focus on older people if we want to reduce NCDs and their complications.
Why is it important to involve the community in NCDs intervention?
Many NCDs such as cardiovascular disease or diabetes are lifestyle related, which means the way you are living. Staff at health facilities can give you medicine, tell you what to do to be healthier and how to avoid complications, but they cannot control how you behave at home. We know from our experience in many countries that if you are alone, it is very difficult to change your behavior. If you have family, friends or neighbours who can help you, it is easier to change your behavior.
Can you explain the relationship between early intervention and cost effectiveness?
With early intervention, you can avoid medical costs. For example, if you have a stroke or diabetes, there are high medical costs. It depends on the health system in the country. If there is private insurance, the insurance company will have to pay those costs, but if there is no insurance and people have to pay by themselves, which puts a big burden on their families. If you can revert hypertension or diabetes symptoms and get back to normal blood pressure or blood sugar levels, you can avoid those medical costs.
There are also costs for society. If a family member has a stroke and cannot get out of bed, the person who cares for them is losing productivity because that person cannot work in the field or perform any income generating activities. Some older people still do useful work. Even if they are not very active, they can look after their grandchildren or work in some other useful capacity. Losses in productivity place a big burden on society. You can avoid that through early diagnosis and early prevention.
What have we learnt so far?
We are still at an early stage but we have learnt that even though countries have national programmes or policies, these are difficult to implement. Many health facilities have poorly trained staff or staff are not sufficiently aware of NCD issues. For community groups, the level of functioning is different in each country. We need to work on all those aspects. We cannot give trainings and information without follow-ups. The ability of people and the availability of follow-ups are important elements to make the programmes sustainable.
I hope we can show that you can get better results when health facilities, health centres and dispensaries work together with communities. I hope that we will change the mentality from one of curative care, or treating people when complications arise from their NCDs, to one of prevention of NCDs in the first place. This is part of a bigger programme to achieve better health for people.