GLHLTH641K
Non-CommunicableDiseases
inLow-andMiddle-Income
Countries:Trends,Causes,
andPreventionStrategies
Dates/contacthours:Seven-weeksession,300minutesperweekcontacttime
AcademicCredit:3-creditcourse
TagsfortheDukeUndergraduateSystem:
AreasofKnowledge:RecommendedNS,SS(NaturalSciences,SocialSciences)
ModesofInquiry:RecommendedSTS(sciencetechnology)
ThiscourseisdesignedfortheMasterofScienceinGlobalHealth(DKU)programbutisalsoopento
advancedundergraduatestudents.
Instructor’sInformationandOfficeHour
_______________________________________________________________________________
LijingL.YAN,Ph.D.,MPH
AssociateResearchProfessor,DukeGlobalHealthInstitute
Head,NCDResearch,GlobalHealthResearchCenter,DukeKunshanUniversity
Email:[email protected];phone:0512-3665-7057;186-1038-3698(wechatNCDs@LMICs)
Officehours(byappointments):Wednesday8-9amand5-7pm
Office:Room1057intheConferenceCenter
Prerequisite(s),ifapplicable
None.
CourseDescription
Globalhealthattentionhashistoricallybeenfocusedonacuteandinfectiousdiseases.Witheconomic
developmentandshiftsinpopulation,environments,andlifestyles,infectionsanddiseasesofundernutritionnolongeraccountformostofthediseaseburdeninhigh-incomecountries.Thesamepatterns
arestartingtoemergeinmanylow-andmiddle-incomecountries(LMICs),atamuchfasterrate,
however,thaneverseenbeforeinhistory.Thiscourseprovidesaglobaloverviewoftherecenttrendsin
non-communicabledisease(NCD)epidemiologyandstrategiesforpreventionandcontrolofthese
diseaseswithaparticularemphasisonChinaandcomparisonsbetweenChinaandothercountries.
ThecoursefocusesonfourmajorNCDcategories:cardiovascular,diabetic,oncologic,andpulmonary
diseases.Casestudiesareusedtohighlightselectedgeographicdifferences.Regionaldifferences
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withinChinawillbeconsidered,inadditiontothecomparisonofChinatoothercountries.Byusing
lectures,videos,assignedreadings,andclassroomdiscussionsaswellasvariousassignments,thecourse
aimstoprovidethestudentswithafirmunderstandingoftheshiftingdiseaseburden,stakeholders,and
interventionstoaddressNCDsinLMICs.
CourseGoals/Objectives
Attheendofthecourse,eachstudentwillbeableto:
1.
2.
3.
DefineandarticulatetheconceptofNCDsinthecontextofglobalpublichealth.
CompareandcontrasttrendsamongregionsofChinaaswellasbetweenChinaandothercountries.
DescriberecenttrendsinNCDepidemiologywithspecialattentiontodifferencesbetweenhighincomeandLMICs.
4. AnalyzeandarticulatetheupstreamdeterminantsandburdenofNCDsineconomic,social,
environmental,andpoliticalterms.
5. IdentifykeyriskfactorsforNCDsandmainstakeholdersinNCDpreventionandmanagement,and
reviewvariousstrategiestoaddressNCDsbythesestakeholders.
6. Applytheaboveobjectivestothecaseofcardiovascular,diabetic,oncologic,andpulmonary
diseases.
Inthiscourse–anadventurousjourneyweembarkontogether,Ihopethatwe(re)-discoverthereal,
large,andrisingthreatofNCDstopersonal,national,andglobalhealth;(re)-ignitethepassiontodo
somethingaboutit;andtocultivatelearning,criticalthinking,creativeskillsthatwillenableustodoso.
RequiredText(s)/Resources
Norequiredtextbook.Requiredreadings(mostlyinelectronicformats)willprovidedbytheinstructoror
availablethroughDukeon-linelibraryresourcesandthecourseSakaisite.
RecommendedText(s)/Resources
StucklerDandSiegelK(eds.).Sicksocieties:Respondingtotheglobalchallengeofchronicdisease.
OxfordUniversityPress.2011.
AlimitednumberofrelevantbookswillbeavailableintheDKUlibrary.Thelibrarywebsitealsocontains
acoursepageforonlineresources.
StudentswillbeencouragedtotakeadvantageoftheDKUWritingStudioand/ortheDukeWriting
Studio(http://twp.duke.edu/writing-studio/resources).
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CourseRequirements/KeyAssignments
________________________________________________________________________________
Gradingforthiscourseisbasedonfourrequirementswithdifferentiationforundergraduateand
graduatestudentswhenappropriate:Student Evaluations will be based:
1.
AttendanceandParticipation(25%,including5%forapresentationonthefieldtrip)
2.
Studentteaching(presentation)(10%)
3.
Academicdebate(25%,10%grouprating,5%individualrating,10%individualpaper)
4.
ManuscriptDevelopmentParticipation(40%,10%literaturesearchandreview,20%writing,
10%presentationonliteratureandinterviews)
AttendanceandParticipation(25%):Studentswillbeexpectedtoparticipateinclassdiscussions.This
participationmaybeintheformofquestionandanswers,opendiscussions,role-playing,mockdebates,
orsharingofclasssummariesoropinions.Studentsshouldcometoclasshavingreadtheassigned
materialssothattheyarewellpreparedtoparticipate.Particularattentionwillbepaidtoanydifficulties
theEFLstudentsmayhavewithoralcommunicationinEnglishorwiththeUS-styleofclassroom
discussions.TheinstructorwillalsocommunicatewiththeDKUprofessorswhowillbeteachingthe
writingandoralcommunicationsclassesandhelpingstudentsthroughtheDKUWritingStudio.The
instructorwillclearlyexplaintheexpectationsforclassroomengagementduringthefirstclassmeeting
andwillprovidefeedbacktothestudentsonsubsequentclassmeetings.Thestudentshavethe
opportunitytogoontwofieldtrips(co-organizedwithothercourses)withonefieldtripbeingrequired.
Gradingforthispartwillbebasedonattendance(10%)andparticipation(ratingbasedonlevelof
engagementandrelevanceofcomments,10%)andafieldtrippresentation(5%).
Studentteaching(presentation)(10%):Eachstudentwillchooseorbeassignedasessioninthesyllabus
topresentthemaincontentofonekeyrequiredreadingtothewholeclassasabasisforfurther
discussion.Thepresentationwillbe10minuteslong.Graduatestudentsareexpectedtoincludeother
relevantmaterialsinthispresentationbeyondtheonereadingandcanmakethepresentationupto15
minuteslong.Eachpresentationwillbegradedusingthefollowingfivecategories:
•
•
•
•
•
Organization(15%)–Assessmentofphysicalorganization(Doesthepresentationflow?Isit
coordinated,matchedwithvisualaids?Doesitkeepontime?)
Content(40%)–Assessmentofwhethercontentsarerelevantandscientificallypresented?Does
itposemeaningfulquestionsonpopulationhealthimprovements?
Clarity(15%)–Assessmentofwhetherthepresentationisunderstandablewithappropriate
language?
Useofaudiovisualmaterials(10%)–Assessmentofsuitabilityoftheaudiovisualmediaused;
arevisualaidsaddressed,usedwell?
Overallqualityofthepresentation(20%)–Itwouldlookforgoodlanguage,eyecontact,style,
structure,useoftoneandvolume,impactofthemessageandoverallstandardofthe
presentation.
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AcademicDebates(25%):Studentswillformtwogroupswitheachgroupdividedintotheaffirmativevs.
thenegativeparty.EachgroupwillchooseorbeassignedacontroversialtopicrelatedtoNCD
preventionandcontrol.Eachpartyinthegroupwillprepareforthedebateaheadoftimeandengagein
anhour-longLincoln-Douglasstyledebatelaterinthecourse(tobeexplainedduringthefirstsession).
Eachstudentwillspeakbetween5-15minutesineachdebate.Eachpartywillreceiveagrouprating(10
points)andanindividualrating(5points).Inaddition,eachstudentwillturninashortpaper(<500
words)ontheirpropositionbeforethedebate(upto10points).Thetworesolutionsare:
Universalsodiumreductionisabeneficialglobalhealthpolicy.
Polypillisusefulforprimarypreventionofcardiovasculardiseases.
ManuscriptDevelopmentParticipation(40%):Thecoursewillproduceamanuscripttobesubmittedby
theendofthesemester.Participationinthedevelopmentofthemanuscriptwillbegradedbasedupon:
1)eagernesstoparticipate2)finishingassignedportionofworkbythedeadlines3)qualityofwork
performed4)abilitytoworkasateam.Theportionsofthemanuscriptwillbesplitintofourdifferent
partsonthefirstdayofclassandwewillcomeupwithamanuscriptideaandmethodologyasagroup.
Theinstructorwilldiscussmethodsandtipsforwritingthemanuscriptthroughoutthecourse.Afterthe
class,themanuscriptwillbesubmittedwithallclassmembersasauthorsandDr.Yanasthe
correspondingauthor.Studentswillalsoconductinterviewsandmakeapresentationontheirsection
andinterviews.
•
•
TechnologyConsiderations,ifapplicable
Studentsshouldhavelaptopcomputers.Studentswillneedinternetaccessforlibraryresourcesandfor
thecourseSakaisite.
AssessmentInformation/GradingProcedures
Thegradingscaleforthecourseisasfollows:
A+
98-100
C+
77-79
A
93-97
C
76-73
A-
90-92
C-
70-72
B+
87-89
D+
67-69
B
83-86
D
63-66
B-
80-82
D-
60-62
F
<=59
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DiversityandInterculturalLearning(seePrinciplesofDKULiberalArtsEducation)
Readingsandcaseswillbedrawnfromthinkersandsituationsspanningtheglobe.Attentionin
readingsandclasstimewillbedevotedtothechallengesandprinciplesofcreatingaproductive
learningenvironmentforallparticipants.Gradesforthestudents’assignmentsandclassroom
participationwillreflecttheireffortandabilitytoworksuccessfullyinanintercultural
setting.Guidanceongroupworkandclassparticipationwillbeprovidedforstudentsnot
accustomedtoopendiscussionstyleofpedagogy.
CoursePoliciesandGuidelines
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•
•
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CommunityStandards:StudentsareexpectedtoabidebytheDKUcommunitystandardsof
respect,excellence,andintegrity,whicharebasedontheDukeUniversitystandards
(http://studentaffairs.duke.edu/conduct/about-us/duke-community-standard)atalltimes.Ifa
questionablecircumstancearises,pleaseseektheinstructor’sguidancesoonerratherthanlater.
Inparticular,allassignmentsaretobewritteninthestudentsownwords.Anycitingofnumbers
shouldbereferencedappropriately.Allreferencesusedshouldbelistedonthepaper.Ifan
assignmentislate,thestudentmayhanditinatanytimebutwillreceivenomorethan50%of
thepossiblegrade.AnystudentwhocommitsplagiarismwillbereportedtoDGHIMasters
Programleadership.Thepenaltyforplagiarismissevereandcanbeexpulsionfromthe
program.
Attendance:Studentsareexpectedtoattendeachclasssessionunlesstheyhavealegitimate
excuseformissingaclass.Ifpossible,studentsshouldlettheinstructorknowaboutmissing
classesaheadoftime.Attendancewillbetakenatthebeginningofclass.Anyunexcused
absencefromclassortardinesswillfactorintothefinalParticipationandAttendancegrading.It
isthestudent’sresponsibilitytobefamiliarwiththetopicsandmaterialfromanymissedclass.
Assignmentduedates:Writtenassignmentswillbedueby5pmontheduedate.Assigned
workthatisturnedinlateontheduedatewillbepenalized5%ofthetotalgradeforthat
assignment.Workthatisturnedinaftertheduedatewillbepenalized10%ofthetotalgrade
pointsperdaythatitislate.Emailingassignmentsispreferable.Theemaildateandtimestamp
willbeusedtojudgeiftheassignmenthasbeenturnedinontime.
Electronicdevicesintheclassroom:Telephones,pagers,andothercommunicationdevicesare
tobeturnedofforsilencedandarenottobevisibleduringclass.Sendingorreceivingelectronic
communicationofanytype(e.g.,SMS,email,voicemail)isnotallowedincludingpassively
monitoringcommunication.Wheninclass,youareexpectedtobeengagedintheclasssession.
Therefore,useoflaptops,tabletsandothercomputersforpurposesotherthanprovidinga
digitalcopyoftheassignedreadingmaterialortakingnotesisgenerallydisallowed.
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•
Emailcommunication:Discussionofissuesandtopicscoveredinthecourseshouldbereserved
forclasstimeorofficehoursasmuchaspossible.Emailcommunicationwillnotbeusedasa
substituteinthisregard.Theinstructorwillnotreviewviaemailanymaterialorlecturesthata
studentmighthavemissed.Theinstructorwillstrivetoanswerappropriateemailmessagesina
timelyandthoroughmanner.Emailmessagesshouldincludeanappropriatesalutationand
closingandshouldfollowspelling,usage,andgrammarrules.
CourseOutlineandReadingListbyWeekandSession
Readeacharticle/chapterbeforethestartofclassonthedateslistedbelow.Additionalreadingswillbe
assignedthroughoutthesemester.Thedeterminationofarigorousyetmanageablereadingloadwillbe
madeaccordingtoconsultationwithotherDKUprofessorsandfeedbackfromthestudents,aswellas
thestandardsofaDukeUniversitycourseofthislevel.Readingsmarkedwith“(forundergraduate
students”or“(forgraduatestudents)”areforthespecificgroupsandthosewithoutareforeveryone.
Week1Session1
1.1.a GettingtoknoweachotherandNCDs
1.1.bMakingchoicesaboutwhatyouwilldointhecourse
WorldHealthOrganization.2005.Preventingchronicdiseases:avitalinvestment–aWHOglobalreport.
(Requiredbeforeclass:pages35-36only).
Week1Session2
1.2.a TheGlobalBurdenofDiseasesandUnitedNationsNCDDeclaration
ChristopherJLMurrayetal.Disability-adjustedlifeyears(DALYs)for291diseasesandinjuriesin21
regions,1990–2010:asystematicanalysisfortheGlobalBurdenofDiseaseStudy2010.LancetVolume
380,No.9859,p2197–2223,15December2012.
UnitedNations.2011.PoliticalDeclarationoftheHigh-levelMeetingoftheGeneralAssemblyonthe
PreventionandControlofNon-communicableDiseases.
1.2.bDeterminantsofhealthandNCDs
MitchellE.DanielsJretal.ThefactorsbehindtherisingNCDepidemic.In:TheEmergingGlobalHealth
Crisis:NoncommunicableDiseasesinLow-andMiddle-IncomeCountries.2014.CouncilonForeign
Relations,UnitedStates.Largefiledownloadablefromhttp://www.cfr.org/diseasesnoncommunicable/emerging-global-health-crisis/p33883(Forundergraduatestudents)
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DavidStuckleretal.Sickindividuals,sickpopulations:Thesocietaldeterminantsofchronicdiseases.In
StucklerDandSiegelK(eds.).Sicksocieties:Respondingtotheglobalchallengeofchronicdisease.
OxfordUniversityPress.2011.(Forgraduatestudents)
Week2Session1
2.1.aCardiovasculardiseases:Burden,trends,fundamentalstrategies
IOM(InstituteofMedicine).2010.PromotingCardiovascular
HealthintheDevelopingWorld:ACriticalChallengetoAchieveGlobalHealth.
Washington,DC:TheNationalAcademiesPress.(PDFavailableat:
http://www.ncbi.nlm.nih.gov/books/NBK45693/pdf/TOC.pdf)(Pages1-18“Summary”only)(for
graduatestudents).
IOM(InstituteofMedicine).2010.PromotingCardiovascular
HealthintheDevelopingWorld:ACriticalChallengetoAchieveGlobalHealth.
Washington,DC:TheNationalAcademiesPress.(ReportBrief,4pages)(forundergraduatestudents).
2.1.bHypertensionanddyslipidemia:Silentkillersandpolypills
EvaLonn,JackieBosch,KoonK.Teo,PremPais,DenisXavier,SalimYusuf.ThePolypillinthePrevention
ofCardiovascularDiseases:KeyConcepts,CurrentStatus,Challenges,andFutureDirections.Circulation.
2010;122:2078-2088.
Week2Session2
2.2.aFromFramingham,USAtoNorthKarelia,Finland
NathanD.Wong,DanielLevy.LegacyoftheFraminghamHeartStudy:Rationale,Design,InitialFindings,
andImplications.GlobalHeart.2013;8:3-9.
GéraldBaril.TheNorthKareliaProjectinFinland:Asocietalshiftfavouringhealthylifestyles.TheInstitut
nationaldesantépubliqueduQuébec(availableat:http://www.inspq.qc.ca).
http://www.inspq.qc.ca).
2.2.aHealthpromotion:ExamplesofsodiumreductioninruralChinaandPeru
LiNicole,YanLL,NiuW,LabartheD,FengX,ShiJ,ZhangJ,ZhangR,ZhangY,ChuH,NeimaA,Engelgau
M,ElliottP,WuY,NealB.Alarge-scaleclusterrandomizedtrialtodeterminetheeffectsofcommunitybaseddietarysodiumreduction-theChinaruralhealthinitiativesodiumreductionstudy.AmericanHeart
Journal.2013,166(5):815-822.
AntonioBernabe-Ortiz,FranciscoDiez-Canseco,RobertHGilman,MaríaKCárdenas,KatherineA
SackstederandJJaimeMiranda. Launchingasaltsubstitutetoreducebloodpressureatthepopulation
level:aclusterrandomizedsteppedwedgetrialinPeru.Trials.2014;15:93(forgraduatestudents).
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Week3Session1
3.1.aTobaccocontrol(GuestlecturebyProf.AbuAbdullah)
Chap14.CurbingtobaccouseinPoland.
3.1.bStrengtheningprimarycare:ExamplesfromAsiaandAfrica
YanLL,FangW,DelongE,NealB,PetersonED,HuangY,SunN,YaoC,LiX,MacMahonS,WuY.
Populationimpactofahighcardiovascularriskmanagementprogramdeliveredbyvillagedoctorsin
ruralChina:designandrationaleofalarge,cluster-randomizedcontrolledtrial.BMCPublicHealth2014
(14):345.
Week3Session2
3.2.aM-healthandNCDs:ExamplesfromChina&SouthAmerica
DavidPeiris,DevarsettyPraveen,ClaireJohnson,KishorMogulluru.UseofmHealthSystemsandTools
forNon-CommunicableDiseasesinLow-andMiddle-IncomeCountries:aSystematicReview.J.of
Cardiovasc.Trans.Res.2014(7):677–691.
Pao-HwaLin,YanfangWang,EricaLevine,SandyAskew,ShentingLin,CuiqingChang,JianiSun,Perry
Foley,HaijunWang,XuLiandGaryGBennett.ATextMessaging-AssistedRandomizedLifestyleWeight
LossClinicalTrialAmongOverweightAdultsinBeijing.Obesity;2014(22):E29-E37
3.2.bSMSforsecondarypreventionamongNCDpatients
ChowCK,RedfernJ,HillisGS,etal.EffectofLifestyle-FocusedTextMessagingonRiskFactor
ModificationinPatientsWithCoronaryHeartDisease:ARandomizedClinicalTrial.JAMA.
2015;314(12):1255-1263.
EapenZJ,PetersonED.CanMobileHealthApplicationsFacilitateMeaningfulBehaviorChange?Timefor
Answers.JAMA.2015;314(12):1236-1237(forgraduatestudents).
Week4Session1
4.1.aYouarewhatyoueat?
U.S.DepartmentofHealthandHumanServicesandU.S.DepartmentofAgriculture.2015–2020Dietary
GuidelinesforAmericans.8thEdition.December2015.Available
athttp://health.gov/dietaryguidelines/2015/guidelines/.
ScientificReportofthe2015DietaryGuidelinesAdvisoryCommittee.USDA.February2015.(Pages1323ofthePDFfile,PartA:ExecutiveSummarypages1-11only)(forgraduatestudents).
F.B.Hu,Y.LiuandW.C.Willett.Preventingchronicdiseasesbypromotinghealthydietandlifestyle:
publicpolicyimplicationsforChina.Obesityreviews2011(12):552–559.
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4.1.bExerciseasPreventionandMedicine
2008PhysicalActivityGuidelinesforAmericans.Pagesvi–14only.
C.Sanz,J.-F.Gautier,H.Hanaire.Physicalexerciseforthepreventionandtreatmentoftype2diabetes.
Diabetes&Metabolism.36(2010)346–351.
Week4Session2
Overweight&obesity:Trends,measures,consequences,&frontiers
PeterG.Kopelman.Obesityasamedicalproblem.Nature.2000Apr6;404(6778):635-43.
Pre-diabetesanddiabetesinChina:Tipoftheiceberg
FrankHu.Globalizationofdiabetes:Theroleofdiet,lifestyleandgenes.DiabetesCare 2011;34(6):124957.
WenyingYang,etal.
fortheChinaNationalDiabetesandMetabolicDisordersStudyGroup.Prevalence
ofDiabetesamongMenandWomeninChina.NEnglJMed2010;362:1090-101.(Forgraduatestudents
only)
Week5Session1
Cancer:Globaltransitionandcancercare
Bray et al. Global cancer transitions according to the Human Development Index (2008-2030): a
population-based study. Lancet Oncol 2012;13:790-801. (Optional)
Farmer et al. Expansion of cancer care and control in countries of low and middle income: a call
to action. Lancet (2010) vol. 376 (9747) pp. 1186-93
Respiratorydiseases:Airpollution,cookingstove,andmicrobiome
SalviandBarnes.Chronicobstructivepulmonarydiseaseinnon-smokers.Lancet(2009)vol.374(9691)
pp.733-43.
Ait-KhaledN,EnarsonD,BousquetJ.Chronicrespiratorydiseasesindevelopingcountries:theburden
andstrategiesforpreventionandmanagement.BullWorldHealthOrgan.2001;79(10):971-9.(Optional)
Week5Session2
Patient-centeredcare
WHO.Adherencetolongtermtherapies:evidenceforaction.WorldHealthOrganization2003;pp3-25
(WHO,2003).
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http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf
Self-management,andpeersupport
FunnellMM.Peer-basedbehaviouralstrategiestoimprovechronicdiseaseself-managementand
clinicaloutcomes:evidence,logistics,evaluationconsiderationsandneedsforfutureresearch.
FamilyPractice(2010)27(suppl1):i17-i22.
Week6Session1
PrivatesectorandNCDs:industry,innovation,andinspiration
TaraAcharyaetal.Chapter6ActivitiesofthePrivateSector
.InStucklerDandSiegelK(eds.).Sicksocieties:Respondingtotheglobalchallengeofchronicdisease.
OxfordUniversityPress.2011.
WorldHealthOrganization.Chapter3“InnovationsinCare:MeetingtheChallengeofChronic
Conditions”In.InnovativeCareforChronicConditions:BuildingBlocksforAction.(2002)pp.41-65.
Wholeofgovernment,wholeofsociety
FifteenministriesinChina.May2012.2012-2015ChinaNationalChronicDiseasePreventionand
TreatmentPlan(OriginaldocumentinChinese;translatedtoEnglish).
Week6Session2
ClassDebate
Week7Session1
StudentPresentationsonfieldtripandtheirpapersectionsandinterviews
Week7Session2
Groupworkoncompilingthedraftsectionsintoanacademicpaper
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