Non-communicable Chronic Diseases:
New in Humanitarian Programming?
Humanitärer Kongress Berlin 2012
Florian Neuhann, Institute of Public Health
What -I think - do we want to achieve
in this session?
•  Clarify the understanding of the concepts
–  NCDs
–  Humanitarian Aid
•  Do we need and are we able to bridge the 2 ?
Main Determinants of Health
living-and
working
conditions
Work
environment
Housing
conditions
Educational
system
Agricultural
and food
production.
Employment
status
Age, Sex,
Constitution
Adapted from Dahlgren and Whitehead
What can be done about inequalities in
health? Lancet 1991; 338: 1059-1063
Health
System
Water &
sanitation
Environmental
Cultural
Social
factors
Non modifiable
individual factors
Genetic
predisposition
Physical activity ,Diet
Modifiable
Risk factors
Intermediate
risk factors
Step ladder model
for the development
of chronic disease
Adapted from WHO
Impaired glucose
tolerance
Diabetes
Manifest disease
What are NCDs?
•  No universally accepted definition
•  Operationally agreed:
•  WHO classifies NCDs as Type II disease
•  Type I diseases are infectious, maternal, perinatal or
nutritional
•  Type III diseases are injuries
•  According to WHO NCDs include gastro-intestinal &
renal diseases, neurological and mental disorders.
•  Current UN-led initiative focuses upon 4 main NCDs
which are linked to 4 main behavioural risk factors.
•  Decision to exclude mental health is controversial.
Adapted from Albrecht Jahn
The 4x4 concept for NCD control
•  Major noncommunicable diseases:
–  Cardiovascular diseases
–  Diabetes
–  Cancers
–  Chronic respiratory diseases
•  Shared preventable risk factors:
–  Tobacco use
–  Unhealthy diet
–  Physical inactivity
–  Harmful use of alcohol
Albrecht Jahn & WHO concept
BMJ
August
2012
No more
disease
silos
©Dr. Florian Neuhann
WHO Report Chronic
Diseases
Poverty
Chronic
disease
Dealing with Chronic Disease: a virtuous cycle
• 
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Laws and regulations
Tax and price interventions
Improving the built environment
Advocacy
Community based interventions
School based interventions
Workplace interventions
Screening
Clinical prevention
Disease management /treatment
Palliative care
Health
promotion
Prevention
Effective
interventions
Treatment &
Care
incl.
Rehabilitation
Who are these people?
©Dr. Florian Neuhann
Refugees and displaced people from Syria by end August 2012
http://www.who.int/nmh/countries/syr_en.pdf
Humanitarian Aid
Principles of Response
SPHERE Handbook
Humanitarian Aid
Principles of Response
1. Situational analysis
2. Water and Sanitation
3. Food supply and security
4. Shelter
5. Health care
6. Control of epidemic outbreaks
7. Epidemiological surveillance
8. Identification and training of local staff
9. Coordination with other organisations
Assessment – a non exhaustive list
•  Type of emergency (e.g. natural, war,
complex)
•  Geographic Region, Culture
•  Access, Transport, Regional Infrastructure
•  Weather conditions, season
•  Housing Water Sanitation
•  Essential supplies, available resources
•  Composition of affected group (age,
gender, human resources)
Questions to answer – not only for
NCDs
•  What is the spectrum of medical
problems? What is a priority?
•  Who are the vulnerable people? What are
their needs ?
•  What can we do for which NCD?
•  What capacity was available before the
emergency?
•  What is the consequence of not doing
anything vs to start something
substandard?
When thinking about Diagnostics..
•  Which simple, reliable and robust tests are
available?
E.g. Blood pressure, FEV, Blood glucose
•  What is the consequence of knowing?
When thinking about treatment
•  What are the treatment goals?
–  Symptom relief
–  Symptom control
–  Prevention of long term sequelae
•  How can they be achieved?
From : Caring for people with chronic conditions, WHO Europe
Assess Patient‘s goal, clinical status,
risk factors, knowledge beliefs ,
concerns
Adopted
from WHO
5 A‘s
Principle of
good
Chronic
care
Advise:Neutral, non judgemental
language, correct and complete
patients‘s knowledge
Agree on treatment options ,
treatment goals
Assist by providing treatment,
medication, support
Arrange follow up, group
appointments, patient record keeping
Can we bridge the 2 ?
Some thoughts on Conclusions…..
•  Emergencies are a bad time to start caring for
chronic conditions
•  “Know your epidemic know your response“ learn from HIV/ART
•  Follow established sound principles for
Humanitarian Aid
•  Include NCD but realize …
–  Responses must be context, phase, and disease
specific
–  Apply principles of good chronic care
Recommendation
•  Adjust health systems to respond to
needs and demand of people with chronic
conditions -especially for the poor of the
world
•  and
•  even before an acute emergency