PAHO Webinar Series: Tackling Noncommunicable Diseases (NCDs), risk factors and mental health during the time of COVID-19
Introduction
Dr. Anselm Hennis, Director, Department of Noncommunicable Diseases and Mental Health announced the PAHO monthly webinar series on ‘Tackling NCDs during the time of COVID-19’ and welcomed the participants to this first webinar on Approaches to NCDs during the pandemic and post-pandemic period. After noting the disproportionate impact of COVID-19 on people living with NCDs, he introduced the speakers for this session, who were:
- Dr. Jarbas Barbosa, Assistant Director, PAHO
- Dr. Ruy López Ridaura, Director General, National Center for Disease Prevention and Control (CENAPRECE), Secretary of Health of Mexico
- Lt. Col. the Honourable Jeffrey D. Bostic, Minister of Health and Wellness of Barbados.
Impact of COVID-19 on NCD programs
Dr. Barbosa presented an overview of the COVID-19 pandemic in the Region of the Americas, which is the WHO region hit hardest by the pandemic. He highlighted the devastating effects on the economy, as well as social challenges and worsening marginalization, principally affecting those living in vulnerable circumstances.
NCDs account for 81% of deaths in the Region, with 34% of such deaths occurring prematurely in persons aged 30 to 70 years. Dr. Barbosa pointed out that “we are not talking about the natural end of life”. The Region of the Americas ranks first in overweight and obesity among adults and adolescents globally, a risk factor for both NCDs as well as COVID-19. Disruption and closures of health services during the pandemic have caused delays in high priority treatments for NCDs, leading to reduced cancer care and renal dialysis, while stay at home measures have led to increased consumption of tobacco, alcohol, unhealthy diets and reduced physical activity.
The pandemic is also leading to an increasing mental health crisis, if corrective action is not taken. Mental health represents 34% of total disability in the Americas, and persons have increased symptoms of depression and anxiety, due to the pandemic, particularly health care workers.
The Region is not on target to meet the Global NCD Goal of a 25% reduction in NCD premature mortality by 2025, and this will be exacerbated by the COVID-19 pandemic.
Dr. Barbosa concluded that it was critical to preserve public health gains, improve health policies and fiscal measures for NCD risk factors; integrate NCDs and mental health into strengthened primary care while maintaining innovations, investing to make health systems more resilient to future catastrophic emergencies and strengthen surveillance and research on NCDs, translating data into policies, identifying the most vulnerable populations, to learn from what is working well in order to respond optimally.
Country experiences: Mexico
Dr. Ruy López Ridaura noted that in Mexico, it was observed that a large proportion of people dying from COVID-19 also suffered from co-morbidities (73%). Sixty seven percent of these deaths occurred in persons with diabetes, hypertension, cardiovascular diseases and obesity. This has led the Mexican government to prioritize NCDs (including obesity) in the COVID-19 response plan. The Ministry of Health has developed two pillars of work at the inter-ministerial level for the period 2019- 2024, with the support of civil society and international organizations. First, the transformation of the agri-food system to make healthy food more affordable, sustainable and competitive. Secondly, the transformation of primary health care, emphasizing its key role as a point of entry to the health system. The pandemic has provided the opportunity to advance these topics. For instance, as schools begin to reopen, there will be an opportunity to have healthier spaces through communication campaigns, food labelling, healthy foods at school, restrictions on consumption of sweetened beverages, among others.
Before the pandemic, a transformation of the care system was already under way, and there will be strengthening of primary and community care to provide care for COVID and non- COVID patients, including accessing rural localities and building links with the network of care. This strategy has three components: a health and wellbeing component (SABI), the PAHO/WHO HEARTS package for the prevention and control of cardiovascular diseases, and a community COVID-19 component. Community brigades conduct health promotion actions, while specialized and clinic care teams provide care to people. Actions involved are stratification of patients, continuity of care and providing medicines, early detection of acute symptoms of NCDs and referral to hospitals. Standardized guidelines have been developed and are used to provide care for both COVID-19 and NCD patients.
Country experiences: Barbados
Lt. Col. the Honourable Jeffrey D. Bostic stated that Barbados, with a population of 287,000 persons, ranks very high globally in terms of number of centenarians per capita. At the same time 53% of the population has one or more NCDs. The priority for the COVID response was therefore to address the vulnerable population living with NCDs and the elderly, but the human resources were not enough to respond to the COVID pandemic and simultaneously maintain NCD clinics. Furthermore, COVID measures restricted the number of persons in health care facilities. Early measures were taken to secure medicines for NCDs, and 90% of these remained available throughout the pandemic. The shortage in human resources was addressed by recruiting nurses from Cuba and Ghana to take care of the additional needs generated by the pandemic. It has also been necessary to create an atmosphere of confidence to encourage patients to attend the clinics. Outpatient clinics were refurbished in rural areas and portable dialysis devices were purchased. In addition, nutritional school policies were completed with the collaboration of PAHO, The University of the West Indies and the Barbados Association of Medical Practitioners to tackle obesity, a risk factor for COVID-19.
A steep decline was observed in the numbers of patients attending health facilities during the pandemic; therefore, a program was established to target persons with severe NCDs through home visits, telemedicine and use of electronic medical records. University students were recruited to conduct household surveys, identifying living conditions of persons with NCDs and the elderly, and possible exposure to COVID.
Priority areas of the ongoing National NCD strategic plan include the nutrition policy; the national cardiology program, with the collaboration of the private sector, to manage patients before reaching the hospital. Another challenge is preparation for the upcoming hurricane season, including provision of shelter for the elderly and persons with NCDs.
Questions and answers
There was active engagement from the participating audience and the presenters were asked to highlight the key innovations and lessons learned to maintain NCD services during these challenging times. Dr. Ruy López Ridaura stressed the need to strengthen integrated primary care and networks of care, for “we cannot respond with a health system disconnected within itself and from the community”. Lt. Col. the Honourable Jeffrey D. Bostic emphasized the buy- in from the entire country, with a systemwide and whole-of-society approach and the need to prepare for future emergencies. Dr. Hennis concluded the session by thanking participants and speakers and inviting everyone to join next month’s webinar, on April 27 at 11:00am ET, which will focus on mental health during COVID-19.
