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Presentation to chronic disease workshop may 2012


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Presentation to chronic disease workshop may 2012

  1. 1. Addressing NCDs in a complex world: A development perspectiveGerald BloomInstitute of Development Studies, UKMay 10, 2012
  2. 2. Influencing change in a complex world: multiple development pathways Complex market systems involve public and private providers of goods and services (local, national and trans-national) Competing perspectives and interests influence the design and enforcement of regulations Policy initiatives have unpredictable outcomes and there is a risk of unintended consequences. Good intentions are not enough and it is important to:• assess potential impacts of alternative strategies• build common understandings and partnerships for action• provide strategic leadership based on an understanding of the context
  3. 3. Health promotion, development and politics  Food and nutrition for large numbers of people moving to cities and out of agricultural production (production, distribution, processing and cooking)  Creating a modern food sector (local, national and global actors)  Tobacco and alcohol (vices, livelihoods and interests)
  4. 4. Social protection, health and public finance  Households face multiple challenges associated with rapid economic change and coping with a triple burden of care (children, elderly, disabled)  Pressure on governments to meet multiple needs and decide on the best use of public funds  Individuals have to finance some aspects of their health and social care – governments have a role in protecting their interests as consumers
  5. 5. Responses of complex health systems to NCDs 5
  6. 6. Spread of markets for health services,drugs and food Large variety of providers of health-related goods and services (regulated and un-regulated) Blurring of boundaries between public and private (market-like activities in government facilities) Inter-relationship between local and global markets (eg. pharmaceutical producers and distributors) Development of institutional arrangements has lagged behind the spread of markets
  7. 7. The changing health knowledge economy Spread of the media and growth of commercial advertising National and global advocacy groups and lobbying organizations Mobile telephones and the internet are important sources of knowledge and influence and knowledge intermediaries are looking for value-added content People have access to many sources of information but need to identify reliable knowledge and unbiased advice In many countries the health knowledge economy is virtually unregulated
  8. 8. Citizen organization for improved healthand health services  Social and political organisation for accountability and change  Organisation around specific diseases (advocacy for rights and provision of support for managing health problems)  Organisation around specific localities or specific ethnic or cultural groups
  9. 9. Development pathways for drug treatment of NCDs Publicity about the availability of drug treatment could stimulate people to seek drug treatment for NCDs (ageing as a treatable medical condition) Providers of outpatient services and pharmaceuticals respond to health needs and build market share (Henan Province - China) Knowledge intermediaries provide information, medical advice and prescriptions (Telemedicine Reference Centre - Bangladesh) Citizen organisations advocate for increased services and/or provide mutual support (MoPoTsyo - Cambodia) Governments under pressure to do something about the rising problem for families of caring for someone with a NCD, but they need to choose carefully how to use their financial resources and regulatory power
  10. 10. Pathways of response to the challenge of NCDs The problem of NCDs needs to be understood in the context of rapid urbanisation, modernisation, demographic change and changing forms of political accountability The response to NCDs is taking place at many levels and is influenced by many competing interests Health systems are strongly influenced by the types of partnerships that are established and the understandings and mutual interests that influence their behaviour Governments play a key role in facilitating the creation of effective partnerships that take into account the needs and interests of the poor. There is a need for experimentation and evaluation of alternative strategies for translating global policy objectives into effective systems in low and middle income countries.