Non-communicable Diseases

Non-communicable diseases (NCDs) are an emerging epidemic with profound ramifications for global health both in terms of the burden of morbidity and the strain they will place on healthcare systems around the world.  As populations undergo demographic transitions, the incidence of cancer, diabetes and coronary arteries amongst other NCDs are increasing and critically the relative proportion of the burden placed on low and middle incomes countries is increasing rapidly (LMICs).

The problem in LMICs is particularly worrisome as healthcare systems often have insufficient resources to deal with existing threats let alone deal with the emerging burden of protracted chronic diseases.  Moreover the evidence base (both for the effectiveness of treatments and the importance of risk factors) as well as the capacity to conduct research in LMICs is grossly inadequate.  Whilst the number of clinical trials conducted in LMICs is increasing the vast majority of these are commissioned and designed externally with little or no input from local investigators and are often not started with the specific aim of addressing local research priorities.  However, there is increased resolve to tackle the challenge of NCDs by building capacity for clinical research through infrastructure and expertise in clinical research in LMICs. 

But why the need for research conducted locally, by local researchers and according to locally defined priorities?  Environmental and genetic risk factors historically identified in mainly European populations may differ markedly with risk factors in the local population.  The resultant impact on preventative public health measures and healthcare planning for country specific disease prevalence indicates the seminal importance of locally conducted epidemiologic research. Differential funding and reimbursement systems and country specific organization of healthcare institutions necessitate the exploration of locally generated health economic and health policy research.  Furthermore clinical trials, often conducted in special trial conditions in Western healthcare systems cannot be guaranteed to generate findings which are applicable in low resource healthcare systems and may even cause harm.  Pragmatic trials conducted locally may help to translate the findings of existing trials into new contexts.  Add to this the emergent field of personalized medicine with treatment according to individual patient genetics and the impact of ethnic variation between countries becomes yet another compelling reason to support local research.

Global Health NCDs has been started to create a research capacity building community in the field of NCD research.  Global health NCDs provides a platform for sharing of expertise in the design and execution of clinical trials in a variety of contexts around the world.  It will create communities of practice in order to reduce redundancy in expertise, leverage global institutional partnerships and drive efficiency in building capacity in LMICs.  Global Health NCDs provides a conduit for the Global NCD research community to connect remotely and provides the tools to facilitate distance learning and mentoring of clinical researchers.  In so doing Global Health NCDs aspires to support others in training a cadre of clinical researchers in LMICs who can themselves begin to tackle the challenges that lie ahead.