What can we learn about non-communicable diseases in Brazil?

The following article was written by Ronaldo J. Pineda Wieselberg, a student of the Medical School of the Santa Casa de São Paulo and member of the IDF Young Leaders in Diabetes Program, based in São Paulo, Brazil.

The Forum on Intersectoral Efforts to Fight NCDs in Brazil (Forum Intersetorial para Combate as DCNTs no Brasil) is an initiative of Global Health Leaders’ (GHL) Public Private Competency Building strategy. Led by GHL Fellow and Medtronic Foundation Associate Dr. Mark Barone, the initiative aims to build cross-sector competencies with local, national, and regional public, private and NGO stakeholders in Brazil, and foster intersectoral partnerships to address NCDs. Dr. Barone hosted the first event for the newly created Forum on October 25, 2017 in São Paulo, Brazil. The event was attended by Esther Tahrir, Global Health Leaders Director at the Public Health Institue (PHI) in Oakland, California, USA, as well as Andrew Pines, a PHI board member, both of whom presented on PHI’s leadership development capacity in non-communicable diseases and the role PHI can play in fostering more intersectoral partnerships in Brazil.

Dr. Mark Barone, GHL Director Esther Tahrir, and PHI Board Member Andrew Pines at the Forum on Intersectoral Efforts to Fight NCDs in Brazil.

On October 25th, 2017, at the Legislative Assembly of São Paulo State, Global Health Leaders, a program of the Public Health Institute, hosted the launch of the Forum on Intersectoral Efforts to Fight Non-Communicable Diseases (NCDs) in Brazil in partnership with Medtronic Foundation.  Participants of the forum included representatives from the Brazilian Ministry of Health (MoH), São Paulo Municipal Health Secretary, the private sector and non-governmental organizations (NGOs) focused on combating NCDs.

NCDs are currently one of the biggest problems in public health globally. Statistics from the World Health Organization indicate that NCDs are responsible for 68% of deaths around the globe, particularly cardiovascular diseases, cancer, respiratory diseases and diabetes. In Brazil, the case is no different, as NCDs and violence have replaced infectious diseases as the main causes of death in recent years.

These diseases require regular appointments to ensure effective treatment. For example, after an acute heart attack, it is not possible for a patient to carry on with their life in the same way – and the reality is the same for patients with other NCDs. Moreover, NCDs are not transmitted among people, which sets them apart from bacterial and viral infections. This is why prevention of NCDs is just as important as treatment.  Some of the main risk factors for developing an NCD include sedentary behavior, bad eating habits, and abusive use of alcohol and tobacco.

Dr. Maria de Fatima Marinho presents on Brazilian Ministry of Health programs promoting health in Brazil.

The Brazilian Ministry of Health has developed a strategy aiming to address these risk factors for NCDs. Doctor Maria de Fátima Marinho, representative of the Brazilian Ministry of Health and panelist at the Forum on Intersectoral Efforts to Fight NCDs in Brazil, told us that it all starts with health promotion, as the ministry’s strategies are focused on information, evaluation and monitoring of pre-existing risk factors. These strategies are being implemented by programs such as: Programa Saúde nas Escolas (“Health in Schools Program”) and the Academia da Saúde (“Health Gym”); the Pesquisa Nacional de Saúde (“National Health Survey”, PNS); Pesquisa Nacional de Saúde nas Escolas (“National Health Survey in Schools”, PeNSE), focused on monitoring risk factors in children and teenagers; and the vigilance system for identifying NCD risk factors by telephone survey (VIGITEL). According to Dr. Marinho, with these programs and monitoring strategies, a significant reduction has occurred in deaths caused by cardiovascular diseases in Brazil, however, there is still much to be done.

Behavioral habits do not change instantly. Thus, the process of mobilizing a population towards increased physical activity and healthy eating habits demands time and energy. Non-governmental initiatives, such as Agita São Paulo (“Move São Paulo”) and Nutrição em Ação (“Nutrition in Action”) help a lot in this process, however, being isolated initiatives, they have limited reach throughout the country. In an effort to overcome these obstacles, public-private partnerships arise, uniting the innovation of the private sector with the support of public entities and programs. In Brazil, due to several legal, normative, cultural, and tax barriers, projects performed by public universities, specifically federal ones, become an elegant solution.

Esther Tahrir, Global Health Leaders Program Director, presents on a panel with Maria de Fatima Marinho, Brazilian Ministry of Health, and Maria José Delgado, Interfarma.

Leadership programs are being implemented all around the world, including in Brazil, focused on leveraging public-private partnerships to fight NCDs. These programs are placing a high priority on innovation and developing new solutions. HealthRise Brazil, as presented by Davi Rumel, is one of these innovative initiatives. Partnering with municipalities, states, and the MoH, the program works with other key national and international partners, such as IEP-HSL, UFVJM, UFMG, UFBA, IHME, Abt Associates, and Medtronic Foundation, to strengthen access to quality healthcare for under served populations in Vitória da Conquista and Teófilo Otoni, two different regions of Brazil. According to Esther Tahrir, of the Public Health Institute, leadership programs such as Global Health Leaders are also key to providing expertise that public health professionals need to make a difference in local and global communities, while simultaneously sparking change in public policies and stimulating public private partnerships. The establishment of these programs is integral to combating NCDs, since well-implemented innovations, local leadership, funding, and partnership with the private sector are often limited.

The launch of the Forum on Intersectoral Efforts to Fight NCDs in Brazil was the first step in a new multi-pronged initiative that will work to bring the public and private sectors together in Brazil, in order to share both knowledge and resources, in the fight against NCDs.


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