On Tuesday, October 23rd, over 40 authorities and representatives of the public and private sectors in Brazil gathered at the third meeting of the Intersectoral Forum to Fight NCDs in Brazil at the São Paulo State Legislative Institute, part of the São Paulo State Legislative Chamber. The focus of the meeting was to build action plans to accelerate efforts in the fight against non-communicable diseases (NCDs) in the country. Notable attendees included officials from the Ministry and State Secretariats of Health, banks, academia, industries, and international and national NGOs supporting research and development of projects in the health sector.
Working together, experts devoted their efforts to designing joint strategies, with clear targets and deadlines aimed at improving prevention and treatment of NCDs including cancer, diabetes, respiratory and cardiovascular disease. The strategies themselves heavily focused on prevention, such as through healthier eating, active lifestyle and avoiding tobacco and alcohol; as well as improving access to quality treatment for NCD patients.
As a GHL Fellow and Technical Advisor for Medtronic Foundation, I organized this third Forum meeting with a specific emphasis on incorporating interdisciplinary perspectives. Throughout the event, it was important to highlight the importance of commitment from Brazil’s public sector as a whole in effectively preventing NCDs, rather than maintaining the status quo of efforts led solely by the Ministry of Health. All areas of government are collectively responsible for the prevention of these diseases, and civil society and the private sector must also join them in a united front.
Report from the UN High Level Meeting on NCDs
The third Forum took place just a few weeks after the UN High Level Meeting on NCDs at the UN Headquarters in New York on September 27th, 2018. The back-to-back timing of the two meetings granted an opportunity for the Forum participants to evaluate progress in NCD prevention and treatment activities being developed in Brazil and compare these efforts with those of other countries from a regional and global perspective. Government officials and Forum participants who, along with myself, also attended the UN High Level Meeting in September shared their experiences with the audience.
The Ministry of Health NCDs Director, Maria de Fátima Marinho, stated that the guidelines issued during the UN meeting could have been more specific, but she was glad to report that the movement to combat NCDs did not suffer any setbacks. Marinho pointed out that Brazil is moving in the right direction, as it is one of the few countries in the world that is on track to reach the goal of reducing the premature death rates from NCDs by one third before 2030. Premature deaths caused by NCDs are experienced by people under 70 years of age. Dr. Marinho believes that global NCD strategy should now target the female population and also focus on alcohol consumption. “While men are smoking less and maintain a steady level of abusive consumption of alcohol, both behaviors are on the rise among women,” Marinho explained, citing studies by the Ministry of Health.
Laura Cury, from ACT Promoção da Saúde (ACT Health Promotion), and Júlia Santos, from Alianza Latina (Latin Alliance) and Abrale (Brazilian Association of Lymphoma and Leukemia), agreed that the general feeling is that the UN High-Level Meeting on NCDs did not propose ambitious targets. “When dealing with the reduction of consumption of harmful products, the language isn’t as strong as it could be. This omission reflects the influence of the industries of tobacco, alcohol, sweetened drinks and ultra-processed food,” said Cury. Taxation of unhealthy products should be reinforced to generate subsidies for public health, Santos added.
Encouraging behavior change
Non-communicable diseases are responsible for more than 72 percent of deaths in Brazil. Cardiovascular issues, strokes, diabetes, different kinds of cancer, and chronic respiratory diseases are some of the most prevalent in the country. One way to effectively reduce this disease incidence is by encouraging behavior change in the population. For example, Marinho, from the Ministry of Health, mentioned that physical activity has reduced breast cancer mortality in Brazil by 12 percent. Forum participants also discussed best practices in preventative methods. Programs that foster healthier cities through bike-share initiatives and bike-lanes were discussed by Pedro de Paula and Hannah Machado, from Vital Strategies, Roberto Kikawa, from CIES Global, and Simone Gallo Azevedo, Itaú’s director. Azevedo said that the bank invests 60 million Brazilian Reais per year in a bike-sharing scheme, and that the project is used by the bank as “a mechanism to foster public policies, to benefit the integration of the citizen with the city and lead to positive impacts on health.” Hannah Machado also observed that “São Paulo has been showing improvements in the pursuit of a healthy lifestyle, and in the paradigm shift that puts pedestrians and cyclists ahead of individual motorized transport.”
Forming essential partnerships
The importance of partnerships to achieve improvements in health outcomes was strongly emphasized by Professor Antonio Luiz Pinho Ribeiro, from the Federal University of Minas Gerais. The potential of public-private partnerships is huge, Ribeiro said, since it “allows the use of the intelligence and capillarity of the public sector with the efficiency of the private sector.” Ribeiro discussed the HealthRise Project, developed in partnership and with funding from the Medtronic Foundation. The project has facilitated the detection and control of diabetes and hypertension in poor Brazilian neighborhoods. The late Doctor Roberto Kikawa, who also took part in the discussion, brought additional expertise in public-private partnerships to the conversation through sharing his success with CIES (Center of Education and Health Integration) Global’s programs, which offer medical care to poor communities through these public-private partnerships.
The best way to attract good partners is through a deep dive to understand local needs, particularly those of individuals who will be the focus of programs, said Johannes Boch from Novartis Foundation. Boch is responsible for the Better Hearts Better Cities project, dedicated to improvements in the fight against cardiovascular diseases in the east region of São Paulo. Márcia Maria de Cerqueira Lima, who leads the Technical Oversight Agency of Health in Itaquera, agreed with Boch’s opinion. For her, local ambassadors are a key part of the program, as they help to tailor the project to the population’s needs, and they engage the community to work in a united effort to combat and prevent of NCDs.
Overall, the Forum conversations expressed that partnerships for health do not need to – nor should they – take part only between the public and private sectors. Rather, cooperation among different organizations of the same sector, and participation of civil society and NGOs are absolutely essential for ensuring successful health outcomes. For more information on the Forum, visit our website at www.ForumDCNTs.org, Twitter profile @ForumDCNTs, or search the hashtag #ForumDCNTs on Twitter.