Reimagine Series: Healthcare – Coping with the shifting burden of disease

In the second post of our series, reimagining healthcare, Prof. Jürgen Maurer, HEC Lausanne (UNIL) focuses on the epidemic of non-communicable diseases (NCDs) such as heart attacks, cancers and strokes, which now kill more people in developing countries than infectious diseases, such as malaria and Aids.

Today, NCDs, which also include lung disease and diabetes, are responsible for three quarters of all deaths worldwide. The vast majority of these occur in low to middle income countries (LMICs) threatening to overwhelm health systems, according to the World Health Organisation.¹

“Many healthcare providers in these countries are ill equipped for this surge. At the same time, insights gained from high income countries may not always apply in developing country settings. We need more NCD research in LMICs. If we want objective evidence on the challenges, we need reliable data, which is still relatively sparse in these countries,” states Jürgen Maurer, professor of health economics and management at HEC Lausanne, member and co-founder of the LCHE (The Lausanne Center for Health Economics, Behavior, and Policy) at UNIL.

Jürgen Maurer leads a project on NCD related challenges in LMICs, which is part of the Swiss Programme for Research on Global Issues for Development. It is called Inclusive Social protection for chronic health problems. Maurer and his colleagues have gathered and analysed new health survey data with a focus on Sri Lanka, Malawi, the Philippines and India. The project has over 50 peer-reviewed publications to-date in leading journals in economics, demography and global health.

Cardiovascular diseases (CVDs) such as hypertension, are now among the biggest killers in developing countries. In a global context, 80% of all deaths due to CVDs occur in LMICs.²

“In many of these countries, a large share of older people with hypertension don’t even know that they have high blood pressure despite frequent contact with doctors and hospitals. They are not often checked for the disease, which only requires a simple blood pressure monitor. This is a missed opportunity that can result in big diagnostic and even bigger treatment gaps,” details Maurer.

His research in India shows that if there was a greater chance of hypertension diagnoses through opportunistic screening, say when patients visit a health centre for other illnesses, diagnosis rates could increase from 55 to 77 per-cent.³ The data also concludes that missed opportunities are more common among poorer, less educated, rural individuals. The study also shows that targeted opportunistic screening could be a first step towards more effective and equitable hypertension treatment.

Such academic research can help policymakers decide on where to focus limited resources. For instance, modelling by the r4d team ⁴ has assisted Sri Lanka’s health ministry. “Officials used our research to make the case for revising the recommended treatment protocol for CVDs. Policymakers are now looking to reduce the risk threshold when statins are prescribed for hypertension,” he states.

Reimagining healthcare also involves gathering evidence in context, empowered by new data. Aside from the issue of diagnosis and treatment, Maurer’s research also shows how risk factors for NCD may be context-specific. For instance, research has shown that poor conditions for babies in the womb can lead to a higher risk of cardiovascular disease in older age. However, a recent study co-authored by Maurer has shown that those Malawian children that were exposed to famine, before birth, had better cardiovascular health 70 years later, not worse, which may be related to different nutrition patterns over peoples’ lifetimes.⁵

“You can’t translate research on risk factors and treatment protocols from high income countries such as the U.S. to low income ones in sub-Saharan Africa and south Asia. Context matters. This is why our research is important,” he concludes.

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