Abstract
In 2017 Public Health England were asked to assist with investigating why 1-year cancer survival rates appeared lower than expected in a local area. We identified 50 premature deaths that surveillance data suggested we would not expect. These deaths highlighted a gap in recognising and responding to this kind of systematic non communicable disease (NCD) outcome variation. We hypothesise that the lack of a universally agreed systematic response to variations is not only counter-intuitive, but wholly unacceptable where non-communicable diseases (NCDs) rather than infectious diseases have become the leading causes of illness and death worldwide. In the United Kingdom (UK) alone over 89% of mortality in 2014 was attributable to NCDs. We argue that a new approach is urgently needed to turn the curve on NCD outcome variation to protect and improve the public’s health. We set out a definition of an NCD “incident” and propose a phased approach that could be used to respond to local variation in NCD outcomes.Establishing parity of response for local variations in NCD outcomes and CD control is critically important. Although evidence shows that prevention and early intervention will make the biggest difference to NCD incidence, collective local whole health economy response, exploiting the wealth of surveillance data in real time, needs to be at the heart of responding to variations in NCD outcomes at a population level. We argue that local and national public health agencies should mandate a standardised ‘incident’ response to significant changes in outcomes from NCD to mitigate and reduce the loss of quality life.
Highlights
We propose six changes, necessary to remove the inherent prejudices and test our proposals to achieve parity of response with the management of outbreaks of communicable disease (CD).CHANGE 1: Remove the ‘strategy paradox’ for non-communicable disease (NCD) Long term non-communicable diseases (NCDs) strategies for international or national geographies guide the implementation of approaches to improve NCD outcomes
CHANGE 5: Implement a standardised incident control response to investigate NCD outcome variation Once we have defined an NCD incident, how do we respond rapidly, locally? We argue that the response could take the same phased approach as a CD response (Table 2) and that lessons can be adopted from the standard guidelines used by health protection teams across the United Kingdom (UK) [12]
Despite efforts over the last 6 years to improve the transparency of data [22] and develop new models of health and care delivery [23], we argue that without concentrated effort and resource to define an NCD incident and standardise a response using evidence informed tools we will not be able to achieve the great strides in health outcome improvements for NCD that have been accomplished by our counterparts working in CD control
Summary
What happens if there are 50 unexpected deaths in a 5 year period attributable to a communicable disease (CD)? In a country with a developed public health system this scenario is almost inconceivable as actions would have been taken to prevent these deaths soon after the incident was recognised. It can be argued that NCD outcome variation can only harm relatively small numbers of people affected at local level over short periods of time whereas localised CD outbreaks can escalate exponentially, and in extreme cases turn into national and international outbreaks harming thousands of people, trade [3] and generating high profile media coverage and, public concern if not rapidly controlled. The aetiologies of NCDs are wide ranging, complex, and, lead time from exposure to diagnosis can be decades [4,5,6] These are often chronic health issues for individuals as opposed to acute CDs. These are often chronic health issues for individuals as opposed to acute CDs This may mask that variation in outcomes for NCDs may be an acute issue for a local health system. The failing of health and public health systems to effectively and efficiently tackle variation in outcomes [6] is at odds with the significant achievements public health agencies have demonstrated in reducing the burden of CDs [10]
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