Noncommunicable Disease

Program in Global Noncommunicable Disease and Social Change

Gene Bukhman, MD, PhD, Program Director

Background

Young people who live on less than one dollar per day too often die from treatable non-communicable diseases, including cervical and breast cancer, lymphomas, cardiomyopathies, rheumatic heart disease, obstructive lung disease, epilepsy, and insulin-dependent diabetes. These conditions often result from the inequalities facing poor communities worldwide, especially exposure to infectious disease, and a lack of access to food, shelter, education, and existing health care interventions.

During the early 20th century, the movements to address tuberculosis and, later, non-communicable diseases drew strength from a common focus on the needs of the poor. In this century, the growing global commitment to health care as a human right has created an opportunity to forge similar bonds between leading infectious-disease initiatives and efforts to address the non-communicable diseases of the bottom billion.

The Program in Global Noncommunicable Disease and Social Change, housed in the Department of Global Health and Social Medicine, brings together scholars, researchers, educators, and health care practitioners to share lessons from disease-specific approaches that serve patients with non-communicable diseases. By harnessing the resources, passion, and best practices of health care systems worldwide, the Program’s faculty and fellows aim to place the care of patients with endemic non-communicable diseases squarely within the dialogue on health and human rights.

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Objectives

Projects undertaken by the Program in Global Non-communicable Disease and Social Change are linked to ongoing clinical, research, and advocacy efforts in the Americas, Africa, and Europe. Program objectives include:

  • Supporting, monitoring, and evaluating community-based initiatives that integrate prevention, diagnosis, and management of non-communicable diseases along the care spectrum, from the community to referral centers.
  • Training medical students, newly minted physicians, and other health care professionals at in-country centers which operate in partnership with Harvard-affiliated hospitals.
  • Researching the links between global infectious disease, non-communicable diseases, and mental health issues.

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Featured Initiatives

Strengthening Chronic Care Infrastructure in Rural Rwanda

This project supports efforts by Rwanda’s Ministry of Health to expand on its successful HIV initiatives through scalable approaches to health care delivery for other chronic conditions common in rural areas, including rheumatic heart disease, cardiomyopathies, chronic respiratory disease, insulin-dependent diabetes, and hypertension, as well as hemato-oncologic and neuropsychiatric conditions.

Cancer Care and Control in Haiti, Rwanda, and Malawi

A partnership among Partners In Health, the Dana-Farber Cancer Institute, Harvard Medical School, the Harvard Equity Initiative, and Brigham and Women’s Hospital working in rural Malawi, Rwanda, and Haiti is proving that the absence of specialists and specialty centers can be surmounted even in the poorest settings. These experiences demonstrate that the absence of oncologists need not delay the implementation of mutually reinforcing efforts at prevention, screening, treatment, and palliation for cancer in resource-limited areas. Developing models that deliver as much care as possible close to a patient’s home and social support is critical, as is the engagement of other local physicians and those in referral centers who can provide care not available in rural centers, such as some complex surgeries. The cases are providing input into the work of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, and the lessons from the Partners In Health–supported sites will be projected to other countries.

Cardiac Surgery for Rheumatic Heart Disease in Rwanda

Cardiac surgical services are scarce in sub-Saharan Africa. Team Heart, a Boston-based nongovernmental organization, together with Brigham and Women’s Hospital and other partner organizations from Australia, Belgium, and the United States, has supported Rwanda’s efforts to initiate a national cardiac surgical program for rheumatic and congenital heart disease. This work has involved coordination with a national initiative to expand chronic care infrastructure and acute care for Streptococcal pharyngitis.

Chronic Care for Noncommunicable Disease in a Rural Malawian District

Together with the Malawian Ministry of Health, the nonprofit Partners In Health has established a clinic for patients with noncommunicable diseases most commonly found among people living in Malawi’s Neno District. The clinic, which opened in May 2009, treats patients with asthma, diabetes, epilepsy, heart failure, and hypertension.

Navajo Community Outreach for Chronic Diseases

A collaboration with the Navajo Nation and the Indian Health Service of the U.S. Department of Health and Human Services, this initiative delivers intensive community-based support to individuals with chronic conditions. Community health workers serve as a liaison with health care providers to provide close monitoring of care and to promote behavioral change among individuals with poorly controlled chronic diseases, especially people with diabetes.

Community Health Promoters Network – Chiapas, Mexico

This Partners In Health–supported project trains and fosters a network of community health promoters in poor and isolated villages in the Sierra Madre mountains of Chiapas, Mexico. To address the high prevalence of such chronic diseases as epilepsy, diabetes, and hypertension in these areas, project workers provide high-quality acute and chronic care to hundreds of patients. Health promoters are also developing, implementing, and testing new technologies that promise to contribute significantly to the long-term management of these diseases.

PACT-Chronic Disease

This is an intensive home-based intervention targeting high-risk, vulnerable patients with multiple chronic diseases and comorbid mental illnesses across Massachusetts. PACT works in close collaboration with a MassHealth managed care organization and Commonwealth Care Alliance to integrate community health workers into home-based primary care teams that extend the reach of clinics into the community. Teams work to help patients overcome barriers to self-management, improve self-efficacy, and reengage with primary care infrastructure—with the ultimate goals of improving health outcomes and supporting effective health care utilization.

PACT–Diabetes

PACT–Diabetes is a home-based, community-health-worker intervention targeting high-risk diabetic patients in Boston’s Dorchester neighborhood. PACT works in close collaboration with the Codman Square Health Center to integrate community health workers into a primary care team to help patients overcome barriers to self-management and become more engaged in their own health care.

Social and Biologic Determinants of Tuberculosis

This project focuses on conducting systematic reviews and meta-analyses of possible links among diabetes, tuberculosis drug resistance, and treatment outcomes. The project aims to produce mathematical models that can calculate how diabetes contributes to the tuberculosis epidemic and help assess the potential impact of interventions that concurrently treat the two diseases.

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The Program in Global Non-communicable Disease and Social Change is dedicated to developing strong ties with institutions and organizations that share its goals, including national and international governmental and nongovernmental agencies. Current affiliations include the Government of Rwanda, the Navajo Nation, Indian Health Service, Harvard-affiliated hospitals, and Partners In Health.

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