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Thursday, January 10, 2019

In Conversation: Harvard's Dr. Lindsay Jaacks on NCDs in India

Dr. Lindsay Jaacks, Assistant Professor, Harvard Chan School of Public Health

Dr. Lindsay Jaacks, Assistant Professor at the Harvard Chan School of Public Health, will be participating in a Symposium on 'Models for Control of Non-Communicable Disease in Global Health.'  In this candid conversation, she sheds light on Non-Communicable Disease in India in the context of global trends.

Why is ‘NCDs in India’ an interesting issue for Harvard to explore?

Many students in our school are unaware of the great improvements in maternal and infant mortality that have been achieved by India over the past decades, and the huge gains in life expectancy that have resulted. As such, India is rapidly progressing through what has been called the “epidemiological transition,” a theory that is taught in our classrooms in Cambridge.
We are eager to learn about this transition first-hand, learning from patients in India with NCDs, what it means to them to have a chronic disease, what treatment and health care look like in this context, what the challenges are and what strategies are being used to overcome them.
The disease patterns in India and the US are converging on diet-related NCDs like diabetes, hypertension and cardiovascular disease as well as some cancers, and so I hope that the tips and lessons learned from India will provide new ideas for innovations back home in the US.

What do you hope to learn from India, and specifically ACF’s health interventions?


We were first drawn to ACF’s health interventions by mention of the ‘tobacco-free village’ model, which is very unique to the India scene and has the potential for huge global health impact if successfully scaled up. Our first objective is really to learn more about the interventions and hear about their experiences with implementation and their impression of the local impact.
Secondly, given our expertise in NCDs and ACF’s growing interest in NCDs, we hope to provide some inputs from our research elsewhere on what might be done to address NCDs in these villages, with a focus on primary prevention.

How do you think partnerships between Academic Institutions (like Harvard) and Foundations (like Ambuja) can help address global health challenges?


Academic institutions like Harvard bring important expertise in program measurement and evaluation to the table. This is absolutely essential to know whether or not a program has worked - and if so, why, and how can it be scaled up. They are also a resource for results from other countries on what has worked and what hasn’t worked, and can facilitate capacity-building through scholar exchanges.
With these inputs, I see academic institutions as a sort-of ‘booster’ to existing programs being implemented by foundations like Ambuja who are striving to improve global health. Together with the know-how on program implementation from foundations, the know-how on program measurement and evaluation from academic institutions can ensure that the best programs are run and that they are achieving the improvements we all seek in doing this work.

Is India’s NCD situation similar to other countries around the world that Harvard Studies?


Yes, India is quite similar in that the top killer is cardiovascular disease, but the onset of disease is at much younger ages in India compared to, for example, the US. Another unique aspect in India and many other countries in South and Southeast Asia and Sub-Saharan Africa as compared to the US is that these diseases are more common in urban areas and in high-SES people (e.g., those with higher educational attainment), whereas in the US they are more common in rural areas and lower-SES people – but we predict that this will soon be the case in India as well.
We have also found much greater state-to-state variation in India as compared to the US, but that likely reflects the huge diversity of cultures (e.g. dietary patterns), climate (which can influence physical activity patterns), environmental exposure (for example, air pollution is much higher in northern India), and the fact that health care is a state matter in India.
Similar to most countries around the world, tobacco and alcohol use among men is commonplace, unhealthy diets high in refined carbohydrates and trans-fat, and low in fruits, vegetables, nuts and seeds are common across socio-demographic strata, physical activity levels are low and environmental pollutants are pervasive. These are all shared risk factors for the top NCDs – cardiovascular disease, diabetes, cancer, and respiratory disease – and must be addressed all across the world if we are to tackle this pressing global health challenge.

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