2018 was an important year for Non-Communicable Diseases (NCD’s).
In September, the Global Health community came together in New York for the United Nations Third High Level meeting on the prevention and control of NCDs. NCDs such as cardiovascular diseases, diabetes and cancers are the leading causes of death worldwide. Over 80% of deaths occur in low- and middle-income countries and most people in these countries lack access to care for NCDs.
In the many side events during the week, great initiatives to improve access to care and medicines for NCDs in low and middle-income countries were presented. However, what was missing from these discussions? The importance of ‘lifestyle as medicine’. Such as the use of evidence-based lifestyle therapeutic approaches, including healthy food, regular physical activity, adequate sleep, and stress management to prevent, treat, and reverse lifestyle-related chronic diseases.
A healthy lifestyle can prevent up to 80% of cardiovascular diseases and around 40% of cancers. Lifestyle as medicine is extremely important to prevent and reverse disease. Especially in settings where there are not enough doctors or money to treat the growing number of people with a chronic condition. Lifestyle counseling has been present in clinical guidelines for years now. Yet, for most doctors, drugs are the cornerstone of treatment for chronic conditions and lifestyle measures are often restricted to one-time advice. What needs to happen to change this?
A healthy lifestyle can prevent up to 80% of cardiovascular diseases and around 40% of cancers.
1. Convince the doctors
Doctors are among the most trusted professionals globally. A doctor telling a patient to lose weight or stop smoking is more powerful than a general health awareness campaign. Doctors are also powerful advocates to convince other stakeholders in the health system, such as insurers, to embrace lifestyle as medicine. But they first need to be convinced themselves. Although no doctor will question the positive effect of a healthy lifestyle, most are very skeptical about people succeeding in changing habits.
Type 2 diabetes is a great example of what Lifestyle as Medicine can help. The DiRECT trial showed that weight management reversed diabetes in half of the participants. The Netherlands’ Reverse Diabetes program showed that 25% of the participants were able to completely reverse their condition through healthier living within 6 months and no longer require medication. 68% reported a substantial decrease in medication use. Side-effects of the program included better perceived health and better quality of life. We need success stories like these to get the medical world to truly embrace and advocate for lifestyle as medicine.
The Netherlands’ Reverse Diabetes program showed that 25% of the participants were able to completely reverse their condition through healthier living within 6 months and no longer require medication.
2. Use mobile technology for low cost personalized services
One of main criticisms of lifestyle coaching programs is that they are human resource intense. But almost everyone has a mobile, even in the most remote corners of the world. Smartphone penetration is also rising quickly. It is now possible to reach almost everyone directly at low cost. Tech companies have shown that they are very successful in changing behavior. Why not use this approach for health?
Health-tech company Lark proved that the use of an artificial intelligence-based health coach was associated with weight loss comparable to in-person lifestyle interventions. Kenyan company Boabab Circle has a diabetes and hypertension self-management app that also includes lifestyle coaching via the phone. X2AI is delivering mental healthcare including stress management and therapy for depression and anxiety through chatbots to people in Nigeria.
Mobile services generate real-time data that are suitable to continuously test what motivates users and how to effectively engage them. Mobile technology can also be used to create groups that work on their health together. Peer groups were one of the key success factors in the Dutch Reverse Diabetes program. Behavioral economic principles can be used to reward individuals and groups for engagement in healthy living.
3. Create new models for financing
One of the biggest barriers is the lack of financing for lifestyle interventions. Lifestyle services are rarely reimbursed by payers in healthcare, and especially in low and middle-income countries where there are many competing priorities, the willingness to invest in prevention initiatives with a long-term return on investment is low. However, the global move towards outcome-based financing in healthcare creates new opportunities.
For example, the Community Hypertension Prevention Initiative is a Canadian lifestyle-change program to help seniors at risk of developing hypertension adopt healthier habits. The program is financed through a social impact bond. The Public Health Agency of Canada has entered into a performance-based contract with the organization that implements the program, with better results triggering higher payouts and payouts that only happen after an independent evaluator concluded that the program delivered results. This agreement helped to attract private impact investors to fund the program upfront, with the promise of a return of investment if the program performs well. Impact bonds or other innovative financing models are also suitable for lifestyle as medicine services with measurable outcomes in LMICs, such as reversing diabetes programs.
2019 will be another important year for NCDs. This year, the UN holds a high-level meeting on Universal Health Coverage (UHC). The Global NCD community is advocating for inclusion of NCD care in UHC benefit packages. But UHC will never be sustainably financed if the NCD epidemic continues to grow. Lifestyle as medicine is an essential building block to tackle the root causes of the epidemic and can facilitate the shift to a healthier lifestyle for everyone.
Marleen Hendriks, Director of Innovation, Joep Lange Institute