The ​Impact​​​ of the RTI Center for Global Noncommunicable Diseases

Noncommunicable diseases (NCDs), such as cardiovascular disease, diabetes, respiratory conditions, cancer, and mental health conditions now account for the largest burden of premature death and illness at a global level and in countries of all income groups around the world.  

A decade ago, RTI International saw this serious threat to the world—especially for individuals living in and near poverty—and, aligned with its mission to improve the human condition, founded a Center for Global Noncommunicable Diseases in 2016. Led until 2022 by ​Dr. Rachel Nugent​, the Center partnered with governments, research institutions, multilateral agencies, and private sector philanthropic programs to produce evidence that would inform the design, delivery, and prioritization of NCD programs, policies, health services, and funding.  

We had a chat with Dr. Nugent, and ​Dr. Angie Jackson-Morris​, the Center’s current Acting Director, to learn more about RTI’s contribution to improving the lives of people affected by NCDs. 

Why did RTI first invest in developing a center to address global noncommunicable diseases?

Dr. Nugent: RTI takes its mission of improving the human condition very seriously. By 2011, when the UN General Assembly first held a high-level meeting on NCDs, it was apparent that chronic diseases and their risk factors were affecting everyone in the world and were only getting worse. RTI also saw that official global health donors were not ready to make investments to prevent and manage these diseases. As a mission-driven non-profit research organization, RTI committed to building the evidence needed to raise awareness and support action toward NCDs and it established a center in global NCDs. Around the same time, in 2015, the global community demonstrated a political commitment to addressing NCDs in the form of Sustainable Development Goal 3.4: to reduce premature mortality from NCDs by one-third by 2030.  

What would you describe as the key accomplishments of the Center for Global NCDs? 

Dr. Nugent: At first our emphasis was on making the economic case for global and national investments in NCD prevention and control. In early 2018, RTI International launched the Lancet Task Force on NCDs and Economics, which helped people understand that NCDs impede economic development and are both a cause and a consequence of poverty. We also produced global estimates of the economic benefit of investing in adolescent mental health. Working closely with the United Nations Development Programme (UNDP) and partners in more than 40 countries, we demonstrated the economic benefits of reducing NCDs and their risk factors, as well as mental disorders. In sum, a broad consensus now exists about the economic importance of preventing and controlling the epidemic of NCDs and the most cost-effective ways of doing so – both globally and within many countries.    

Dr. Jackson-Morris: Taking a “big picture” perspective over the years, the Center contributed to an evolution of thinking around NCDs, which many now believe is the critical issue in global health. Through its work, the Center helped build the evidence base around how we can support countries to foster more effective policies and interventions that protect their populations from NCDs. This highly practical topic has two major strands:  

• Supporting governments with insights and analyses to guide how to design and implement effective prevention policies and practical measures in communities and health systems on the major modifiable risk factors that can prevent NCDs in populations, such as tobacco, unhealthy diet, low physical activity, air pollution, and harmful use of alcohol. Examples included prevention of NCDs in Malaysia  and guidance for funders and policymakers on how to leverage research to support implementation of strategies and programmes to reduce NCDs.  
• Supporting countries to build NCD health care for people living with chronic conditions. Critically, the Center provided technical support and evidence on how to do this. A few examples ​​include: investigating which early cancer detection strategies are effective, flexible, and responsive to local needs in rural India; research to guide the design of digital tools to support primary care professionals in LMIC health systems to strengthen diabete​​s screening, diagnosis and follow up; and creating innovative tools and developing skills for health planners in budgeting for effective hypertension management interventions. Our work addressed the importance of developing NCD services and programs that integrate well within existing health systems and can provide more “joined-up” care for patients, for example, integrating NCD care within HIV-AIDS services.​​   

What are you most proud of about the Center for Global NCDs?

Dr. Nugent: I am proud that we set out with a mission in mind, and we accomplished it. The influence and impact of the entire global NCD community is far more than it was a decade ago and the Center’s contributions to that are undeniable. Further, I hope – and believe – that our work inspires many young global health professionals to commit themselves to improve the lives of people who experience NCDs around the world. From a personal angle, I felt very honored to give the Lancet-UCL Global Health lecture in 2019 and to be selected as a Global Health Luminary Leader by the Washington Global Health Alliance in 2021. To me, both of these honors meant that the Center’s work on NCDs was getting noticed and was drawing attention to the need for more action on NCDs.  

Dr. Jackson-Morris: I am proud that our work primarily focused on LMIC needs, whose populations face the largest current and future burden of NCDs, and of the “extra mile” approach that our team applied to meet each partner’s needs and circumstances. Over the course of my career, I’ve come to appreciate the central importance of assisting policymakers to identify the policy priorities that will be most effective for their populations. With this in mind, if I had to identify one stand-out example of our impact, I would highlight the analysis our team developed to support ​​UNICEF with their national advocacy to improve school food environments in Mexico, which contributed to the passage of two policies by national and state-level lawmakers in ​​​​Mexico. 

What advice would you offer to the global NCD community to help achieve further progress? 

Dr. Nugent: The first part is an action: to proselytize about NCDs wherever you are, especially if it’s among other global health folks, to find people working in other areas that are interested and are willing to become knowledgeable insiders or even advocates for NCDs. We can’t do it alone and shouldn’t have to. The message is that it’s just as important to manage gestational diabetes as delivery care for the pregnant woman; to offer mental health services as family planning to the adolescent; to provide early breast cancer detection and protect a woman from cancer-related financial catastrophe as to give her child anti-malarials. NCDs are a natural and necessary part of health promotion, disease prevention, and primary health for everyone. Spread the word.  

Dr. Jackson-Morris: The global community now benefits from cost-effective intervention packages on various (but not all) NCD issues, but focused implementation research is the magic ingredient that can help tailor NCD intervention/s to the population and context, making them more likely to succeed. When developing a strategy or implementation plan, analysis can ensure a realistic fit for the relevant systems, capacities, and budget. Too often, previously, I would hear about a great plan that had not been implemented due to such a lack of planning and/or budget. I urge funding entities to support countries to undertake such analyses and build the local implementation science capacities that are crucial for success on SDG3.4.