Facing the double burden of disease: An innovative approach to addressing chronic diseases by harnessing reproductive and maternal health care platforms

The global health community is gravely concerned about the burgeoning epidemic of chronic non-communicable diseases (NCDs). Low and Middle Income Countries (LMICs) have been especially hard hit by a double burden of disease in which the risk of communicable diseases, malnutrition and reproductive illness remains significant, but increases in risk factors for NCDs such as poor diet and lack of physical activity are on the rise. Women are especially susceptible to NCD risk factors: they often cook inside on wood- or coal-fired stoves; they are more likely than men to be overweight or obese as gender norms can discourage exercise; they experience less well-recognized symptoms of cardiovascular disease and therefore may not receive treatment promptly. The double burden's toll on women calls for an innovative approach to public health policy and programming, one that integrates the treatment and prevention of NCDs with maternal and reproductive health services across the life cycle to capitalize on their synergies, and moves beyond the traditional dichotomy of vertical and horizontal programming. We propose to operationalize this via a “diagonal approach” in which, for example, family planning service provision is an opportunity to screen for cervical cancer, pregnancy-related care is a platform from which to monitor blood pressure and weight, and postnatal care is venue to counsel women on appropriate dietary practices. Building upon reproductive and maternal healthcare infrastructure by integrating NCD prevention and treatment will help the global health community move quickly and comprehensively to meet the exponentially growing burden of NCDs in LMICs.