Identifying a package of cost-effective interventions to address non-communicable diseases in Gaza

Long term diseases are increasing worldwide, including in developing countries, resulting in a huge economic and health burden to society. While there are known policies and interventions to prevent and control long term diseases, these may not be applicable in settings exposed to prolonged armed conflict, such as Gaza. It is therefore important to understand which policies could best work in these situations to minimise the harm long term diseases cause to societies.

This research will involve conducting a household survey of the population in Gaza in order to understand the types of long term diseases experienced (e.g. diabetes, heart disease) as well as their risk factors (e.g. smoking, unhealthy diet). The data from this household survey will inform a statistical model, which will predict how long term diseases and their risk factors will change over time depending on the policies that governments and other agencies implement in Gaza. This modelling component will test different scenarios under different conditions, such as siege, blockage, armed conflict, and restrictions to farming and imports, and will aim to identify set of value for money and feasible interventions best suited to the population of Gaza.

Non-communicable diseases (NCDs) are increasingly prevalent in low- and middle-income countries (LMICs), and pose a substantial economic and health burden. "Best buy" interventions to prevent and control NCDs in LMICs may not be applicable in settings with intense resource constraints, political instability and conflict, such as Gaza. Better understanding of interventions to prevent and control NCDs in such settings are important to minimise the NCD burden.

This research will conduct a cross-sectional household survey among adults in Gaza, to capture detailed sociodemographic, NCD, and NCD risk factor data in a representative manner. These data will inform a microsimulation model which will test cost-effective interventions known to prevent and control NCDs, under different scenarios, to produce an optimal package for Gaza. This model will incorporate the unique political and economic constraints in Gaza, such as armed conflict, dwindling resource for healthcare providers, restrictions on farming, etc., and incorporate a number of sensitivity analyses to increase robustness.

This research will provide the basis for a wider programme of work evaluating changes to NCD policies in Gaza, part of which will form the basis of a Full Research Proposal to HSRI. For example we have undertaken some preliminary discussions about UNRWA's plan to modify how they deliver food aid to Palestine refugees in Gaza which may form the basis for a future application. The Foundation grant will form the baseline data collection in a research project that includes a pre-post study design, which is critical for a more robust evaluation of a variety of NCD policies in Gaza.

The main beneficiaries of this research will be policymakers in UNRWA and the Palestinian Ministry of Health and in other countries doubly affected by protracted armed conflict and growing burden of non-communicable diseases (NCDs). This research will provide the evidence needed to make changes to policies targeting the prevention and control of NCDs while being mindful of the political and economic constraints imposed on the country.

Researchers from the Al-Quds University, the American University of Beirut, and Imperial College London involved in this project also stand to benefit tremendously. Researchers will be able to share learning across institutions based on past experiences, expose junior researchers on the team to sound research and wider research networks. All of these facets will help develop capacity for NCD research locally and regionally.

One final beneficiary is the people of Gaza. Already at a socioeconomic disadvantage given the protracted armed conflict in the region, living with NCDs can worsen quality of life and reduce life expectancy. Policies that better support NCDs can promote healthier choices and a better standard of living, which may make some small contribution to the dire situation there.

More details on how these beneficiaries will be engaged are given in the Pathways to Impact document.