ENCD Collaboration

END NCD Disparities Collaboration, also known as ENCD is a network of researchers, activitists and health professionals, formed in the wake of NCD epidemic to consolidate actions to reduce disparaties in chronic non communicable disease globally.Building on from cutting-edge statistical methods, the collaboration aims to further query into a classical problem in epidemiology, "why poor get sick, and why sick gets poor"? This has urged to go beyond the traditional drivers of ill-health and explore the 'causes of causes' using life-course perspective. As well as estimating total health gains and cost savings of implementing policy options to tackle disparities.

Continuing projects from ENCD collaboration 💡:

Heterogeneity in disease occurrence across populations

Building cutting-edge statistical methods, the collaboration wanted to further query into a classical problem in epidemiology, "why poor get sick, and why sick gets poor"? This urged the collaboration to go beyond the traditional drivers of ill-health and explore the 'causes of causes' using life-course perspective. This project has three objectives:

To investigate the burden of non-communicable diseases and its risk factors at entire-population level, using the nationally representative data globally.
To explore geographic and socio-economic disparities in burden of non-communicable disease and their risk factors.
To pool data from local and global sources to examine i) trends in NCDs and risk factors, and ii) health service utilization.
Project description in ResearchGate website.

With colleagues, the collaboration used both simple as well as sophisticated statistical techniques to explore geographical variations in disease and risk factors, accompanied by geographical mapping and visualization. Further the collaboration compared both single-level and multi-level modelling technique to measures the differences between individual level and population level factors in public health.

Paper in Journal of Human Hypertension (2019 Aug;33(8):613-25): link
Paper in Journal of Hypertension (2018 Aug 1;36(8):1680-8): link
Paper in Gautam S. Mishra SR. Individual and cumulative effects of socioeconomic factors on hypertension in low- and middle-income countries: Analysis of nationally representative data among 1 million adults.eClinicalMedicine (Drafted)(2023)

Intervention modelling to measure potential health gains

Reducing health disparities has become a major public health agenda in Australia and globally. However, policy options on how best to achieve this goal is not clearly understood. Simulation modelling using varying sources of data (e.g., registries, panel data study) has the potential to bridge this gap; this approach can produce unique evidence on the evidence base around the poverty reducing impact of cross-sectoral interventions affecting cardiovascular health. Therefore, exploring the effectiveness of several ‘what if’ counterfactual scenarios can guide future implementation of these policies.

Methodological illustration by Prof T. Blakey
Modelling framework with Python code
A recent paper using simulation modelling: Mishra SR, Wilson T,... Blakely T. The total health gains and cost savings of eradicating cold housing in Australia. Social Science & Medicine. 2023 May 5:115954 code

Community-based interventions in public health

Community based interventions have huge potential to contribute to public health, in low resource setting. With colleagues, at COBIN study, we measured the effectiveness of community-based strategies for CVD risk factors management in Nepal. The study showed that the intervention effectively reduced the systolic blood pressure by 4.90 mm Hg (2.00 to 7.78) among hypertensive patients from a resource-limited setting in Nepal. The study has provided important insights for development of community-based strategies for CVD risk factors management in South Asia.

Paper in Lancet Global Health (2018 Jan 1;6(1):e66-73): link
Paper in JAMA Network Open (2021 Feb 1;4(2):e2035799): link
A commentary in our: paper
Training material and resources for diabetes management at community level: link

Contact 📧:

Requests for additional information on ENCDColab can be directed to:

Dr Shiva Raj Mishra, NHMRC Clinical Trials Center, University of Sydney.

Email: shiva.mishra@sydney.edu.au.