A UMMS faculty member is helping to lead a groundbreaking effort to improve the quality and access to care for certain noncommunicable diseases across low- and middle-income countries.
In the past two years, David Flood and his colleagues in the Global Health and Population Project on Access to Care for Cardiometabolic Diseases (HPACC) have published more than a dozen papers contrasting care and the availability of common treatments for conditions like diabetes, hypertension, and others. By gathering and standardizing national surveys from countries around the world, the HPACC team has been able to shed light on the prevalence of diseases that constitute a growing public health threat, identifying care trends, gaps, and opportunities—often in settings where little benchmarking data exists.
“There are other networks that do similar comparisons—contrasting the prevalence of disease or the disease burden—but quality of care is our niche. We’re very focused on that, and we’ve been able to reveal a lot of disparities,” said Flood, MD, MSc, Assistant Professor of Internal Medicine.
Cardiometabolic diseases have become a growing health crisis worldwide, with a disproportionate impact on LMICs, settings that are often least equipped to deal with the rising prevalence of these diseases. HPACC was formed in 2017 as a collaboration among Harvard University, the University of Birmingham, the University of Göttingen, and Heidelberg University. Flood’s first collaboration with the network was a 2022 study looking at the use of statins, commonly prescribed to patients with a history or risk of cardiovascular disease, across 40-plus countries.
He has since taken on a leadership role, helping to direct studies exploring aspirin use to prevent cardiovascular disease; diagnostic testing gaps for common heart diseases; how well health systems are managing patients with both diabetes and hypertension; and more.
The work has appeared in The Lancet Global Health, JAMA, and Diabetes Care, among others. In the process, Flood has collaborated with clinical and public health researchers around the world, from Brazil to Bhutan and almost everywhere in between. The HPACC dataset includes 80 countries, representing 90% of the adult population in LMICs.
“The academic success has been tremendous, but the best part for me is interacting with researchers from so many different places,” Flood said. “It’s meaningful to get feedback from the in-country collaborators who really direct us to what’s most important to them.”
The project is garnering attention. In 2023, the leadership of the WHO called on HPACC to help produce its Global Diabetes Compact report, outlining key health metrics and treatment targets for diabetes, and emphasizing the need for better care and prevention methods.
“I feel like the people we’re trying to reach are getting to know us, which is gratifying,” Flood said. “For so long, in most of these places, it was difficult to quantify what’s really been happening at the ground level. But you need to be able to do that to make a good argument for change. I think we’ve been able to put a spotlight on some of the disparities that exist in a way that is rigorous and hopefully ultimately beneficial.”