Policy Webinar: Steatotic Liver Disease (SLD) – The missing piece in the NCD puzzle
The European Association for the Study of the Liver (EASL), as part of the Healthy Livers, Healthy Lives Coalition held a policy webinar on 31 January 2024. Moderated by Nicola Bedlington and featuring esteemed speakers from around the world, this event focused on steatotic liver disease (SLD) and its crucial role in the context of non-communicable diseases (NCDs). The discussion, which took place directly after the 154th Executive Board Meeting of the World Health Organization (WHO), shed light on the challenges and opportunities in recognising SLD, integrating it into global health policy, and addressing its impact on public health. The webinar was organised as a continuation of efforts to engage world health leaders and actors which began in 2023 in Geneva when EASL hosted a World Health Assembly side event. The WHA76 in 2023 convened multidisciplinary experts from around the world to strategise a coordinated response to the growing SLD epidemic.
The global scale of SLD
Aleksander Krag, Secretary General of EASL, opened the discussion by highlighting the preventable nature of most liver diseases; he also emphasised the challenges, including inequities, limited screening, and political will that the liver community continues to face. SLD has emerged as a major public health threat, with one of the highest disease prevalences worldwide. Krag underscored the importance of raising awareness and EASL’s involvement in the Healthy Livers, Healthy Lives Coalition, aiming to integrate SLD into global NCD strategies.
“How can policy make changes to protect our citizens? Our sister societies have formed a global coalition for Healthy Livers, Healthy Lives, to come together under one flag and elevate the profile of liver disease. We want to integrate SLD in the World Health Organization (WHO) NCD portfolio, where it is not seen yet, but where it belongs,” he said in his intervention.
Nomenclature change
Grace Su, President-elect of the American Association for the Study of the Liver (AASLD), highlighted the staggering impact of SLD, which affects over one-third of the global adult population. She stressed the need to implement a nomenclature change, as the first step in recognising SLD in the International Classification of Diseases (ICD). Such recognition can have an enormous impact on public health. Furthermore, Su expressed her commitment to creating resources to facilitate the integration of the new nomenclature in various regions and countries.
Egypt’s perspective
H.E. Dr. Khaled Abdel Ghaffar, Minister of Health and Population from the Arab Republic of Egypt, shared insights into the evolving landscape of chronic diseases in Egypt. While the country has seen a reduction in Hepatitis C prevalence, it is grappling with the increasing prevalence of MASLD. This shift is largely attributed to changes in dietary habits, with processed foods, sugar-sweetened beverages, and high-salt, high-sugar foods becoming more common. As SLD often goes undiagnosed until cirrhosis is detected, the burden of the disease is frequently increased through comorbid disorders. Egypt is also facing a significant burden of overweight and obesity, especially among women. Ghaffar highlighted the Ministry of Health and Population’s focus on nutrition and access to high-quality, nutrient-dense food and the upcoming NCD survey in 2024 as part of their health strategy.
Policy and public health
Jeffrey Lazarus, Coordinator of the HLHL Coalition, stressed the importance of public health responses in addressing the growing prevalence of MASLD/MASH and emphasised the need for global collaboration. He called for a holistic approach that includes public health interventions alongside medical ones. Lazarus also highlighted the challenges in researching SLD in children and the crucial role of social and commercial determinants in liver health.
Insights from the World Health Organization
Julianne Williams, technical officer at the WHO Regional Office for Europe, which supports 53 member states in the WHO European region, drew attention to the high prevalence of overweight and obesity in the region. She expressed concern that despite evidence-backed policies to address these issues, countries struggle to adopt them. Williams also highlighted alcohol-related cirrhosis as a priority, emphasising the effectiveness of pricing, availability, and marketing restrictions. Tobacco consumption remains another significant concern. Williams called for a comprehensive approach to address the obesity epidemic and stressed the importance of proper documentation to strengthen advocacy efforts.
“How do we integrate these approaches in existing frameworks, and what are the main challenges? If we can properly show the burden of liver diseases in Europe, we will have a stronger voice. We are excited for the conversation that is happening in this webinar,” she said in her intervention.
Patient advocacy and collaboration
Patient organisations are critical actors in the fight against SLD. José Willemse from Liver Patients International, highlighted their role in shedding light on unmet needs and called for guidance and collaboration in the global and regional political spheres.
“Patient organisations cannot do this alone. We need more guidance, not only a plan, but what does a healthy liver mean? What is a healthy lifestyle? We call for a collaborative approach,” she said in her intervention.
Diabetes and SLD – Interconnected health challenges
Sergio Paoletti from the International Diabetes Federation Europe branch emphasised the interconnectedness between diabetes and steatotic liver disease within the realm of NCDs. While diabetes often takes the spotlight in NCD discussions, the undeniable link between diabetes and SLD should not be overlooked. He advocated for a shift away from the “shame approach” that focuses solely on individual behaviours like alcohol consumption and physical exercise. Instead, he underscored the critical need for comprehensive support from authorities and across medical and social communities. The importance of working together between specialists like hepatologists and endocrinologists, and an emphasis on education at the WHO level was stressed.
Towards a holistic approach
Alison Cox, from NCD Alliance emphasised the need to move away from siloed approaches and focus on integrated health services that address the broader determinants of health. She called for a people- and rights-based approach and highlighted the importance of engagement with civil society and people with lived experience.
“SLD is part of the NCD agenda and we hope it will benefit from the momentum we are trying to build on the global policy level. Multiple morbidity is a key factor. We want to reduce mortality by NCDs by 30% by 2030. This is not about lifestyle and individual choices – we need to tackle the global determinants of health,” she said in her intervention.
Making SLD visible
In her closing remarks, Nicola Bedlington highlighted the urgency of addressing SLD, WHO’s willingness to collaborate, the importance of integration, and the importance of involvement of patients. The participants recognised that while SLD might be a missing piece in the NCD puzzle, concerted efforts in advocacy and policy change will help elevate its profile.
In the words of H.E. Dr. Khaled Abdel Ghaffar, “SLD is truly a missing piece in the NCD puzzle, but through our conversations, advocacy, and sharing of experiences, this missing piece will become crucial in revising policies and moving towards healthy livers, healthy lives.”
About the Healthy Livers, Healthy Lives Coalition
The HLHL coalition, a unifying force in the global health community, was founded by the American Association for the Study of Liver Diseases (AASLD), the Latin American Association for the Study of the Liver (ALEH), the Asian Pacific Association for the Study of the Liver (APASL), and the European Association for the Study of the Liver (EASL).
This coalition represents a concerted effort to address critical issues in liver health at clinical, public health, and policy levels. Originating from years of dedicated work primarily on MASLD, HLHL has evolved to cover a broader range of activities and health issues, as determined by its Council and Steering Committee. The coalition is committed to responding to the changing landscape of liver health challenges.
The Healthy Livers, Healthy Lives Coalition’s activities are supported by MSD. MSD have had no input into the content of the Health Livers, Healthy Lives Coalition’s activities.