NCDs used to be thought of as diseases of the rich world. Now they’re on the rise in developing and middleincome countries
FOCUS include far more than the direct medical ones. They hit economies through reduced labor productivity and absenteeism, which affects company competitiveness and national growth. They strain health systems and, if the breadwinner is stricken, this can result in lost earnings or even jobs, pushing families into poverty. Family members may be forced to give up employment or forgo education to take care of the ill person. For example, there are more than nine million Indonesian adults suffering from diabetes. According to a report by McKinsey, this costs the Indonesian health system $1.6 billion a year – 40% of government spending on NCDs overall. If no effective action is taken by 2020, there could be a total of 1.2 million new cases and an overall $66 billion GDP loss attributable to diabetes alone. NO MEDIA SPOTLIGHT Such figures make NCDs one of our greatest global heath challenges, but they rarely generate big headlines. Pandemic outbreaks, new infections like the Zika virus or the growing resistance to antimicrobial drugs, grab the media spotlight. While heart disease may not rouse the same reporting passion, says Nikolic, what is lost by lack of coverage is the magnitude of the challenge. “We argued, and it is the case still, that decision-makers need to put more priority on addressing NCDs, particularly in developing countries where their rapid increase will pose dramatic challenges to economies, health systems, families and individuals.” Many health systems in developing countries are woefully ill-prepared for the challenge, as they are designed for acute rather than chronic problems. As noted, diabetes is rapidly increasing in Indonesia, yet only half of sufferers are diagnosed as equipment is lacking in many public health centers. Jim Yong Kim, president of the World Bank, has noted that analysis of universal health coverage systems in 24 countries shows coverage and implementation are weakest for NCDs. Nikolic argues that mounting evidence indicates how millions of deaths can be averted and economic losses reduced by billions of dollars. “There are concrete measures that can reduce the costs and suffering linked to NCDs,” she says, “and as NCDs have often received less focus, solutions can be effective and inexpensive.” WEIGHTY PROBLEM A 2012 World Health Organization report estimated the cost for population-based measures to reduce tobacco and harmful alcohol use, as well as unhealthy diet and physical inactivity, at $2 billion per year for all developing and middle-income countries – less than $0.40 per person. Yet while the solutions may be effective and inexpensive, the difficulty is that implementation runs into a complex overlap between food-industry practices, political priorities and established mind-sets and behaviors, says Nikolic. “Even rich countries are finding this hard to change.” Obesity, a key modifiable risk factor in NCDs, is becoming a weighty burden worldwide. Almost a third of the world’s population is overweight or obese. This has an impact on global GDP of $2.1 trillion, rivalling smoking and armed violence, war and terrorism, according to McKinsey. Public Health England has estimated that if obesity were reduced to 1993 levels, the National Health Service would save £1.2 billion a year ($1.6 trillion) by 2034, not including the large cost of treating associated diseases. Yet despite all the interventions and analysis, waistlines will continue to expand, with 36% of men and 33% of women predicted to be obese in 2030 (up from one in five today). A COMPREHENSIVE APPROACH If a wealthy nation like the United Kingdom, with a wellfunded health care system, has difficulties tackling NCDs, what chance do cash-strapped developing nations have? “The mistake is to see it predominantly as a health challenge,” responds Nikolic. “What is required is a comprehensive approach that makes NCDs everyone’s business.” The greatest impact, she explains, can be achieved with healthy public policies that promote prevention and control throughout the life cycle, while strategically adapting health systems and societies. In developing countries, existing communicable disease management channels and community worker schemes should be used to complement expensive hospital-based care. Linked to this should be a comprehensive approach that includes education and agriculture, as well as other sectors that target NCD risk factors and promote a healthy lifestyle. This will not be easy, concludes Nikolic. But if it is not attempted, NCDs could spiral out of control, significantly increase out-of-pocket costs for patients and undermine the sustainability of public health systems. “However, if we get it right, reducing diseases and deaths from noncommunicable diseases will be one of best value investments we can make to increase the health and wellbeing of people.” Allianz • 19
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