WEALTH

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