My previous blog summarized some of the recent findings on broader health and development, the impacts of non-communicable diseases (NCDs), highlighting the particular challenges for countries in Asia and the Pacific. This blog summarizes some of the latest findings on the economics and financing of NCDs.
The starting point is that NCDs impose significant – but often avoidable – financial and economic costs on individuals, households and economies. The recently published WHO report Invisible numbers: the true extent of noncommunicable diseases and what to do about them indicates that between 2011 and 2030, the global cost of lost productivity due to the four main non-communicable diseases – cardiovascular diseases (heart disease and stroke), cancer, diabetes and chronic respiratory diseases – is estimated at $30 trillion. Adding mental health increases that cost to US$47 trillion.
A recent study published in July 2022 confirmed that NCDs lead to large, “catastrophic” and impoverishing health expenditures, particularly affecting the poorest quintile. This is due to the frequent complexity and often long duration of non-communicable diseases such as diabetes, cancers and heart disease/stroke.
Yet despite the high health and economic burden, international funding – known as development assistance for health (DAH) – is surprisingly low when it comes to preventing and treating NCDs. The most recent report from the Institute for Health Metrics and Evaluation (IHME), Financing Global Health 2020: The Impact of COVID-19, finds that total DAH for NCDs was US$887 million in 2020. This represents only 1.6% of the $54,828 million in global DAH spending for that year. This despite the fact that, as the IHME report states, “NCDs were the leading cause of health loss globally in 2019, causing nearly three times as many deaths (over 42 million) as communicable, maternal, neonatal and nutritional diseases, plus injuries, combined(emphasis mine).
Figure 1 shows that although the DAH for NTMs – the red line – has been increasing since 1990, it remains the smallest component of the main DAH categories. Advocacy group NCD Alliance picks up on this theme in its latest report Invest to protect. This report states that “NCDs receive the least funding relative to the global burden (of disease) by a huge margin. To illustrate what they call “the devastating neglect of NCDs by international donors”, they argue that NCDs attract $0.64 per disability-adjusted life year (DALY, a standard measure combining premature death and disability) , against 194 USD per DAH. per DALY for HIV/AIDS, and that on this basis “funding for HIV/AIDS is 300 times higher than for NCDs”.
Figure 1: Total development assistance for health by priority health area, 1990-2020 (in billions of 2020 US dollars)
The rapid increase seen in “other infectious diseases” in 2020 includes DAH for COVID-19.
Source: Financing Global Health 2020page 53
Yet recent reports from the WHO and others show that investing in the prevention and treatment of noncommunicable diseases can be technically feasible, affordable, cost-effective and cost-effective.economy, even in low-income countries. For example, the WHO report published in December 2021, titled Saving lives, spending less: the case for investing in noncommunicable diseases, features updated information on 16 “best buys” for the prevention and treatment of NCDs. The WHO estimates that these 16 “best buys” could benefit 76 low- and middle-income countries with populations of nearly four billion, or about half of the world’s population.
Table 1 summarizes the highlights of WHO’s latest “best buys”. The first column identifies the six key strategic areas for the prevention and treatment of NCDs. The second column provides an illustrative and practical example of the 16 “best buys” identified for each strategic area. (Detailed descriptions of each of the 16 “best buys” are given in Saving lives by spending less.) The third column shows the estimated return on investment for every US dollar invested in NCD prevention and control.
Saving lives by spending less shows that investing in “best buys” is a potentially cost-effective way to improve public health and generate economic returns. For example, the report estimates that for an additional investment of US$0.84 per person per year in NCD prevention, seven million lives would be saved and 50 million healthy life years gained; as well as US$230 billion in economic gains – a return of US$7 on every dollar invested.
Investing in NCD prevention is also potentially affordable, even for low-income countries. The investment package proposed in the report represents around 5% of annual national health expenditure by governments in low- and middle-income countries – a relatively small figure, given the health burden it addresses. When grouped by income classification, the average per capita investment required is even less for low-income countries: US$0.51 per year. For lower-middle-income countries, the average per person is $0.90.
Successful early screening and identification of NCDs and their risk factors, as well as subsequent prevention, also avoid significant financial hardship at the individual and family level. The NCD Alliance Report Invest to protect notes that in lower-middle-income countries, out-of-pocket NCD outlays often exceed 40% of non-food expenditures. Such “catastrophic” healthcare expenditures occur in over 60% of cancer, cardiovascular disease and stroke patient populations in some countries due to the complexity and duration – sometimes lifelong – of the treatment.
The WHO notes that the major risk factors for non-communicable diseases are well known, but progress in addressing them is slow. In 2017, United Nations governments endorsed a set of policy interventions that address key NCD risk factors – tobacco use, alcohol consumption, unhealthy diets and inadequate physical activity – as well as the need for better management of cardiovascular diseases, diabetes and cervical disorders. cancer. The last WHO 2022 Non-Communicable Disease Tracking Report finds only mixed progress in implementing the full range of NCD prevention strategies. On the one hand, 77 countries have fully achieved more than 16 agreed policy and program indicators in 2022 compared to 2020. On the other hand, premature mortality from NCDs has increased in more than 20 countries, mostly at low or middle income. 54 countries have lost ground, achieving fewer indicators than in 2020. There is still a lot to do.
In October of this year, the WHO published another report, titled Report on the world state of physical activity 2022. This report concludes that “nearly 500 million people will develop heart disease, obesity, diabetes or other non-communicable diseases attributable to physical inactivity between 2020 and 2030, which will cost 27 billion dollars per year. … There are few areas of public health – such as physical activity – where the evidence for required action is so compelling, cost-effective and practical”. Of particular concern to many lower-middle-income countries in Asia and the Pacific.
Figure 2: Number and proportion of preventable NCD cases attributed to physical inactivity by country income level, 2020-30
Source: WHO, Global status report on physical inactivity 2022, page 11.
In short, NCDs represent a significant health, financial and economic challenge, especially for many low- and middle-income countries in Asia and the Pacific. Recent analysis and data, however, provide the urgency and evidence needed to take preventive measures that are affordable, achievable and effective.
This is the second blog in a two-part series.