Why do over 15 million people die prematurely each year due to noncommunicable diseases (NCD), and what can be done about that?
Dr Alexey Kulikov is External Relations Officer at the UN Interagency Task Force on NCDs. Follow him on Twitter @KulikovUNIATF
We have become used to seeing supermarket shelves full of products loaded with salt, sugar and trans fats; alcohol products without labels informing the customer of their effects on the body; and cigarettes costing less than 1 dollar per pack, often sold in proximity to schools in many countries around the world.
Industries producing tobacco, alcohol, junk food, and sugary drinks focus their marketing efforts on the youth, enlisting loyal customers from an early age. For example, the majority of sports events are sponsored by multinational food, soda and alcohol giants, implying that good health goes hand in hand with a pack of crisps, a can of soda or a bottle of beer. That puts the next generation at an even greater risk of becoming overweight or obese, or having diabetes, cancer, alcohol-related diseases, and other deadly health issues.
Changes in consumption, and living and working patterns, have become defining risk factors for population health being linked to so-called noncommunicable diseases (NCDs) that, in the last decade, have become the world’s biggest killers, causing 80% of all deaths worldwide, including 15 million people dying prematurely each year between the ages of 30 and 70 years.
The epidemic of NCDs, principally cardio-vascular diseases, cancer, diabetes and chronic lung diseases, are fueled by tobacco and alcohol use, unhealthy diets, physical inactivity and rapid urbanization. Air quality is also a significant risk factor, with about 8 million people a year dying of diseases related to air pollution. Stress and depression also affect hundreds of millions of people worldwide.
In the past, infectious diseases such as TB, HIV/AIDS and malaria were the major threat to people’s health; nowadays, chronic diseases affect both high-income and low-income countries, causing suffering and challenging the sustainable social and economic development of societies. In the past, the health sector was the only one in charge of protecting people’s health, while nowadays, without proper engagement from other sectors, it would be impossible to ensure a healthy environment worldwide.
Population exposure to health risk factors is determined largely by policies in labour, education, urban planning, tax and other sectors that operate beyond health. This means that premature death and disability from NCDs is largely avoidable through better policy coherence across sectors.
NCDs reduce productivity and economic growth through losses in the workforce due to illness and premature death and through reduced performance of unwell workers who remain at work. Under a ‘business as usual’ scenario, it is estimated that cumulative economic losses to low- and middle-income countries from the four main NCDs to surpass US$ 7 trillion between 2011-2025, equivalent to approximately 4 percent of their annual output in 2010. Health costs from NCDs are also a major burden on the national budget. It has been estimated that the direct annual cost of diabetes alone is more than US$ 827 billion globally.
Premature deaths from NCDs result in a loss of income for families, communities and countries. Deaths from NCDs have increased worldwide, and in every region since 2000, and urgent action is required to reverse this trend.
World Health Organization and “Best Buys”
The good news is that the solution is actually in hand: the World Health Organization (WHO) “best buys” – policy options and cost-effective and recommended interventions that focus on price and tax measures to reduce availability and affordability of unhealthy products such as tobacco, alcohol, soft drinks, and foods rich in sugar, salt and trans fats. They also involve changes to packaging of tobacco, alcohol, food and sweetened beverages, the reformulation of food to contain less salt and trans-fats, and more regulation of advertising, promotion and sponsorship by tobacco, alcohol, food and beverage industries, as well as the promotion of awareness about healthy living among the population.
A change of paradigm is needed to effectively implement “best buys” and also to switch from “spending” money on treating sickness to “investing” into health and disease prevention, providing a huge return on investment and strengthening human capital.
The WHO global investment case shows that the costs of inaction on NCDs – to the health of people, companies and economies – far outweigh the investments required to stave off these costs and ensure healthy and productive societies. For every US$ 1 invested in scaling up interventions to address NCDs in low- and lower-middle-income countries, there will be a return of at least US$ 7 in increased employment, productivity and longer life. If all countries used these interventions, the world would move significantly closer to achieving Sustainable Development Goal 3.4: to reduce premature death from NCDs by one-third by 2030. The national NCD investment cases developed by the UN Task Force on the Prevention and Control of NCDs demonstrates that governments may gain up to US$ 100 for each dollar invested in health-protection policies, particularly in the area of tobacco control, unhealthy diets, harmful use of alcohol and physical inactivity.
Despite the fact that NCDs are responsible for more than 80% of worldwide deaths, global financing for NCDs is severely limited, receiving less than 2% of all health funding. This is despite the health gains involved; investing just US$ 1.27 per person per year in low- and lower-middle-income countries will save 8.2 million lives through 2030 and will generate US$ 350 billion through averted health costs and increased productivity during the same period.
A number of proven interventions already exist that can reduce the number of people dying prematurely from NCDs while bringing benefits to entire governments. Even the poorest countries can afford these. Price and tax measures on tobacco and alcohol products as well as on unhealthy foods and beverages cost little to implement and are effective in reducing NCDs. Such measures can rapidly reduce consumption. They also bring significant resources to governments. For example, raising cigarette excise by US$ 0.75 per pack in all countries would generate an extra US$ 141 billion in revenue globally.
What can be done?
The year 2018 is a very important one for the global NCD agenda; in September, heads of state and governments will gather together in New York at the Third High-level Meeting on NCDs to assess the progress achieved so far in ensuring health for the populations of the world, and to agree on a way forward to protect people from dying too young from heart and lung diseases, cancers and diabetes.
In particular, governments now need to move forward rapidly on the following:
- Prioritization of NCDs and health in all policies, at all levels, from capitals to small villages. Political leadership and responsibility are required to undertake multistakeholder national action on NCDs to ensure policy coherence and inclusion of NCDs into SDG and national development plans, social protection policies, embracing food and transport systems, urban planning, conflict mitigation, and control of air pollution, with the key goal of achieving global health. At the local level, for example, caring for people with NCDs diverts resources from other municipal priorities, straining healthcare budgets. If trends persist, cities will find it increasingly difficult to finance adequate healthcare and social support services for people with NCDs, amidst overcrowding, inadequate sanitation, violence and crime, and other overlapping challenges.
- Implement effective regulation and legislation ensuring healthy environments and making healthy choices the easier choices. This would require greater engagement with the civil society and the private sector to develop whole-of-society approaches to NCDs. Legislative bodies must scale up prevention, alongside efforts to achieve universal health coverage. Primary and secondary prevention are excellent investments. For example, almost all deaths from cervical cancer would be avoided if adolescent girls were immunized against human papillomavirus (HPV), and if cervical screening and treatment of pre-cancerous lesions were available to all women. These strategies are all cost-effective.
- Adequate financing for NCD programmes both at global and national levels is required. Scaled up domestic investments (due to price and tax measures) are required for health, health promotion, and essential public measures to ensure strengthened human capital and economic growth. Fiscal policies for tobacco and alcohol and other unhealthy products have already proven its efficiency. Most countries already tax tobacco, alcohol and unhealthy food and sugar-sweetened beverages in some form. However, these countries are forgoing billions in revenue by not taxing these products at higher rates. Revenue from these taxes can bolster public finances for health and education, ensuring healthy food and safe drinking water in schools, increasing health promotion programmes, and funding primary and secondary education. The Philippines, for example, uses revenues from its landmark Sin Tax Reform Law to finance universal health coverage and better health care.