Stanford University
Center for Innovation in
Global Health  

September 2011

The Cost of Action vs. Inaction for Curbing the NCD Epidemic

On September 18, at the UN Summit in New York, two important reports were unveiled that analysed the cost of action and inaction against the growing global noncommunicable disease (NCD) epidemic. "The Global Economic Burden of Non-communicable Diseases", produced by the World Economic Forum and Harvard School of Public Health, takes a closer look at the catastrophic effects as well as the global price tag of continuing the status quo. "Scaling up action against Noncommunicable Diseases: How much will it cost?" is a WHO-prepared financial planning tool that helps low and middle income countries determine how to scale up interventions against NCDs. Together, these two reports outline what could happen in the near future, how expensive these outcomes could be, and what could be done to prevent the spread of NCDs around the world. In our current economic climate, I find it especially important to understand information regarding the finances of stemming the NCD tide, so I have summarized here for you readers the most pertinent information.

The first report examining the cost of inaction for low and middle income countries from the time period 2011-2025 put global losses at $47 trillion from NCD effects. These losses were calculated for mortality and prolonged disability from NCDs, whose economic impact extends beyond hospital expenses to losses in income, capital formation, and productivity. Cardiovascular diseases account for the biggest costs, making up 51% of total losses due to NCDs. Respiratory diseases are the second at 22%, cancer at 21%, and diabetes at 6%.

cost_of_inaction.jpgCompare the $7.28 trillion economic losses from NCDs to $170 billion, the price of taking action against this epidemic in the form of policy changes for prevention and treatment from 2011-2025. This comes out to an annual per capita investment of less than $1 a person in low-income countries, $1.50 in lower-middle countries, and $3 in upper middle countries. These numbers were calculated as a best buy package for NCD prevention and control, consisting of individual-based and population-based interventions. Individual-based interventions include better primary care through health system strengthening, increased accessibility to cardiovascular drugs, and more vigilant screening for cervical cancer. Population-based interventions included in the report target NCD risk factors such as tobacco, alcohol, and physical inactivity. These large scale risk factor reductions make up a small portion of the overall price tag, costing $2 billion a year or less than $0.40 a person.

Looking at the numbers, one can see why it is of dire importance to take action against NCDs. How feasible are all the population and individual-based interventions outlined in the reports? My personal opinion is that the population-based interventions are relatively feasible on a shorter time scale - policy changes can mandate tax increases on tobacco, alcohol, or salt and fat content in food, just to name one example. Individual-based interventions such as increasing primary care are another story. These interventions will take years, and that is only if national governments view the restructuring of health systems as a priority. Strengthening healthcare infrastructure is a heavy time investment, but countries that are successful will be able to use these new systems to tackle health problems other than NCDs such as infectious diseases or rising neonatal mortality. Additionally, the countries assessed in these reports must raise funds or reassess their national budget to finance the package of "best buys" outlined by the WHO. Countries such as the United States and Canada that have a long history of being international donors are strapped for cash right now, and it is difficult to ask them to increase their aid for NCDs on top of what they are currently doing for other initiatives such as HIV, malaria, or TB. The first step to get the ball rolling is for countries to recognize the NCD epidemic, which I would say is one big accomplishment of the UN Summit. Then, once low and middle-income countries find a way to independently raise funds for interventions, these countries can tailor WHO policy suggestions to fit their own needs and finances.

Country Profiles for Non Communicable Diseases

ncd_profiles.jpgIn preparation for the UN High-Level Meeting next week, the WHO released today 193 country profiles on noncommunicable disease (NCD) trends. The country profiles break down what percentage of deaths in each country are attributable to each of the four main noncommunicable diseases: chronic lung disease, cardiovascular disease, cancer, and diabetes. The comprehensive reports also show disease prevalence, presence of risk factors such as body mass index and blood sugar, and action that countries have taken towards reducing NCDs. In essence, these profiles are report cards for countries to monitor how their country has been handling the increasing burden of NCDs. The reports also provide opportunities for countries to see what areas they need to improve upon to strategically and effectively target these diseases.

Globally, NCDs caused over 36 million deaths in 2008. Cardiovascular disease accounted for 48% of these deaths, cancers 21%, lung diseases 12%, and diabetes 3%. More than 9 million of these deaths occurred before the age of 60, and 90% of those deaths happened in low-income countries. Gone is the misconception that NCDs plague only high-income countries; with an aging population and industrialization bringing with it a wave of new exposures to NCD risk factors, low-income countries must address this growing public health problem.

"This report indicates where each government needs to focus to prevent and treat the four major killers: cancer, heart disease and stroke, lung disease and diabetes," says Dr Ala Alwan, Assistant Director-General for Noncommunicable Diseases and Mental Health at WHO.

I am very excited to see how these country profiles will be used at the Summit next week, and how they may factor into the creation of the Outcomes Document. WHO is also releasing some more important documents regarding NCD policies and steps towards implementation, so keep coming back for more updates!

NCD Country Profile Report in its entirety
Noncommunicable Disease Country Profiles: downloadable PDF versions for each country
USA Country NCD Profile.pdf

My guest blogpost on

My first guest blogpost has been published on this morning! Dr. Kevin Pho is social media's leading physician voice, and his website on breaking medical news has over 100,000 subscribers on Facebook, Google+, LinkedIn, and RSS. Quoting from his site:

"The Wall Street Journal calls a “punchy, prolific blog that chronicles America’s often dysfunctional health care system through the prism of a primary care provider,” while others have noted that “a lively comment stream on one of Kevin Pho’s posts provides more insight on the day-to-day realities of health care than any piece of journalism can ever hope to impart.” hailed as a “must-read blog,” and named @KevinMD as one of its five recommended health care Twitter feeds."

I wrote a short post about the power of social media in a medical student's world, citing my Stanford-NBC Global Health Media Fellowship as an example. The link to the guest post is here:

Big thanks to Dr. Enoch Choi for introducing me to Dr. Pho, and a huge thank you to Dr. Pho for giving me this opportunity to share my experiences with his large reader base!

Please comment, retweet, and share with your friends!

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