Abstract
Noncommunicable diseases (NCDs) are a broad challenge for decision-makers. NCDs account for seven out of every 10 deaths globally, with 42 percent occurring prematurely in individuals under age 70. Despite their heavy toll, NCDs are underfunded, with only around two percent of global funding dedicated to the disease set. Country governments are responsible for funding targeted actions to reduce the NCD burden, but among other priorities, many have yet to invest in the health-system interventions and policy measures that can reduce the burden. This article examines “investment cases” as a potential mechanism for catalyzing attention to—and funding for—NCDs. In Jamaica, using the UN inter-agency OneHealth Tool, we conducted an economic analysis to estimate the return-on-investment from scaling up strategic clinical interventions, and from implementing or intensifying policy measures that target NCD risk factors. In addition, we conducted an institutional and context (ICA) analysis, interviewing stakeholders across sectors to take stock of promising policy pathways (e.g., areas of general consensus, political appetite and opportunity) as well as challenges to implementation. The economic analysis found that scaling up clinical interventions that target CVD, diabetes, and mental health disorders, and policy measures that target tobacco and alcohol use, would save over 6,600 lives between 2017–2032, and avert JMD 81.3 billion (USD 640 million) in direct and indirect economic costs that result from mortality and morbidity linked to NCDs. The ICA uncovered government economic growth targets and social priorities that would be aided by increased attention to NCDs, and it linked these targets and priorities to the economic analysis.
Highlights
Encompassing a wide range of diseases and mental and substance use disorders, non-communicable diseases (NCDs) account for seven out of every 10 deaths globally, with 42 percent of all NCD deaths occurring prematurely [1]
The NCD burden is driven by a complex array of factors, including increasing life spans, and changes in urbanization, trade, and globally integrated markets that have increased populations’ exposure to environmental and behavioral risk factors [2]
To analyze the extent to which the NCD burden can be reduced, the investment case follows six methodological steps: 1) Select policy measures and interventions for analysis; 2) Assess the baseline coverages of each policy measure and intervention, and the target goals for scale-up over the 15-year period; 3) Estimate the health gains that can be achieved as a result of implementation and scale up; 4) Estimate the financial costs to achieve those health gains; 5) Monetize health gains to assess the impact on the labor force and economic output, and: 6) Calculate the net benefits and return on investment of each policy measure and intervention
Summary
Encompassing a wide range of diseases and mental and substance use disorders, non-communicable diseases (NCDs) account for seven out of every 10 deaths globally, with 42 percent of all NCD deaths occurring prematurely (among individuals under the age of 70) [1]. Cost-effective interventions to address NCD risk factors exist Many of these interventions require the meaningful engagement of sectors beyond health (e.g., ministry of finance collaboration to increase tobacco or alcohol taxes). Certain products which exacerbate NCD burdens (e.g., tobacco, alcohol, and processed foods and beverages high in sodium, trans fatty acid and/or sugar) are often strongly integrated in national market economies. Such products are deeply tied to industry and trade, and are bases of government revenue (e.g., through taxation). Decision makers have incomplete information on why to act, presenting a barrier to NCD action, amongst the economic sectors needed to finance and implement key interventions. Individuals with NCDs are more likely to not participate in the workforce [8], to miss days of work (absenteeism) and/or to work at a reduced capacity while at work (presenteeism) [9, 10]
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