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NON-‐COMMUNICABLE DISEASES (NCDs) NATIONAL FORUM AT THE GREAT RIFT VALLEY LODGE, NAIVASHA, KENYA: AUGUST
24-‐26, 2011
The Political Economy of NCDs and Country Development
Klaus Hornetz, Atia Hossain, Anna Carin Matterson, GIZ Kenya
http://www.thecommonwealth.org/news/236456/090511ncdlancet.htm
Economic Facts and Assumptions Some Case Studies Costing and Financing NCDs in Kenya
The Economics of NCDs and Country Development
affect and for lower income countries threaten -‐ economic and human development
Economic costs of NCD
Life years lost Poverty enhanced
-‐of-‐pocket expenditure Decreased earning
Productivity decreased (% of GDP) Resource allocation and spending changed focus
Poor/developing countries face challenges where NCDs become a major problem -‐ than double by 2020, compared to 2005* -‐ to cost USD237 Billion to the National Income by 2015**
Social and economic costs of NCD are high: -‐ China will lose over $550 billion in productivity between 2005 and 2015* -‐ $84 billion of lost national output from 2006-‐2015 in 23 low-‐ and middle-‐income countries*** NCDs share of all global healthcare costs = 75%****
Sources: * Dr Shin Young-‐soo, Director for Western Pacific. WHO. 2010. ** India Health Progress. 2010 /PRNewswire. *** The Rising Prevalence of NCDs: Implications for Health Financing and Policy. Charles Holmes, 2011. PEPFAR, USAID. **** Medtronic Innovation for Health.
1/3rd of people living on US$1-‐2 a day die prematurely of NCDs*
Low-‐income households suffer from the cost of long term treatment and the cost of unhealthy behaviours*
Out of pocket expenses for treatment range from 4 to 34% of household income/expenditures** Cost of caring for a family member with diabetes can be 23% (Sudan) -‐ 34% (India) of low-‐income household*** Poorest households spend > 10% of their income on tobacco* Cost of essential drugs to treat and cure cancer -‐ unaffordable for the poor*
Sources: * WHO, Economic and Social Council resolution High-‐level Segment 2009.; ** The Rising Prevalence of NCDs: Implications for Health Financing and Policy. Charles Holmes, 2011. PEPFAR, USAID. *** Self-‐reported social class, self-‐management behaviors, and the effect of diabetes mellitus in urban, minority young people and their families. Lipton R et al. Arch Pediatr Adolesc Med.2003.
Macro-‐economic impact of NCDs: lost national income
050100150200250300350400450500550600
Brazil
China
India
Nigeria
Pakistan
Russian
Fede
ratio
n
Tanzania
2005
2006-‐2015(cumulative)
billion
$
WHO: "Heart disease, stroke and diabetes alone are estimated to reduce GDP between 1 to 5% per year in developing countries experiencing rapid economic (WHO Chronic Diseases Report, 2005)
Public Policy and the Challenge of Chronic Non-‐communicable Diseases. Olusoji Adeyi et al. 2007. World Bank.
Improving primary care for the prevention and treatment of people at risk of is cost effective and will reduce the burden on health systems
How much prevention How much medical care?
The Case of Northern Karelia
Early Seventies men in Finland had the highest :mortality rates of coronary heart disease in the world, Intervention: a comprehensive prevention program to reduce the risk factor levels in the population through general lifestyle changes Results: over the years, great reductions in the population levels of the risk factors took place, associated with dramatic reduction in age-‐adjusted CVD mortality rates and improvement in public health.
experience of diminishing the prevalence of risk
factors in the population is a powerful demonstration of how the CVD epidemic can be successfully
National Institute for Health and Welfare (THL), FI-‐00271 Helsinki, Finland. pekka.puska@thl.fi
The Case of Northern Karelia
First province of North Karelia as a pilot
(5 years), then national action (1972 77)
Continuation is North Karelia as national demonstration (1977 95)
Good scientific evaluation to learn of the experience
Comprehensive national action
Adapted from Pekka Puska , 2009`
The Case of Northern Karelia
Use of Butter on Bread (men age 30 59)
%
0
20
40
60
80
100
1972 1977 1982 1987 1992 1997 2002
North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province
Adapted from Pekka Puska , 2009`
Milk Consumption in Finland in 1970 and 2006 (kg per capita)
0
20
40
60
80
100
120
140 kg
1960 1970 1980 1990 2000 2010
Whole milk
Whole form milk
Low fat milk
Skim milk
Source: Pekka Puska , 2009
CHD Mortality in All Finland and in North Karelia, Men Aged 35-‐64
North Karelia
All Finland
start of the North Karelia Project extension of the Project nationally
Source: Statistics Finland
-‐ 85%
-‐ 80%
0
100
200
300
400
500
600
700
69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06
Year
Per 100 000
Source: Pekka Puska , 2009`
Mortality Changes in North Karelia from 1969 71 to 2006 (Men 35 64 Years, Age Adjusted)
Rate (per 100.000) Change from 1969 71 2006 1969 71 to 2006 All causes 1509 572 - 62% All cardiovascular 855 182 - 79% Coronary heart disease 672 103 - 85% All cancers 271 96 - 65% Lung cancers 147 30 - 80%
Source: Pekka Puska , 2009
Source: OECD 2011 http://www.oecd.org/document/11/0,3746,en_2649_37407_47731659_1_1_1_37407,00.html
Morbidity is much more expensive than mortality. Once engaging in NCDs on larger scale will result in ever growing resource needs.
Germany
Health care cost and age in Germany
12
13
14
15
16
17
18
19
1970 1975 1980 1985 1990 1995 2000 2005
Time [years]
Pop
ulat
ion
> 65
yea
rs [%
]
9
10
11
12
13
14
> 65 years New born
Demographic trends in Germany
Engaging on national level against NCDs is not only a diagnostic and therapeutic enterprise: Systems of social protection and care are to be developed in parallel to meet NCD related challenges i. a. to avoid catastrophic expenditures, need for long-‐term and for palliative care.
Chile
The individual in society is not an abstract entity: one is born, develops, lives, works, reproduces, falls ill, and dies in strict subjection to the surrounding environment, who different modalities create diverse modes of reaction, in the face of the etiologic agents of disease. This material environment is determined by wages, nutrition, housing,
S. Allende
Chile: Health Care Expenditures 1970 -‐ 2000
NCDs will not from national policy and political discourses. Those paying taxes and insurance premiums are the same citizen demanding adequate diagnostic and therapeutic infrastructure.
Who shall live And who shall die Who shall fulfil his days
Yom Kippur; Day of Atonement Prayer Book
La Historia de la Medicina en Mexico: gente demanda mejor salud, 1953, Fresco, Hospital de La Raza, Ciudad de México
+++
poor
--
wealthy
+ +++
Disease dynamics in Kenya and the Dilemma of Health Politics:
Demand Matrix
poor wealthy
Disease dynamics in Kenya and the Dilemma of Health Politics:
Cost Matrix
Prevalence of overweight and obesity amongst Kenya women aged 15 49 years
BMI >25
0
5
10
15
20
25
DHS 1993 DHS 1998 DHS 2003
Per
cen
tag
e
BMI >25
Trends in 15 49 yr olds
Source: KIPPRA 2010
NCDs today depend largely on domestic resources Despite the growing importance of NCDs for low and middle income countries, only 2-‐3 % of donor funding supports NCDs while 46% goes into the 3 big ones only.
Sector Budget paper 2011 (requirements as presented in sector budget hearing on 12 January 2011)
Millions KSHs -‐ Education about 60% of total
Sub-sector 2011/12 2012/13 2013/14
Education 162,360 167,644 173,198
Labour 3,964 4,414 4,889
Medical Services
56,740 60,704 63,067
Public health 35,846 40,189 45,411
Total 258,910 272,951 286,565
Total User fees (KES million) collected
Source: KIPPRA 2010
for responding (to CDs) represent opportunities for
improving health systems in low and middle income countries provided that such investments are planned to include these broad objectives at the onset.
Thank You
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