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