A new WHO study reveals that low-income countries could introduce a core set of strategies to prevent and treat cancer, heart disease, diabetes and lung disease for just US$ 1.20 per person per year.
“Non-Communicable Diseases (NCDs) are the leading cause of death worldwide, killing ever more people each year. Nearly 80 per cent of these deaths occur in low- and middle-income countries,” says Dr Ala Alwan, assistant director-general for Non-Communicable Diseases and Mental Health at WHO. “The challenge to these countries is tremendous, but this study proves that there are affordable steps all governments can take to address NCDs.”
The impact of NCDs goes beyond health: their socio-economic effects are staggering. The cost of not taking action to address this global threat is already severe and will intensify over time.
“NCDs are one of the leading threats to global economic growth and development. Over the next 15 years, NCDs will cost low- and middle-income countries' more than US$ 7 trillion,” says Jean Pierre Rosso, chairman, World Economic Forum (WEF), quoting the results of a WEF and Harvard School of Public Health study released today. “When so many of the workforce is sick and dies in their productive years, national economies lose billions of dollars in output. And millions of families are pushed into poverty.”
The WHO study set out to help low- and middle-income countries identify low-cost interventions that can help turn the tide on NCDs and reduce their economic burden. The interventions must be highly cost-effective and there must be strong evidence that they prevent disease and save lives.
The list includes measures that target the population as a whole, such as excise taxes on tobacco and alcohol, smoke-free indoor workplaces and public places, health information and warnings, as well as campaigns to reduce salt content and replacement of trans fats with polyunsaturated fats, along with public awareness programmes about diet and physical activity.
Other tactics focus on the individual. These include screening, counselling and drug therapy for people with or at high risk of cardiovascular disease, screening for cervical cancer, and hepatitis B immunization to prevent liver cancer.
Many countries have already adopted these approaches, and have seen a marked reduction in disease incidence and mortality. WHO monitored progress over ten years in 38 countries taking steps to address cardiovascular disease at both the population and individual level: all recorded a substantial decrease in exposure to risk, incidence of disease and deaths.
“The new tool will help countries with limited resources work out what the “best buys” are and what they will cost,” adds Alwan. “Implementing them would save literally millions of lives over the next 15 years.”
In compiling the tool, WHO considered five key ingredients: the size of the population; the extent of the burden of disease; the proportion of the population that would be covered by the strategies; the resources required (human, medicines, technology); and the unit cost for example salaries, medicines. No intervention that costs more than US$ 0.50 per person per year was included.
The total cost for adopting these strategies in all low- and middle-income countries would be US$ 11.4 billion per year.
Providing access to population-based interventions in all low- and middle-income countries would cost a total of US$ 2 billion per year. That breaks down to less than US$ 0.20 per person per year in low-income and lower-middle-income countries, and around US$ 0.50 per person per year in upper-middle income countries.
Providing access to individual-level NCD best buys costs roughly US$ 10 billion per year for all low- and middle-income countries. For the period 2011-2025, the annual per capita cost will be: US $1 in low-income countries; US$ 1.50 in lower-middle-income countries; and US$ 2.50 in upper-middle-income countries.
High-income countries spend US$ 4 trillion per year on health. The United States of America alone spends US$ 2 trillion per year. NCDs like heart attacks and strokes, cancers, diabetes and chronic respiratory disease - account for over 63 per cent of deaths in the world today. Every year, NCDs kill 9 million people under 60 years old - 90 per cent of these premature deaths occur in low- and middle-income countries.
A highly cost effective intervention generates an extra year of healthy life for a cost that falls below the average annual income or GDP per person in the country/region in question. For example, the average annual income per person in India is around US$ 1000: an intervention that generates a healthy year of life for less than this would be counted as very cost-effective.