Investing in health: the case for non-communicable diseases

Non-communicable diseases (NCDs) are the largest challenge in the post Millennium Development Goals era in global health. Responding to the “NCD epidemic” will likely be the most difficult part of achieving universal health coverage – it is particularly challenging for many low- and middle-income countries who are seeing a growing prevalence of NCDs, while they are still struggling to lower the prevalence of infectious diseases. While many countries have made great efforts to finance and fight infectious diseases, such as HIV/AIDS, malaria and tuberculosis, enthusiasm for financing and mobilising efforts to respond to NCDs is lacking, despite the World Health Organisation’s 2020 NCD action plan.

In response, the United Nations Development Programme and the World Health Organisation (WHO) have been supporting countries to create NCD “investment cases”; a written report and accompanying material summarising a set of essential public health interventions to combat NCDs. The country case studies include the respective cost and expected economic benefit of these interventions to make the case for investing in preventing and managing NCDs.

Our senior health consultant, Odd Hanssen, attended a consultation on national investment cases for NCDs organised by the UN Inter-agency Task Force at the All Russian Public Health Forum in Moscow in October. The event brought together representatives from health insurance agencies, health and finance ministries from over 20 countries, and health economists and public health experts from several UN agencies. Linking directly to the forum’s theme of healthy lifestyles, the consultation focused on the process for creating national investment cases for combating NCDs, applying the messages and methods from a WHO report that forms the global evidence base for NCD investments.

Key highlights from the event

• Countries shared their experience in developing national investment cases for health, particularly relating to tobacco control, over the past four years. Even without systematic evaluations to measure it, the impact of these is evident through the implementation of new taxes, creation of new directorates within Ministries of Health, and increased financing to combat NCDs.

Successes

• For the first time, benefits from these investment cases often included the opportunity for technical staff across ministries to meet as equal partners to discuss the value of investing in battling NCDs, and health expenditure more generally. Support for this approach was often found with unlikely partners, such as Defence Ministries or the Executive Branch of Governments.

• The existence of investment cases across very different types of countries, from Zambia to Saudi Arabia, demonstrates the global need for technical assistance and advocacy for NCD investment. At the same time, the approach to investment cases should vary depending on the needs of each country; a case in Sweden should be significantly different to one in Laos.

Challenges

• A common challenge identified was the lack of buy-in from other sectors, particularly when trying to convey health messages to financial and economic stakeholders. Most notably, the financial impact of interventions proposed as part of the investment cases around health taxes caused significant opposition by the tobacco, alcohol, and food industries, whose profit margins could be affected by the changes.

• The demand to increase the scope of analysis for current NCD investment cases exceeds the current intellectual and methodological evidence and tools available to support it. Additional efforts - and funding to mobilise those efforts - are needed to incorporate modelling for the health impacts of scaling interventions and to include additional risk factors such as mental health, road traffic injuries, air pollution and others.

In all cases, though, the evidence for greater investment is overwhelming; the benefits, from increased life expectancy to avoided treatment cost, and economic growth, are many times larger than the resources needed for investing in combating NCDs.

Photo: Anton_Ivanov/Shutterstock.com