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NCD prevention: are governments doing enough?

by host

Cardiovascular diseases, type 2 diabetes, stroke, chronic respiratory diseases, cancer and dementia have more in common than meets the eye. They are all noncommunicable diseases (NCDs), they disproportionately affect the poor and the marginalized, and in many cases they are preventable. By addressing key risk factors — tobacco, alcohol, unhealthy diets, lack of physical activity and air pollution — it is estimated that 80 percent of premature deaths from these diseases could be prevented.

Yet deaths and disability due to NCDs are rising — fast. Already totaling 41 million per year, 74 percent of all deaths globally, this figure is projected to escalate to 52 million deaths by 2030. In economic terms, a lack of action on the prevention and control of NCDs is costing the world more than $2 trillion per year in lost productivity.

We’re at tipping point with NCDs. There is strong evidence that underscores the urgent need to invest now in proven strategies to save lives, and to prevent and treat NCDs. Investments in NCDs are not only cost-effective but they guarantee a quick return, not a generation from now, but within a few years. That timeframe is politically palatable. However, failure to act now will result in millions of preventable illnesses and deaths across the globe, impacting most heavily on poorer communities.

Every U.N. member country committed to the Sustainable Development Goals (SDGs) in 2015, which pledged to deliver health and wellbeing for all, achieve Universal Health Coverage, and build a more prosperous, equitable and sustainable world. NCDs are integrated throughout the SDGs, but also have a specific target, SDG 3.4: to reduce by one-third premature mortality (between the ages of 30 and 70, accounting for 15 million deaths per year) from NCDs through prevention and treatment by 2030.

80 percent of premature deaths from these diseases could be prevented.

To achieve this target, governments endorsed in 2017 a package of 16 affordable, cost-effective and evidence-based policy measures, known as the WHO NCD Best Buys. They focus on addressing the major NCD risk factors and are affordable for every country (costing on average an additional $0.84 per year, per person in low- and lower-middle income countries). These interventions also contribute to social and economic development in those countries, offering an average return on investment of $7 for every dollar invested.

By 2030, implementation of the WHO NCD Best Buys could save close to seven million lives, prevent 10 million cases of heart disease and stroke, and add a total of 50 million productive life years. When converted into economic and social benefits, these health gains are estimated to be worth more than $230 billion due to averted deaths and disability. The total figure would be much higher considering the direct costs of health care that governments and individuals bear, as well as the additional benefits of protecting populations from infectious diseases. For example, people living with NCDs are at higher risk during coronavirus epidemics (including COVID-19, but also MERS and SARS), so healthier populations are better equipped and more resilient.

Along with the WHO NCD Best Buys, adding taxes or removing subsidies on health-harming commodities including tobacco, alcohol, sugar-sweetened beverages and fossil fuels are effective ways to curb NCDs and protect the health of populations, while at the same time raising additional funds that can be channeled into health system strengthening and NCD prevention programs.

As of 2021, more than 50 countries have introduced a tax on sugar-sweetened beverages (SSB). Robust evidence from many of these countries shows that taxes have been successful in raising funds and reducing consumption, and so protecting health. For instance, Mexico introduced an SSB tax in 2014, which led to a price rise of about 11 percent for soft drinks. By 2016, it had also led to a 37 percent reduction in SSB purchases. It’s predicted that over the next 10 years, the Mexican SSB tax will prevent 239,900 cases of obesity – many in children. Additionally, for every dollar invested in its implementation, Mexico’s SSB tax returns four dollars in health care savings. In light of the links between obesity and death or severe cases of COVID-19, Mexico is among the countries that have toughened up legislation to reduce children’s exposure to junk food. Find out more on Mexico’s war on obesity.

The bottom line is this: Investing in NCD prevention will save money and lives, and is indispensable to achieve the SDG target 3.4.

The bottom line is this: Investing in NCD prevention will save money and lives, and is indispensable to achieve the SDG target 3.4. Scaling up and accelerating action on NCDs should be seen as the fulfilment of a promise by governments, the best way to save lives and prevent disability for current and future generations. It is time to act upon commitments made towards healthier populations and since COVID-19, it’s more urgent than ever to act on NCDs.

Evidence suggests that 60-90 percent of people who died from COVID-19 were living with NCDs like hypertension, diabetes and chronic respiratory diseases. The COVID-19 pandemic is a perfect storm of infectious diseases and chronic diseases meeting head on, taking a huge toll on people, families, communities and economies. But it’s not the only example. For instance, people living with HIV have a significantly higher risk of cardiovascular disease, some cancers and mental health conditions. People living with tuberculosis are much more susceptible to diabetes and vice versa.

This link between infectious and noncommunicable diseases signals an opportunity for integrated health programs, and a crucial moment to turn the tide on NCDs, which is essential to achieving universal health care. Prevention, alongside screening and diagnosis, is the foundation of primary health care, but it is an approach that has regrettably been neglected in so many policy debates, which focus on treatment, care and cure. OECD countries still spend only around 2 percent of health budgets on prevention — which is an unconscionable missed opportunity. Intervening earlier to prevent, or diagnose at an early stage of disease, will save money on treatment down the line and give us all the best chances to live in good health well into old age.

In response to COVID-19, public health legislation was enacted in a matter of weeks to protect the public. We need the same urgency now for proven NCD prevention measures. The levers for NCD prevention and promoting healthy societies lie in the hands of governments and regulators: legislation, regulation and fiscal measures.

But beyond these tools, we need a new vision and commitment to create and sustain healthy populations. People expect more from their leaders. We need governments to protect people’s fundamental right to healthy lives and ensure that everyone has healthy places to live, grow, move, work and play.

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