From Burden to "Best Buys": Reducing the Economic Impact of Non-Communicable Disease in Low- and Middle-Income Countries

There is growing awareness and concern about the large and escalating burden of chronic, non-communicable diseases (NCDs) not just from the public health perspective but also from the economic one. The social burdens associated with the four diseases that are the focus of the UN High-Level Meeting on NCDs – cardiovascular disease, diabetes, cancer and chronic respiratory diseases – include prolonged disability, diminished resources within families and reduced productivity, in addition to tremendous demands on health systems. This report addresses current information gaps in our understanding of how to mitigate these challenges by highlighting recent findings about the social costs of NCDs and the resource needs for managing these conditions. Specifically, the report brings together findings from two new studies aimed at equipping decision-makers in government, civil society and the private sector with key economic insights needed to help reduce the growing burden of NCDs: A global analysis of the economic impact of NCDs by the World Economic Forum and the Harvard School of Public Health An analysis of the costs of scaling up a core intervention package in low- and middle-income countries by the World Health Organization The economic consequences of NCDs are staggering. Under a “business as usual” scenario where intervention efforts remain static and rates of NCDs continue to increase as populations grow and age, cumulative economic losses to low- and middle-income countries (LMICs) from the four diseases are estimated to surpass US$ 7 trillion over the period 2011-2025 (an average of nearly US$ 500 billion per year). This yearly loss is equivalent to approximately 4% of these countries’ current annual output. On a per-person basis, the annual losses amount to an average of US $25 in low-income countries, US$ 50 in lower middle-income countries and US$ 139 in upper middle-income countries. By contrast, findings from the second study by the WHO indicate that the price tag for scaled-up implementation of a core set of NCD “best buy” intervention strategies is comparatively low. Population-based measures for reducing tobacco and harmful alcohol use, as well as unhealthy diet and physical inactivity, are estimated to cost US$ 2 billion per year for all LMICs – less than US$ 0.40 per person. Individual-based NCD “best buy” interventions – which range from counselling and drug therapy for cardiovascular disease to measures to prevent cervical cancer – bring the total annual cost to US$ 11.4 billion. On a per-person basis, the annual investment ranges from under US$ 1 in low-income countries to US$ 3 in upper middle-income countries. In health terms, the return on this investment will be many millions of avoided premature deaths. In economic terms, the return will be many billions of dollars of additional output. For example, reducing the mortality rate for ischaemic heart disease and stroke by 10% would reduce economic losses in LMICs by an estimated US$ 25 billion per year, which is three times greater than the investment needed for the measures to achieve these benefits. Policy-makers, members of civil society and business leaders all face the issue of how best to respond to the challenges posed by NCDs. This overview of two recent reports supplements existing knowledge by demonstrating not only the economic harm done by NCDs but also the costs and benefits related to addressing them.