The continuous increase in so-called non-communicable diseases such as diabetes, cancer, cardiovascular disorders, and chronic lung diseases, could become ruinous for national economies, Dr Armin Fidler said today at the European Health Forum Gastein (EHFG). A strategic advisor for public health policy at the World Bank and an EHFG board member, he said: “If the frequency of non-communicable illnesses increases by 10%, that translates into minus 0.5% in terms of economic growth. The indirect costs of these illnesses far exceed the direct costs, for economies which have already been hit by the global crisis this poses a major risk. So it’s clear that the mass epidemic of lifestyle illnesses is far more than a public health matter, it is a cross-sectoral problem.”
Today’s high-level EHFG debate focussed on how to implement the conclusions of the recent UN summit on non-communicable diseases, and how to combat them. The panel also considered how Europe might learn from the experiences of other parts of the world, for instance Asia, in preventing diseases. The debate ranged freely across economic as well as health policy, since the two have become inextricable. For instance in the USA seven non-communicable diseases, cancer, cardiovascular illnesses, hypertension, diabetes, psychiatric disorders, chronic lung diseases, and strokes had in a single year cost the economy more than 1 trillion US-dollars, mainly because of productivity loss: “Only” 300 billion US-dollars of that was accounted for by medical treatment.
Non-communicable diseases “responsible for 86% of deaths in WHO region Europe”
Cardiovascular diseases, chronic lung problems, diabetes, and cancer make up 77% of the burden of illnesses in the 53 countries of the WHO region Europe and are the cause of 86% of all deaths. But poorer and developing countries were fast catching up with wealthy countries in terms of so called “civilisational illnesses”, said Dr Fidler. Globally, according to the WHO Global Status Report, these were responsible for 63% of the 57 million deaths in the world.
“In the past, infectious diseases were seen as the big threat to global health,” he said. “It is pleasing that international attention, including at the highest level, is now focussing on the problem of non-communicable diseases. These have a dramatic influence not only on health systems, but on economic progress altogether. At least as important as the diagnosis of the world-wide threat posed by non-communicable diseases is the issue of effective interventions. Many countries are looking for the way out of this critical development by means of clinical medicine, more diagnostic procedures and treatments. But the costs alone mean this is not going to solve the problem.”
Effective prevention was not only necessary, but had long since proved its economic value, Dr Fidler said. He described a current investigation into the demonstrable “rate of return on investment” from targeted prevention, a World Bank investigation into lifestyle interventions with people who had a high risk of diabetes proved their high cost-benefit value.
In a low-income country, a preventive package focussing on dietary advice and exercise could save at least two dollars of treatment costs for every dollar of investment. In middle-income countries the savings were over three dollars. “So tailor-made prevention quite clearly makes economic sense”, Dr Fidler said.
Preventive measures “cross all the policy boundaries”
But, contrary to what was commonly believed, prevention must not be limited to health education and appeals to lead healthier lifestyles, he said. “This goes beyond the typical competencies of ministries of health, and the right legal and structural frameworks need to be in place, which means a concerted action in all areas of politics. It’s an issue that crosses all the boundaries, from taxing alcohol and tobacco, and perhaps unhealthy food as well, to legal prohibition of certain substances which are damaging to health, environmental protection, transport policy, to voluntary undertakings by certain industrial sectors. These important health goals will not be attainable unless all sectors co-operate; the health sector cannot manage this alone.”
Only recently experts writing in the Lancet evaluated prevention measures according to their cost-benefit, effectiveness, and feasibility, and recommended a number of top priorities: stricter control of tobacco, reduction of salt consumption, encouraging healthy nutrition and exercise, and the reduction of alcohol abuse. “Concentrated efforts in all these areas could at least halve the social coasts of non-communicable diseases,” Dr Fidler said.
More information: www.ehfg.org
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