Battling Non-Communicable Diseases: The Role of Institutions and Micro Policies

By Sumudu Hewawasam

Health is a matter of our main concern regardless of socioeconomic backgrounds and ill health can keep us away or restrict full participation from our responsibilities. The right to the enjoyment of health is a part of fundamental human rights and understanding of a life in dignity.

The burden of chronic non-communicable diseases (NCDs) across the globe increased, particularly in the South East Asian Region including Sri Lanka, threatens an already over-stretched health services. Diseases and conditions such as cardiovascular diseases, high blood pressure, cancer, diabetes mellitus, mental health problems, chronic respiratory disease and injuries and disabilities challenge the health systems and absorb substantial amounts of resources. The economic impact of NCDs goes beyond the costs to health services. Indirect costs, such as lost productivity, can match or exceed the direct costs. In addition, a significant proportion of the total cost of care falls on patients and their families. People die from all chronic diseases at dramatically younger ages.

NCDs account for more than 60% of the global mortality, Sri Lanka no exception. Of the 35 million deaths attributable to NCDs annually worldwide, about 80% are in low- and middle-income countries and 26% are premature deaths. From 2006 to 2015, deaths due to NCDs are expected to increase by 17%. The major NCDs share common behavioural risk factors (tobacco, unhealthy diet, physical inactivity and harmful use of alcohol) and provide common pathways for prevention. Hence, the policies for prevention and control of NCDs need to address the unhealthy behaviours of people and health needs to be a key consideration of sector-wide public policies such as transport, agriculture, education, finance, social services trade etc in order to empower people to adopt healthy living choices.

It’s well understood that the states have the primary obligation to protect and promote the health of citizens living in their territories by strengthening the institutions and adopting legislative measures including setting structural process and outcome indicators and benchmarks in order to ensure equal access to essential safe food, to get private actors conform with human rights standards when providing services such as regulating the composition of food products to control fat, sugar, salt content & chemicals such as food preservatives and agrochemicals which are harmful for wellbeing, to prevent third parties from interfering with the right to health and privatization does not become a threat to the availability, accessibility, acceptability and quality of goods and services. There is also an increasing debate about the extent to which other actors in society - eg. Individuals, families, NGOs, professionals and especially business – who have responsibilities with regards to the promotion and protection of health. As business also can affect the right to health in many ways, high attention needs to be paid immediately to incorporate health and human rights into the business operations. Government policies need to support correct infant feeding practices, provision of healthy meals in schools, labelling of food, responsible marketing of food and beverages, consumer education, capacity building etc to control NCDs burden. Increasing attention worldwide to human rights in relation to NCDs related policy documents are encouraging, although currently remains insufficient, however this new trend offers an entry point for new understanding, analysis and action.               

            Poverty and ill health are some of the most basic forms of injustice and inequality and lagging behind other areas such as education and poverty reduction. In countries faced with a chronic disease burden like NCDs, failing to address root causes of them will hit economies considerably harder and for a longer period of time. The challenge facing national authorities is to deliver on priority, while building successful and effective systems to address multiple diseases and multiple root causes with scarce human and financial resources to fund specific programmes. Improvements and diversifications in health delivery systems giving equal emphasis on prevention sector which in turn depend on public sector management, new forms of engagement with the private sector, interventions and strong partnerships well beyond the health sector including education, economic development, social services, religious affairs etc required as health is essential if progress is to be made with the other development goals including reduction of poverty. Partnerships beyond health sector and rational cross sectional approach will be highly beneficial for control of NCDs and health development as marginalized and excluded people also can participate in decisions that impact their health. Proper communication of entitlements and minimum standards of service will help people to hold policymakers and providers to account for their action.      

            It’s true that increases in aid are necessary, however the progress will depend equally on policy and institutional change of both donors and governments, as well as management of international debt and increase access to developed country markets with innovative products also important considering the magnitude of financial needs required for health and social development and looking towards long term financial stability.

At the same time we need to realize that health spending does not automatically benefit vulnerable communities. Hence developing a consensus on what constitutes effective policy, institutional change and benchmark required for health development will also be a key component. Only the projects with clear purpose, linked to clear health impact and outcome and aligned with national strategies need to be implemented.  Reprioritizing preventive care for chronic diseases has the potential for large savings, but the governments must take the initiative eg. Massive amounts of more money are required for management and treatment of complications of diabetes mellitus and heart diseases rather than more cost effective primary prevention, early detection and secondary prevention. As the government spending on health in most developing countries is below 5% of GDP (in 2012, Sri Lanka spent 3.1% of GDP for health) people become impoverished because of out of pocket catastrophic health care costs. Vulnerability to NCDs may increase substantially unless governments protect social spending and improve social health protective measures.