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Dr. Klaus Hornetz Presentantion on NCDs 2011

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  • 1. NON-COMMUNICABLE DISEASES (NCDs) NATIONAL FORUM AT THE GREAT RIFT VALLEY LODGE, NAIVASHA, KENYA: AUGUST 24-26, 2011 The Political Economy of NCDs and Country Development Klaus Hornetz, Atia Hossain, Anna Carin Matterson, GIZ Kenya
  • 2. http://www.thecommonwealth.org/news/236456/090511ncdlancet.htm
  • 3. The Economics of NCDs and Country Development • Economic Facts and Assumptions • Some Case Studies • Costing and Financing NCDs in Kenya
  • 4. • NCD’s affect and – for lower income countries threaten - economic and human development
  • 5. Economic costs of NCD• Life years lost• Poverty enhanced – Increased (“catastrophic”) out-of-pocket expenditure – Decreased earning• Productivity decreased (% of GDP)• Resource allocation and spending – changed focus
  • 6. • Poor/developing countries face challenges where NCDs become a major problem - Indonesia’s private healthcare spending is projected to more than double by 2020, compared to 2005* - India’s NCD mortality to cost USD237 Billion to the National Income by 2015**• Social and economic costs of NCD are high: - China will lose over $550 billion in productivity between 2005 and 2015* - $84 billion of lost national output from 2006-2015 in 23 low- and middle-income countries***• NCDs share of all global healthcare costs = 75%****Sources: * Dr Shin Young-soo, Director for Western Pacific. WHO. 2010.** India Health Progress. 2010 /PRNewswire.
  • 7. • 1/3rd of people living on US$1-2 a day die prematurely of NCDs*• Low-income households suffer from the cost of long term treatment and the cost of unhealthy behaviours* – Out of pocket expenses for treatment range from 4 to 34% of household income/expenditures** – Cost of caring for a family member with diabetes can be 23% (Sudan) - 34% (India) of low-income household*** – Poorest households spend > 10% of their income on tobacco* – Cost of essential drugs to treat and cure cancer - unaffordable for the poor*Sources: * WHO, Economic and Social Council resolution High-level Segment 2009.;** The Rising Prevalence of NCDs: Implications for Health Financing and Policy. Charles Holmes, 2011. PEPFAR,USAID.*** Self-reported social class, self-management behaviors, and the effect of diabetes mellitus in urban, minorityyoung people and their families. Lipton R et al. Arch Pediatr Adolesc Med.2003.
  • 8. Macro-economic impact of NCDs: lost national income 600 550 500 450 400 2005billion $ 350 300 2006-2015 250 200 (cumulative) 150 100 50 0 Pakistan China Federation India Nigeria Tanzania Brazil Russian WHO: "Heart disease, stroke and diabetes alone are estimated to reduce GDP between 1 to 5% per year in developing countries experiencing rapid economic growth“ (WHO Chronic Diseases Report, 2005)
  • 9. Public Policy and the Challenge of Chronic Non-communicable Diseases.Olusoji Adeyi et al. 2007. World Bank.
  • 10. Improving primary care for the preventionand treatment of people at risk of NCD’s,is cost effective and will reduce theburden on health systems
  • 11. How much preventionHow much medicalcare?
  • 12. The Case of Northern Karelia
  • 13. • Early Seventies men in Finland had the highest :mortality rates of coronary heart disease in the world,• Intervention: a comprehensive prevention program to reduce the risk factor levels in the population through general lifestyle changes• Results: over the years, great reductions in the population levels of the risk factors took place, associated with dramatic reduction in age-adjusted CVD mortality rates and improvement in public health.“The experience of diminishing the prevalence of riskfactors in the population is a powerful demonstrationof how the CVD epidemic can be successfullyconfronted”National Institute for Health and Welfare (THL), FI-00271 Helsinki, Finland.pekka.puska@thl.fi
  • 14. The Case of Northern Karelia• First province of North Karelia as a pilot (5 years), then national action (1972–77)• Continuation is North Karelia as national demonstration (1977–95)• Good scientific evaluation to learn of the experience• Comprehensive national action Adapted from Pekka Puska , 2009`
  • 15. The Case of Northern Karelia
  • 16. Use of Butter on Bread (men age 30–59) %100 North Karelia Kuopio province 80 Southwest Finland Helsinki area Oulu province 60 Lapland province 40 20 0 1972 1977 1982 1987 1992 1997 2002 Adapted from Pekka Puska , 2009`
  • 17. Milk Consumption in Finland in 1970 and 2006 (kg per capita) kg140120 Whole milk100 Low fat milk 80 Whole form milk 60 40 20 Skim milk 0 1960 1970 1980 1990 2000 2010 Source: Pekka Puska , 2009
  • 18. CHD Mortality in All Finland and in North Karelia, Men Aged 35-64 Per 100 000 700 start of the North Karelia Project extension of the Project nationally 600 500 North Karelia 400 300 200 - 85% All Finland 100 - 80% 0 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Source: Statistics Finland Year Source: Pekka Puska , 2009`
  • 19. Mortality Changes in North Karelia from 1969–71 to 2006 (Men 35–64 Years, Age Adjusted) Rate (per 100.000) Change from 1969–71 2006 1969–71 to 2006All causes 1509 572 - 62%All cardiovascular 855 182 - 79%Coronary heart disease 672 103 - 85%All cancers 271 96 - 65%Lung cancers 147 30 - 80% Source: Pekka Puska , 2009
  • 20. Source: OECD 2011 http://www.oecd.org/document/11/0,3746,en_2649_37407_47731659_1_1_1_37407,00.html
  • 21. Morbidity is much more expensive than mortality.Once engaging in NCDs on larger scale will result inever growing resource needs.
  • 22. Germany • Who’s Life? Demographic trends in Germany Health care cost and age in Germany 19 14 18 13Population > 65 years [%] 17 New-born [‰] 12 16 15 11 14 10 13 12 9 1970 1975 1980 1985 1990 1995 2000 2005 Time [years] > 65 years New born
  • 23. Engaging on national level against NCDs is not onlya diagnostic and therapeutic enterprise:Systems of social protection and care are to bedeveloped in parallel to meet NCD relatedchallenges i. a. to avoid catastrophic expenditures,need for long-term and for palliative care.
  • 24. Chile
  • 25. The individual in society is not an abstract entity: one isborn, develops, lives, works, reproduces, falls ill, and dies instrict subjection to the surrounding environment, whodifferent modalities create diverse modes of reaction, in theface of the etiologic agents of disease. This materialenvironment is determined by wages, nutrition, housing,clothing, and culture…S. Allende
  • 26. Chile: Health Care Expenditures 1970 - 2000
  • 27. NCDs will not “go away” from nationalpolicy and political discourses. Those payingtaxes and insurance premiums are the samecitizen demanding adequate diagnostic andtherapeutic infrastructure.
  • 28. Who shall liveAnd who shall dieWho shall fulfil his daysAnd who shall die before his time….Yom Kippur; Day of Atonement Prayer Book
  • 29. La Historia de la Medicina en Mexico:gente demanda mejor salud, 1953, Fresco, Hospital de La Raza, Ciudad de México
  • 30. Disease dynamics in Kenya and the Dilemma of Health Politics: poor wealthy“diseases ofpoverty” +++ --“diseases ofaffluence” + +++ Demand Matrix
  • 31. Disease dynamics in Kenya and the Dilemma of Health Politics: poor wealthy“diseases ofpoverty” € €“diseases ofaffluence” Cost Matrix
  • 32. Prevalence of overweight and obesity amongst Kenya women aged 15 – 49 years Trends in 15 – 49 yr olds BMI >25 25 20 BMI >25 Percentage 15 10 5 0 DHS 1993 DHS 1998 DHS 2003Source: KIPPRA 2010
  • 33. • NCDs today depend largely on domestic resources• Despite the growing importance of NCDs for low and middle income countries, only 2-3 % of donor funding supports NCDs while 46% goes into the 3 big ones only.
  • 34. Sector Budget paper 2011 (requirements as presented in sector budget hearing on 12 January 2011) Millions KSHs - Education about 60% of totalSub-sector 2011/12 2012/13 2013/14Education 162,360 167,644 173,198Labour 3,964 4,414 4,889Medical 56,740 60,704 63,067ServicesPublic health 35,846 40,189 45,411Total 258,910 272,951 286,565
  • 35. Total User fees (KES million) collectedSource: KIPPRA 2010
  • 36. “Interventions for responding (to CDs)and NCD’s represent opportunities forimproving health systems in low andmiddle income countries provided thatsuch investments are planned to includethese broad objectives at the onset. “
  • 37. Thank You