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Klaus naivasha1 2011 nc ds[1]
 

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    Klaus naivasha1 2011 nc ds[1] Klaus naivasha1 2011 nc ds[1] Presentation Transcript

    • 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  
    • http://www.thecommonwealth.org/news/236456/090511ncdlancet.htm      
    • The  Economics  of  NCDs  and  Country  Development   Economic  Facts  and  Assumptions     Some  Case  Studies   Costing  and  Financing  NCDs  in  Kenya    
    • affect  and    for  lower  income  countries  threaten  -­‐  economic  and  human  development    
    • Economic  costs  of  NCD  Life  years  lost    Poverty  enhanced   -­‐of-­‐pocket   expenditure     Decreased  earning  Productivity  decreased  (%  of  GDP)  Resource  allocation  and  spending    changed  focus    
    • Poor/developing  countries  face  challenges  where   NCDs  become  a  major  problem     -­‐   than  double  by  2020,  compared  to  2005*   -­‐   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.    
    • 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,  minority  young  people  and  their  families.  Lipton  R  et  al.  Arch  Pediatr  Adolesc  Med.2003.  
    • Macro-­‐economic  impact  of  NCDs:     lost  national  income   600 550 500 450billion  $   400 2005 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 (WHO Chronic Diseases Report, 2005)
    • Public  Policy  and  the  Challenge  of  Chronic  Non-­‐communicable  Diseases.    Olusoji  Adeyi  et  al.  2007.    World  Bank.  
    • Improving  primary  care  for  the  prevention  and    treatment  of  people  at  risk  of  is  cost  effective  and  will  reduce  the  burden  on  health  systems  
    • How  much  prevention    How  much  medical  care?      
    • The  Case  of  Northern  Karelia  
    • 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.       experience  of  diminishing  the  prevalence  of  risk  factors  in  the  population  is  a  powerful  demonstration  of  how  the  CVD  epidemic  can  be  successfully    National  Institute  for  Health  and  Welfare  (THL),  FI-­‐00271  Helsinki,  Finland.  pekka.puska@thl.fi  
    • 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`  
    • The  Case  of  Northern  Karelia  
    • 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`  
    • Milk  Consumption  in  Finland     in  1970  and  2006  (kg  per  capita)   kg  140  120   Whole  milk  100   Low  fat  milk   80   Whole  form  milk   60   40   20   Skim  milk   0   1960   1970   1980   1990   2000   2010   Source:  Pekka  Puska  ,  2009  
    • 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   06  Source:  Statistics  Finland   Year   Source:  Pekka  Puska  ,  2009`  
    • 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  
    • Source:  OECD  2011  http://www.oecd.org/document/11/0,3746,en_2649_37407_47731659_1_1_1_37407,00.html  
    • Morbidity  is  much  more  expensive  than  mortality.  Once  engaging  in  NCDs  on  larger  scale  will  result  in  ever  growing  resource  needs.      
    • Germany       Demographic trends in Germany Health care cost and age in Germany 19 14 18 13 17Population > 65 years [%] 12 16 15 11 14 10 13 12 9 1970 1975 1980 1985 1990 1995 2000 2005 Time [years] > 65 years New born
    • Engaging  on  national  level  against  NCDs  is  not  only  a  diagnostic  and  therapeutic  enterprise:  Systems  of  social  protection  and  care  are  to  be  developed  in  parallel  to  meet  NCD  related  challenges  i.  a.  to  avoid    catastrophic  expenditures,  need  for  long-­‐term  and  for  palliative  care.      
    • Chile  
    • The  individual  in  society  is  not  an  abstract  entity:  one  is  born,  develops,  lives,  works,  reproduces,  falls  ill,  and  dies  in  strict  subjection  to  the  surrounding  environment,  who  different  modalities  create  diverse  modes  of  reaction,  in  the  face  of  the  etiologic  agents  of  disease.  This  material  environment  is  determined  by  wages,  nutrition,  housing,      S.  Allende  
    • Chile:  Health  Care  Expenditures      1970    -­‐    2000  
    •    NCDs  will  not   from  national  policy  and  political  discourses.  Those  paying  taxes  and  insurance  premiums  are  the  same  citizen  demanding  adequate  diagnostic  and  therapeutic  infrastructure.    
    • Who  shall  live  And  who  shall  die  Who  shall  fulfil  his  days      Yom Kippur; Day of Atonement Prayer Book
    • La Historia de la Medicina en Mexico:gente demanda mejor salud, 1953, Fresco, Hospital de La Raza, Ciudad de México
    • Disease dynamics in Kenya and the Dilemma of Health Politics: poor wealthy +++ -- + +++ Demand  Matrix    
    • Disease dynamics in Kenya and the Dilemma of Health Politics: poor wealthy Cost  Matrix    
    • 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
    •     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.      
    •     Sector  Budget  paper  2011   (requirements  as    presented  in  sector  budget  hearing  on  12  January  2011)     Millions  KSHs    -­‐  Education  about  60%  of  total      Sub-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
    • Total  User  fees  (KES  million)  collected    Source: KIPPRA 2010
    • for  responding  (to  CDs)   represent  opportunities  for  improving  health  systems  in  low  and  middle  income  countries  provided  that  such  investments  are  planned  to  include  these  broad  objectives  at  the  onset.    
    • Thank You