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Dr. Klaus Hornetz Presentantion on NCDs 2011
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
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, minority
young 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 2005
billion $
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 prevention
and treatment of people at risk of NCD’s,
is cost effective and will reduce the
burden on health systems
14. • 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 risk
factors in the population is a powerful demonstration
of how the CVD epidemic can be successfully
confronted”
National Institute for Health and Welfare (THL), FI-00271 Helsinki, Finland.
pekka.puska@thl.fi
15. 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`
17. 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`
18. 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
19. 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`
20. 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 2006
All 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
22. Morbidity is much more expensive than mortality.
Once engaging in NCDs on larger scale will result in
ever growing resource needs.
23. Germany
• Who’s Life?
Demographic trends in Germany Health care cost and age in Germany
19 14
18
13
Population > 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
24. 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.
26. 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,
clothing, and culture…
S. Allende
30. NCDs will not “go away” from national
policy and political discourses. Those paying
taxes and insurance premiums are the same
citizen demanding adequate diagnostic and
therapeutic infrastructure.
31. Who shall live
And who shall die
Who shall fulfil his days
And who shall die before his time….
Yom Kippur; Day of Atonement Prayer Book
32. La Historia de la Medicina en Mexico:
gente demanda mejor salud, 1953, Fresco, Hospital de La Raza, Ciudad de México
33.
34. Disease dynamics in Kenya and the
Dilemma of Health Politics:
poor wealthy
“diseases of
poverty”
+++ --
“diseases of
affluence”
+ +++
Demand Matrix
35. Disease dynamics in Kenya and the
Dilemma of Health Politics:
poor wealthy
“diseases of
poverty”
€
€
“diseases of
affluence”
Cost Matrix
36. 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 2003
Source: KIPPRA 2010
37. • 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.
38. 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 2013/14
Education 162,360 167,644 173,198
Labour 3,964 4,414 4,889
Medical 56,740 60,704 63,067
Services
Public health 35,846 40,189 45,411
Total 258,910 272,951 286,565
40. “Interventions for responding (to CDs)
and NCD’s 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. “
