Regional Strategy and Action Plan on Noncommunicable Diseases

Regional Strategy and Action Plan on Noncommunicable Diseases How it fits in…. Branka Legetic, MD, MPH, Ph. D Economic dimensions of noncommunicable diseases in Latin America and

FACING THE FACTS IN THE AMERICAS: disease burden 149 million smokers Chronic respiratory disease 25% persons >15 years old obese 10% Other NCDs 7% Diabetes 8% 45% TOTAL NCD DEATHS 2008 3, 9 M 30% Cancer Cardiovascular diseases 36% deaths are below age 70 years Approx. 200 million people living with an NCD in the Americas

Epidemiologic transition in the Region model 1 Uruguay Model 2 México model 3 . Guatemala Fuente: Sistema de Información de Mortalidad, PAHO/WHO

Trends in NCD premature mortality (30 -69 years) by group of diseases in the Americas, 2000 -2009 Source: Information Mortality System/HA/HSD/PAHO (updated August 2012)

NCDs have a significant impact on economies, health systems, and households Key drivers Economies Health systems Households and individuals § Reduced labor supply § Reduced labor outputs (e. g. , cost of absenteeism) § Additional costs to employers (e. g. , productivity, insurance) § Lower returns on human capital investments § Lower tax revenues § Increased public health and social welfare expenditures § Increased consumption of NCD-related healthcare § High medical treatment costs (per episode and over time) § Demand for more effective treatments (e. g. , cost of technology and innovation) § Health system adaptation (e. g. , organization, service delivery, financing) and adaptation costs § Reduced well-being § Increased disabilities § Premature deaths § Household income decrease, loss, or impoverishment § Higher health expenditures, including catastrophic spending § Savings and assets loss § Reduced opportunities Example impact areas Country productivity and competitiveness Fiscal pressures Health outcomes Poverty, inequity, and opportunity loss Source: World Bank analysis by the authors in “Chronic Emergency: Why NCDs Matter. ” Health, Nutrition, and Population Discussion Paper. 2011. Washington DC: World Ba

INEQUITY: Probability of death from an NCD between ages 30 -70 (2008) Marshall Islands Nauru Turkmenistan Tuvalu Kazakhstan Afghanistan Malawi Cote d'Ivoire Kyrgyzstan Swaziland World Sweden Israel Andorra Cyprus Italy Australia Iceland Switzerland San Marino Japan 0% 10% 20% 30% 40% 50% 60% 70% Unconditional probability of dying from any of cardiovascular disease, cancer, diabetes, chronic respiratory disease between age 30 and exact age 70 (2008)

inequities in life expectancy are slowly diminishing 80 75 GUY TTO SUR esperanza de vida al nacer (años) 70 BOL 65 GT M HN D BRA JAM DO SLV M PRY COL NIC PER VEN ECU ARG BLZ GR N PAN MEX BRB URY CUB CHL CRI 4 years HTI 60 10 years 55 50 45 18 years 40 35 North America 30 25 1890 Latin America & Caribbean 24 years 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010

NCDs affect Development: The economic burden of NCDs will overwhelm health systems and slow economic growth NCD COSTS Each 10% increase in NCD burden is associated with a 0. 5% reduction in annual economic growth Source: WHO Brazil incurs $72 billion in NCD treatment and lost productivity costs. Source: PAHO The Americas will incur $153 billion in cancer care costs and $65 billion in diabetes-related costs per year. Source: PAHO NCDs will cost more than $47 trillion globally between now and 2030 Source: D. Bloom, 2011 9

EQUITY AND SOCIAL PROTECTION AND NCDS • Inequity in access to essential drugs • Inequity in access to high cost treatments • Inequity in access to primary health care • Inequity in the process of health care provision • Financially catastrophic out of pocket expenditures in health (In LAC 78% medicines is out of pocket expenditure) • Community participants and health equity • Equity to care in different health systems and the impact on equity of Health reforms

NCDs and Development Agenda GENDER AGRIFOOD HEALTHY WORK PLACES ENVIRONMENT AND SUSTAINABLE DEVELOPMEN T HEALTH NCDs and Risk Factors URBAN PLANNIN G& TRANSPO RT URBAN PLANNING AND TRANSPORT POVERTY REDUCTION ECONOMIC DEVELOPMEN T EQUITY& SOCIAL PROTECION

UN Declaration calls on Member States to: – Advance the implementation of multisectoral, cost-effective population-wide interventions in order to reduce the impact of the common NCD risk factors -- tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol – Initiate the implementation of interventions to reduce salt, sugar and saturated fats, and eliminate industrially produced trans-fat. – Promote increased access to cost-effective vaccinations to prevent infections associated with cancers. – Promote increased access to cost-effective screening programmes as determined by national situations. . – Strengthen health systems to deliver cost-effective treatment services.

Many Cost Effective Interventions • Tobacco taxes and smoke free spaces (Uruguay, Brazil) • Trans Fat Free Americas • Reduction of sodium in bread, Argentina; restaurants New York • Ciclovias (car free Sundays) • Scale up PHC for diabetes/hypertension (Brazil) • Reduce amputations through foot care (T&T) • School meals reformulation in C Rica and Colombia as part of obesity law. • Quality of care improved using “promotoras” (Mexico) Mostly outside the health sector; need broader political commitment

2004 2012

Regional NCD Framework Strategic Lines of Action

Regional Action Plan : 2004 OBJECTIVE 1: Multi sector policies and partnerships 1. 1: To establish multi-sector partnerships and integration of NCD prevention policies into sectors outside of health; social protection OBJECTIVE 2: NCD risk factor reduction & protection 2. 1: To reduce tobacco use and exposure to second-hand smoke 2. 2: To reduce the harmful use of alcohol 2. 3: To promote healthy eating and active living (salt, Trans fat) OBJECTIVE 3: Health System Response to NCDs 3. 1 To strengthening the capacity of primary health care providers 3. 2 To implement a model of integrated management of NCDs 3. 3. To secure supplies for NCD drugs. 3. 4. To secure coverage of multi-drug therapy OBJECTIVE 4: NCD surveillance and research 4. 1. quality of NCD and risk factor surveillance systems, including cancer registries 4. 2. improve utilization of NCD and risk factor surveillance systems to plan and monitor NCD program Pan American Health Organization

NCD Development Indicators for the Americas 2004 Think Tank working group Proposed Goals and Indicators in Relation to Development Percent of GDP invested by the public sector in NCD prevention Percent of population below the national poverty line that can afford to purchase a quality food basket Percent of people experiencing catastrophic health spending due to NCDs Members: Sonia Angell, Adriana Blanco, Tamu Davidson-Sadler, Majid Ezzati, Vilma Gawryszewski, Amanda Glassman, James Hospedales, John Kirton, Branka Legetic, Rafael Lozano, Deborah Carvalho Malta, Fatima Marino, Tim Miller, Rachel Nugent, Andrea Wilson, Pedro Zitko

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