The report, Chronic disease: an economic perspective, synthesises extensive evidence from across the world and sends out two main messages: first, chronic diseases should be far more prominent on the international development agenda of donors and international organisations, and, second, from an economic perspective, governments need to act to prevent chronic diseases.
The economic relevance of chronic diseases has long been ignored, not least because they were deemed to be a problem affecting mostly the elderly and the wealthy. However, today’s report offers evidence to show that not only are chronic diseases affecting the poor in developed as well as developing economies, but that they are also taking a heavy toll on working age adults across the globe. In low- and middle-income countries, chronic diseases currently account for about 40% of deaths and 80% of the disease impact for those aged below 60. The report also takes cost of illness studies into account and looks at the economic impact at every level down to households and individuals.
According to economic reports, chronic diseases can exact a toll of up to 6.8% of a country’s GDP. In many countries in the developed world, heart disease alone can account for between 1% and 3% of GDP. In developing countries, where there is less evidence, the economic losses also appear to be significant. In China, for example, tobacco consumption and obesity in 1995 imposed costs of 1.5% and 2.1% of GDP, respectively.
Rachel Nugent, director of health and economics at the Population Reference Bureau, Washington DC, and a co-author of the report, stresses: “Given the economic evidence, the role of chronic diseases as both a marker of poverty and as a potential determinant of economic outcomes is becoming increasingly difficult to ignore. Chronic diseases are predicted to become the most common causes of death by 2015 in both the developed and developing world. Despite this, the Millennium Development Goals, which aim to improve the economies of the world’s poorest countries, have failed to include them in their list of health priorities.”
Along with demonstrating the significance of chronic diseases in economic terms, the OxHA report also discusses the economic rationale for why government is justified to interfere in what many might consider to be the exclusively private sphere of the individual, that is, how people decide to lead their lives, such as in the case of smoking, alcohol consumption, physical inactivity and diet.
As Marc Suhrcke, an economist with the World Health Organization and another author of the report, says: “Personal choice is a great principle that we as economists whole-heartedly support – as long as a few conditions are met (e.g. these actions do no harm to other, people are well-informed, they act rationally, etc.) When these conditions are not met – which is what is happening in a number of chronic disease-relevant areas – then there is a justification for government to step in to improve on the market's failure. This is solely a question of efficiency and has nothing whatsoever to do with the ideologically driven call for the ‘nanny state’.”
The report also points out that there are many cost-effective interventions available to address the chronic disease burden, with particular focus on developing countries.
Dr Derek Yach, Director of Global Health at the Rockefeller Foundation and a member of the Oxford Health Alliance Board, concludes, “This report should be a wake up call to governments, economists and philanthropists alike to move chronic diseases up their agenda, if not simply for public health reasons, then because of the negative impact they could have on the economy if unchecked. This is never to downplay the huge importance of communicable, child and maternal health conditions (such as HIV/AIDS or under-nutrition), but it is to make the point that we cannot continue to ignore chronic disease as a global health priority.”
Members of the Oxford Health Alliance’s network will meet in Cape Town next week (20-22 November) to formulate strategies for confronting the fast-growing epidemic of chronic disease. To view or listen to the conference live or on demand, visit www.3four50.com.
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