Every year, 15 million people aged between 30 and 69 die from a noncommunicable disease (NCD) such as cancer, diabetes, heart disease or chronic respiratory disease. More than 80% of these "premature" deaths occur in low- and middle-income countries (LMICs). But with available and effective interventions in place, these deaths could be prevented.
Every UN member state has agreed to work towards achieving an NCD-related target included in the Sustainable Development Goals: to reduce premature mortality from NCDs by one third by 2030.
The global NCD landscape is undergoing a dangerous transition. Once an epidemic largely confined to high-income countries, NCDs are becoming a serious challenge in low- and low-middle-income countries too. Increasing levels of NCD risk factors are driving this shift, including demographic changes, the unintended lifestyle consequences of globalization and urbanization, and the omission of NCD prevention and control from global health investment priorities.
The World Health Organization’s report 'Saving lives, spending less: A strategic response to NCDs', details, for the first time, what is needed to respond to NCDs in LMICs. Governments and global health donors could revolutionise their fight against NCDs by considering the following four factors in their healthcare investment.
1. Most effective interventions
NCD investment should focus on 16 key interventions, called "Best Buys" by the WHO. These are the most cost-effective interventions to prevent the onset of NCDs and premature death of people with NCDs, based on the latest evidence. Importantly, these interventions are feasible, affordable and acceptable in most settings. Currently, they are all implemented at very low levels in LMICs.
2. Affordable additional per capita cost
The additional per capita investment required to scale up implementing these interventions in LMICs by 2030 is up to $1.27 per year. The cost comes from skilled labour, equipment, medicines, consumables and other necessary capital goods. Fiscal and regulatory interventions - that typically account for the smallest fraction of this cost - could provide an affordable start in countries where larger health investments are currently out of reach.
3. Substantial health impact
This annual per capita investment will save more than 1,700 lives every day. In one year, more than 625,000 lives could be saved. Continuous investment could mean that, by 2030, 8.2 million people will have been saved from premature deaths. This would significantly help the LMICs achieve their NCD target.
4. Competitive return on investment
This annual per capita investment has a benefit-cost ratio of 7. With these highly effective interventions in place, governments can expect an economic return of $7 for every $1 they invest.
The return on investment comes from the resulting increases in employment, productivity and income when disability and deaths from NCDs are avoided. By 2030, the total economic returns for LMICs from strategic investment could reach more than $350 billion.
The return on investment in NCDs compares well to returns in other areas of health. For every $1 dollar invested, previous analyses over a similar period of time have shown average returns of: $4.90 from investment in mental health; $5.70 from investment in adolescent health; and $8.70 from investment in reproductive, maternal, newborn and child health.
We tend to accept deaths from NCDs as unavoidable. It seems the burden of disease is too big and complex to tackle. However, this new strategic response, built on the latest evidence and robust economic analysis, suggests that it is time to change the way we think about NCDs. By replicating the most effective measures on a global scale, we can save millions of lives, gain economic benefits and achieve considerable progress towards the Sustainable Development Goals.
Read the WHO's 'Saving lives, spending less: A strategic response to NCDs' here.