Disruptions to vital services like cancer treatment, caused by the COVID-19 pandemic, remind us that health predicates the global functioning of societies and economies.
Fortunately, the dots are beginning to join between demands on governments, global financial flows, and the health of the commons.
Existing tools can be deployed within and beyond health systems to help prevent and treat more NCDs in an effective, cost-effective, and equitable way.
By Bente Mikkelsen and Daniel Hunt
Noncommunicable diseases (NCDs), such as cancers, heart diseases and diabetes, now account for around two-thirds of the global burden of ill-health, and have grown to seven of the ten largest causes of death around the world. But the urgent need to redress this burden is nothing new.
Ten years ago, at the first UN General Assembly high-level meeting on NCD prevention and control, Heads of States and Governments committed to explore providing “adequate, predictable and sustainable resource [for NCDs] through domestic, bilateral, regional and multilateral channels, including traditional and voluntary innovative financing mechanisms.” And more recently, disruptions to vital services like cancer treatment, caused by the COVID-19 pandemic, remind us that health predicates the global functioning of societies and economies.
Though more people die from an NCD than any other disease group, these diseases receive minimal overseas development assistance for health. The Institute for Health Metrics and Evaluation estimates that in 2019, of USD41 billion total assistance for health, just USD730 million was available for NCDs. This discrepancy persisted long before the introduction of the Sustainable Development Goals (SDGs).
Without Health Financing, SDG Targets 3.4 and 3.8 Stay Out of Reach
Given this discrepancy, current investment levels are insufficient to attain the NCD-related SDG targets, specifically target 3.4 to reduce premature mortality from NCDs by one third, and target 3.8 to achieve universal health coverage for all.
As things stand, just 17 countries are on pace to achieve target 3.4 for women, and 15 countries are for men. While premature mortality is declining for most major NCDs, early deaths from diabetes have actually worsened since 2000. Far too many people remain uncovered by essential health services, or rely on ‘out-of-pocket’ expenses that can cost more than a quarter of household income. And all the while, we have only met around 10% of the World Health Organization’s (WHO’s) target to cover one billion more people with these services by 2023.
When a lack of resources stops health systems from preventing or controlling NCDs, sustainable development suffers. Out-of-pocket health costs drive financial poverty among individuals and families, chronic diseases affect a person’s economic or education potential, and inefficient health systems are burdened by treating expensive and risky complications. As such, achieving these targets would deliver mutual gains across the broader development agenda.
Health and Finance: Mutually Beneficial ‘Win-Win’
Four key demands affect how governments can finance action on NCDs:
- the amount of current and anticipated disease among the population,
- the strength of the existing health system to cope with these diseases,
- the country’s financial outlook and reliance on overseas development assistance, and
- the policy options available to the government.
Fortunately, the dots between these demands, global financial flows, and the health of the commons are beginning to join.
Governments around the world now recognize that tobacco use, harmful consumption of alcohol, excessive consumption of foods high in salt, sugar, and salt, and physical inactivity all cause externalities to the health of their populations. Where these risk factors disease or kill an otherwise healthy person, preventing them improves that person’s life chances and advances SDG target 3.4. Preventing these diseases also adds economic productivity, avoids complex and costly treatments, frees up health workers to reach more patients, and generates fiscal revenues to amplify investment.
The World Bank is investing in realizing the mutual benefits of well-funded health systems and strong economies. Recently, it approved a USD 20 million loan to the Kingdom of Eswatini to strengthen its health systems as “human capital development.” By increasing the coverage and quality of its essential health care services, the government can avoid or better manage diseases that lead to stunting, maternal, child, and adult mortality.
Making progress towards SDG target 3.8 will also reset expectations on where the burden of healthcare costs should fall. Currently, too many households fund their own care in ways that need to change. This can happen by covering more people with essential health services and making policy commitments to integrate NCDs within health systems. As a result, harder-to-reach or uninsured households will not be left behind, and services can be cross-subsidized to improve their equity and efficiency.
Financing for NCDs is Good Policy
How do we address the historic imbalance and underinvestment in NCDs? The good news is there are several places to start.
Health-related taxes, development bank mechanisms, and advancing universal health coverage are three opportunities. Others include incentivizing investment from the private sector and bilateral aid agencies, using inter-country provisions for health emergencies to finance services disrupted by COVID-19, and providing catalytic, ‘seed’ funding for interventions that can be scaled if effective. The WHO and the UN Development Programme have also published a guidance note to help governments develop the investment case for health, and the UN Inter Agency Task Force on NCDs also works with governments to do so.
We know what to invest in. Governments can use WHO’s list of best buy policies, technical packages for essential NCD interventions in primary care (WHO PEN) and cardiovascular disease management (WHO HEARTS), as well as bespoke programs to integrate NCDs within national plans for achieving universal health coverage. Combined, these tools can be deployed within and beyond health systems, to help prevent and treat more NCDs in an effective, cost-effective, and equitable way.
Rectifying the persistent underinvestment in NCDs is necessary to stand any chance of reaching the NCD-related SDGs. But all is not lost. Financing instruments for NCDs, however small, will deliver stronger health systems, healthier populations, and more resilient economies.
This guest article was authored by Bente Mikkelsen, Director for Noncommunicable Diseases, World Health Organization (WHO), and Daniel Hunt, Consultant for the Department for Noncommunicable Diseases, WHO.