Tackling Non-Communicable Diseases in Sri Lanka

The demographic transition in Sri Lanka of an older and aging population is well underway as country faces escalating health care costs with rising rates of non-communicable diseases (NCDs) such as heart disease, diabetes, cancers, and asthma, as well as their risk factors such as obesity, smoking, high sugar and salt diets, and alcoholism

The demographic transition stems from a larger proportion of older people in a population as a result of increased longevity and reduced fertility that usually accompany economic growth. People are living longer and having fewer children. Generally the more developed a country is, the farther along in demographic transition it is.

As a result, older populations often face different types of diseases that can be more chronic and expensive to cure. NCDs have already become the largest contributor to disease burden in Sri Lanka, accounting for 85% of ill health, disability and early death. A South Asia regional study found that South Asians suffer their first heart attacks six years earlier than other groups worldwide.

This burden of NCDs will rise in the future, in part, due to further aging of the population with the doubling of the population over the age of 65 from 12.1% to 24.4% over the next thirty years.

These transitions have happened in every country as they move towards middle and high income status. In Sri Lanka though, both transitions are underway and are happening at a very fast pace as the country deals with transitions with a much smaller resource base than most developed nations.

With average life expectancy in Sri Lanka now at 74 years and rising, increasing urbanization and the accompanying life style changes, people are increasingly exposed to risk factors for NCDs. People have become more sedentary, consumption of alcohol and cigarettes has increased, and diets have become less healthy. As a result, Sri Lankans are becoming more vulnerable to NCDs, creating significant new pressures on the health system to treat and care for them.

While life expectancy for women has made steady gains since 1920, it has stalled for men since 1980 due to risk factors such as smoking and excessive drinking and delays in seeking health care.

Reducing risk factors as tobacco use and excessive alcohol consumption along with an active lifestyle and improved diet will go a long way towards healthy aging. Focusing on promoting more active lifestyle and reducing could mitigate the cost of lost wages and treatment.

Given the relatively low health spending of 4% of GDP in 2008, NCD care in Sri Lanka is increasingly financed by out of pocket spending and the burden of NCDs is also increasingly shifting towards the poor. Tackling NCDs in Sri Lanka early on with better prevention and treatment would significantly spare poor people the crushing burden of poor health, lost wages, disabilities, and pre-mature death.

The report encourages Sri Lanka to adopt a number of population based and individual patient based approaches to reduce unhealthy behaviors in the general population and control heart disease, diabetes, cancers and other NCDs. These efforts, such as more effective legislation on the use of Trans fats and tobacco as well as public education to reduce salt intake would help delay the onset of these diseases.

At the clinic level, aspirin and beta-blockers for high risk individuals could reduce the chances of cardiovascular diseases. These initiatives have the potential to reduce mortality by 23% (38,000 deaths) of what otherwise can be expected in the next 10 years in Sri Lanka.

In terms of policy options, scaling up a national NCD program with sufficient resources and authority to focus on cardiovascular disease, diabetes, asthma, and cancer, and an appropriate institutional home that can implement the activities in a coordinated manner. Increasing use of lower-level and more decentralized health facilities allowing for increased Public-Private Partnerships in both financing and provision of NCD care while improving human resources to better screen, and treat NCDs would be effective.

For over 55 years, the World Bank has provided financing and technical assistance to support Sri Lanka’s economic and social development as it has grown to join the ranks of middle-income countries.

The focus on existing operations and new lending in Sri Lanka is towards supporting Sri Lanka as it moves to a middle income country in lasting peace including within the Health sector.

As of Jan. 1, 2011, the World Bank’s lending portfolio in Sri Lanka consists of 17 projects with total commitments of US$1.25 billion in a variety of sectors. In addition, the International Finance Corporation (IFC), a part of the World Bank Group, has a portfolio of $144 million in 10 projects among diverse sectors.