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FEATURE STORY

The Economic Costs of Noncommunicable Diseases In the Pacific Islands

January 16, 2013


Key findings of report:

  • Non Communicable Diseases (NCDs) can impose large health, financial and economic costs on countries. This is particularly important in the Pacific where Government already finances – and provides – the bulk of health services.
  • Risk factors in the Pacific are feeding a pipeline of potentially expensive to treat NCDs, including diabetes and heart disease, but governments are already fiscally constrained in how much more they can provide to the health system.
  • From public health and public finance perspective, many of the NCDs are avoidable ‐ or their health and financial costs can at least be postponed – through good primary and secondary prevention. This will require a more coherent approach to health system financing, and health system operations more generally.
  • If nothing is done to reduce the risk of chronic disease, an estimated $84 billionof economic production would be lost from heart disease, stroke, and diabetes between 2006 and 2015 in the 23 low and middle income countries accounting for around 80 per cent of chronic disease mortality.
  • NCDs are the leading cause of death in twelve Pacific Island Countries for which data is available, frequently accounting for 70% of all deaths. Life expectancy in Tonga has fallen as a result of NCDs. Cardiovascular disease is the leading cause of death in the Pacific, often occurring at rates twice that of more traditional communicable diseases.
  • Existing risk factors suggest that NCDs will be a major health challenge for the Pacific in coming years. Each of the 10 countries in the Pacific for which data is available have 60% of more of the adult population overweight, and in six countries more than 75% are overweight. In four countries of the Pacific at least half the adult population is obese. Obesity and being overweight often occurs at young ages: nearly one in four boys and one in five girls in Tonga are obese.
  • Other risk factors apart from weight are also significant in the Pacific. Over two thirds of people in Kiribati smoke tobacco daily. Over 70% of people in Cook Islands are physically inactive. Only 5% of adult females, and 10% of adult males, were free of any of the preventable risk factors for acquiring NCDs in Vanuatu.
  • Ageing is likely to be a challenge. Most Pacific countries currently have young populations: the median in Samoa, Tonga and Vanuatu is 21 years of age. As these populations age NCDs can be expected to increase. This is especially so given the existing level of all the main risk factors for NCDs laid down in younger life in parts of the Pacific, often summarized as Smoking, Nutrition, Alcohol and Physical inactivity (“SNAP”).
  • Despite data limitations, it is clear NCDs also impose important financial and economic costs especially to Governments in the Pacific. The rise in NCDs has particularly relevance to Governments which currently finance the large majority of health expenditure: the Governments of Vanuatu, Samoa, and Tonga, supported by their development partners, provided 90%, 87% and 81% of total expenditure on health respectively in 2010.
  • Governments in the Pacific face the challenge of financing the response to a double burden: an unfinished agenda of communicable and reproductive needs while also addressing rising costs for NCDs as populations age. But there are limited prospects for significantly increasing Government expenditure to health in absolute terms due to generally subdued economic growth in the Pacific. Nor is there large scope (“fiscal space”) to increase the share of general government expenditure going to health.
  • There are several strategic opportunities where the interests of the Ministers of Health, and the Ministers of Finance, would appear to directly coincide in a “win‐win” situation. Increasing, and then maintaining, the real price of tobacco taxes has a double benefit: it reduces uptake of tobacco amongst the poor and the young, a major risk factor for NCDs, while simultaneously generating extra revenues for Government. Consideration could be also given to increasing taxes on alcohol, junk food and soft drinks, also investing in young female health and antenatal care.