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South Asia at Health Crossroads with High Rates of Heart Disease, Diabetes, Obesity and Other Noncommunicable Diseases―New World Bank Report

February 9, 2011

WASHINGTON, February 9, 2011 – A new World Bank report warns that South Asian countries are facing a health crisis with rising rates of heart disease, diabetes, obesity, and other noncommunicable diseases (NCDs), which disproportionately affect poor families, with possible side effects of disability and premature death, and worsening poverty as people pay for medical treatment out of their own pockets.

According to the new report―Capitalizing on the Demographic Transition: Tackling Noncommunicable Diseases in South Asia―heart disease in the region is now the leading cause of death in adults aged 15-69, and South Asians suffer their first heart attacks six years earlier than other groups worldwide. 

A recent study of 52 countries from all over the world, including Bangladesh, India, Nepal, Pakistan, and Sri Lanka, found that South Asians were six years younger (53 vs. 59 years) than those in the rest of the world at their first heart attack and had high levels of risk factors, such as diabetes and high lipids and low levels of physical activity and healthy dietary habits.

This unfair burden is especially harsh on poor people, who, after heart attacks, face  life-long major illnesses, have to pay for most of their care out of their savings or by selling their possessions, and then find themselves caught in a poverty trap where they can’t get better and they can’t work,” says co-author Michael Engelgau, M.D., a World Bank Senior Public Health Specialist on secondment from the U.S. Centers for Disease Control and Prevention

Engelgau says that low birth weight—common among poor families in the eight countries of South Asia—is an important risk factor for NCDs in adults and that multiple risk factors, such as obesity, high blood pressure, high cholesterol, and glucose, frequently occur in the same person. 

Aging and Shifting Disease Patterns 

The new report says that with average life expectancy in South Asia now at 64 years and rising, people are getting older without the better living conditions, healthier nutrition, rising incomes, and access to good healthcare that benefitted older people in developed countries in previous decades. As a result, South Asians are becoming more vulnerable to heart disease, cancers, diabetes, and obesity, and are creating significant new pressures on health systems to treat and care for them.

Although the region has recorded yearly average growth of 6 percent over the last 20 years and reduced poverty rates, this performance has not been inclusive or fast enough to significantly reduce poverty and the risk factors for ill-health for the poor. 

South Asia is at a crossroads with rising inequality; poor people struggling to get access to quality health, education, and infrastructure service; a growing share of the population aging unhealthily; and with health systems that are failing to adjust to people’s needs,” says Michal Rutkowski, the World Bank’s South Asia Director for Human Development.

Given existing health financing patterns in many low- and middle-income countries, Rutkowski says that the costs associated with chronic NCDs are likely to weigh more heavily on those least able to afford them, increasing the risk of economic loss and impoverishment. The poorer a country is, the more likely it that poor people will end up paying for their medical treatment themselves. 

“Tackling NCDs in South Asia early on with better prevention and treatment would significantly spare poor people the crushing burden of poor health, lost earnings, deepening poverty,  and the risk of disability and premature death, which are becoming all too common in the changing demographics of the region,” says Rutkowski

Options for Better Managing NCDs 

The new report encourages the eight countries of South Asia to adopt and carry out a number of country and regional approaches to reduce both unhealthy risk factors in their general populations and control heart disease, diabetes, cancers, and other NCDs. 

Regional strategies ― Harmonizing health policies and strategies at a regional level boosts effective NCD prevention and control efforts, especially for tobacco and food. Indeed, failure to harmonize on tobacco may cause harm because the tobacco industry tends to target its marketing efforts at countries with fewer restrictions and where tobacco is taxed less and is easier to buy. Marketing from countries with fewer restrictions can therefore affect neighboring countries with more restrictive policies. Also, countries with low cigarette prices relative to their neighbors increase the incidence of smuggling. 

NCD risk factors ― Expanding and harmonizing tobacco advertising bans through collective bargaining with media companies for advertising, and industry for tobacco labeling, would give countries more leverage. Most countries ban tobacco advertising for national media, though rarely try to with international media viewed within their borders. Standardizing and mandating food labeling policies would provide a much stronger negotiating position for countries vis-à-vis the food industry, as well as economies of scale (similar labels can be used for several countries). Regional food labeling can also help local governments and their communities manage their rising obesity problems, through increasing awareness of calorie content, and, possibly, complement awareness campaigns for healthy foods. 

Improving health systems — 1) Collaborate on group purchasing of essential medications. Increasing access and affordability of essential medications means that the negotiating power of drug procurement units would increase (especially in smaller countries), and bulk purchasing would reduce costs and help assure sufficient supplies. 2) Establish a health technology assessment institution. It would be difficult for a single country to create and run such a body, yet a regionally funded and managed institution could provide critical guidance on policy development for intervention and treatment at the country level. 3) Synergize regional education and training capacity. With perennial shortages of trained medical staff, and the considerable “brain drain” effect of migrating doctors, nurses, and other health professionals, sharing NCD education and training capacity at the regional level is an attractive option. 4) Establish a regional network of surveillance and burden assessment. Such a network would benefit from cross-country learning. It would also carry out a range of surveys across the region and from the collective bargaining with institutions that conduct such surveys.

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