World Bank: NCDs Weaken Health Systems & Hinder Economic Growth in The Caribbean

18th November 2011

WASHINGTON, November 17, 2011 Heart disease, cancer, strokes, obesity, diabetes, and other non-communicable diseases (NCDs) are the leading cause of death in the Caribbean and represent a rapidly increasing share of total health expenditure for countries in the region, says the World Bank.

According to two new reports Non-Communicable Diseases in Jamaica: Moving from Prescription to Prevention and The Growing Burden of Non-Communicable Diseases in the Eastern Caribbean much of the rise in chronic diseases in the Caribbean can be traced to individual risk factors such as poor diet, physical inactivity, tobacco use, and alcohol abuse.

NCDs impose an increasing burden on Caribbean health systems as its population ages and rates of fertility and mortality continue to decline. The growing NCDs disproportionally affect more women and people living in poverty, said Shiyan Chao, World Bank Senior Health Economist and lead author of the studies. In the reports we argue that NCDs are largely preventable by reducing the main behavioral risk factors, focusing on prevention and using a multi-sectoral and coordinated approach.

The NCD burden can be reduced through effective health promotion and disease prevention programs that tackle such risk factors. Particularly effective are low cost measures to curb tobacco use, such as taxes, and to reduce salt in processed and semi-processed foods.


Obesity, smoking and drinking are important risk factors

According to the Bank, obesity is the most prevalent NCD in the Caribbean, mainly the result of unhealthy diet (including excessive salt, fat, and sugar intake) and lack of physical activity, particularly among adult women. Globalization and urbanization contribute to unhealthy eating behavior such as eating out, eating more staple foods, less fruits and vegetables, and consuming sugar-saturated soft drinks and fast food. The proportion of physically inactive adults has doubled over the last decade. More than 60 percent of Jamaicans aged 35 to 54 are either obese or overweight and the majority of them are women.

Dominica has the highest obesity prevalence in both gender groups in the Eastern Caribbean, and it is projected that about 38 percent of males and 65 percent of females will be obese by 2015. In addition, tobacco use and excessive alcohol consumption are widespread across the Caribbean; of particular concern is the early age of onset. The prevalence of smoking and heavy drinking is relatively high in all age groups but more so among men and those who live below the poverty line. Household tobacco expenditures have shown a steady increase from 2000 to 2008. Poor regulations and generally relaxed societal attitudes reinforce this trend, which is starting as early as 12 years of age.


NCDs carry high economic costs

NCDs impose a large economic burden on patients, their families, and society at large. In Saint Lucia and Jamaica, patients spend on average one third of household income on healthcare services and pharmaceutical purchases. Poorer households carry a heavier financial burden as they spend 48 percent of their per capita out-of-pocket healthcare costs on NCD care while the richest spend less than 20 percent. In recognition of the growing need to prevent and control NCDs, the Government of Jamaica established the National Health Fund (NHF) to reduce the cost of treatment by providing free or subsidized medicines to patients with NCDs conditions.

The NHF also finances various prevention programs to promote healthy lifestyles and to reduce exposure to the risk factors that lead to NCDs. The Jamaica report analyzes the NHF, which has shown that access to treatment has improved. However, coverage of these programs is still limited, uneven and has not effectively reached the poor. We are aware that we have fallen short in some areas, while we remain strong in others. We will be taking some of these recommendations on board to assist us to design appropriate policies and targeted interventions to improve the health of the population, said the Hon. Rudyard Spencer, Minister of Health of Jamaica.


Anti-NCD measures should focus on prevention

The new reports note it is vital to prepare health systems in the Caribbean to deliver cost-effective and fiscally sustainable NCDs care for poor people, and that comprehensive prevention programs can target a number of risk factors at the same time. The authors suggest the following policy options:

1. Prevention is integral to effective NCD interventions. Policies that encourage physical activity, promote a healthy diet, and reduce the harmful use of alcohol and tobacco are the most effective.

2. Involve non-health ministries, civil society organizations, and the private sector in NCD prevention and control. School programs have the largest return on investment when it comes to promoting a healthy lifestyle. Strategies and incentives could encourage the food industry to manufacture, distribute, and market healthier products, and to include health messages in marketing campaigns.

3. Strengthen surveillance and monitoring. Reliable data collection for NCDs is needed to help policymakers to more accurately target high risk groups.

4. Establish and enforce legislation across borders. Standardized legislation in the areas of tobacco, alcohol, food and essential medicines can help to better coordinate pricing and taxation initiatives, establish smoke-free work and public environments, and restrict the sale of alcohol to appropriate age groups.

5. Resource mobilization. Raise political awareness to secure adequate financing from the government and private sector. The United Nations High-Level Meeting on NCDs prevention and control last September in New York reinvigorated a global movement against premature death and preventable diseases in developing countries, said Joana Godinho, World Bank Manager for Health, Nutrition and Population for Latin America and the Caribbean.

The Caribbean region played an instrumental role in raising the profile of the issue during this meeting and should build on this momentum to ensure that prioritization of NCDs on a global stage is mirrored at country and regional level.