Using Economic Evidence to Support Policy Decisions to Fund Interventions for Non-Communicable Diseases
- Non-communicable diseases need greater investment to meet the sustainable development goal targets
- The solutions do not lie entirely within the health sector
- Analysis of the economic costs of NCDs strengthens arguments to fund interventions
- Development of investment cases can help identify which cost-effective interventions are best suited to each country and stimulate multi-sectoral action
The global burden of non-communicable diseases (NCDs) is rising, and financing needs in low and middle income countries are increasing rapidly. This has led to a growing global debate about the required response and how to finance it. Current levels of investment in preventing and controlling NCDs in almost all low and middle income countries are insufficient to meet health and development targets.
Global estimates suggest that investing in a set of cost effective and feasible interventions would prevent 8.1 million premature deaths and generate $350bn (£270bn; €310bn) in economic growth between 2018 and 2030.
To support low and middle income countries to make the economic case for greater domestic and international financing for NCDs, the World Health Organization and UN Development Programme are supporting countries to develop NCD investment cases, providing economic arguments on the benefits of expanding their NCD responses. This article describes the investment case work in the broader context of NCD financing along with some examples of how the investment cases have been used to support policy change in the Americas.
WHO recommendations on selecting NCD interventions
- Interventions that are most cost effective
- Interventions that protect against financial risk
- Interventions that prioritise the poorest people
- Current and future projected disease burden in the country
- Priority government sectors that need to be engaged (particularly health, trade, commerce, and finance)
- Concrete coordinated sectoral commitments based on co-benefits for inclusion in national SDG responses
Economic analysis of interventions to reduce non-communicable diseases can encourage countries to increase investment,” says Melanie Bertram and colleagues, as per BMJ.
NCDs in the global health financing agenda
To rapidly implement the best buys for all four of the main NCD risk factors—tobacco, harmful use of alcohol, unhealthy diet, and physical inactivity—and scale up the treatment best buys to reach 50% coverage by 2030 will cost an estimated $0.62 per capita in low income countries and $1.44 per capita in middle income countries. This is an average of just $1.27 a year for every person in these countries. Given average per capita health spending globally is $1011 a year, it seems feasible and affordable for countries to make these investments, particularly as the interventions also have the capacity to generate additional revenue.
Spending on NCD action must be done through domestic funding as well as through catalytic investments and innovative financing options such as the proposed NCD and Mental Health Catalytic Trust Fund.
Health authorities can use economics to communicate challenges and solutions in a manner that resonates with other sectors. Economics is usually associated with two types of analysis: costing the implementation of interventions and calculating the burden of disease in monetary terms. However, economics provides a wider framework that can provide insights throughout the policy design and evaluation process.
Country investment cases
Experience of using investment cases in countries shows that they have the potential to help ministries of health to better understand funding priorities and to reconsider orienting health budgets towards more investments in the prevention and control of diseases rather than spending money on treating illnesses and their consequences.
An investment case provides evidence that health ministries can use to back their requests to finance ministries for increased investment in NCDs and also justification for development partners to start or increase their investments in the prevention and control of NCDs.
Further investment cases help countries in planning national efforts to tackle NCDs, specifically:
- supporting the implementation of new excise taxes on tobacco, alcohol, and sugar sweetened beverages; salt reduction campaigns
- risk communication strategies such as warning labels
- national childhood obesity strategies, better tobacco and e-cigarettes legislation and regulation
- NCDs being incorporated into national development plans and UN development assistance frameworks
Yet, gaps remain in translation of this economic evidence into policy decisions.
The investment case process has highlighted the value of local institutions sharing and analysing data across sectors to develop budgets and policy. Which incentives exist, and how they collide or reinforce each other, is therefore an important consideration in investment cases. The economic data stimulate a dialogue about what societies value in building NCD responses—this could be health, economic productivity, or societal aspects.
Although the investment cases are based on robust evidence and accepted academic literature, they are not meant to be the final word. The focus in their delivery remains on advocacy, and WHO and UNDP are piloting follow-on components that would allow countries to take a deeper look at specific components such as tobacco control, mental health, air pollution, and harmful use of alcohol. Using economic data to support policy making will hopefully lead to a transparent and consistent approach to policy decision making and increased efficiency in health sector spending.