Simple solutions could cut non-communicable diseases

Simple policies such as taxing cigarettes could be a cost-effective way to largely meet the proposed global development target of slashing premature deaths from non-communicable diseases (NCDs), according to a study.

The report, published by think-tank the Copenhagen Consensus Center on 2 March, says that five prevention and treatment interventions “could avert 5 million premature deaths from NCDs in 2030, equivalent to a 28.5 per cent reduction in projected NCD mortality”.

A target under Goal 3 of the proposed Sustainable Development Goals aims to reduce premature mortality from NCDs through prevention and treatment by a third by 2030.

To achieve this, the report urges governments in developing countries to do more to address growing health threats such as obesity, heart disease and lung cancer. Interventions could be made relatively cheaply, but must begin now to prevent the problem from snowballing, it says.

Rachel Nugent, a global health researcher at the University of Washington, United States, and the report’s author, says poorer countries risk overburdening their health systems if NCDs are allowed to expand. The report suggests that governments should encourage people to reduce the amount of salt they eat, introduce a tobacco tax and ensure access to multi-drug treatment for heart disease.

“These are cost-effective interventions and policies that can be put in place in these countries,” Nugent says. “The longer we wait, the more expensive it’s going to be to deal with the problem.”

Proposals for reducing deaths from non-communicable diseases in developing countries by 2030

• Treat heart attacks: Give aspirin to 75 per cent of those who have heart attacks

• Reduce salt intake: Cut the amount of salt in manufactured food by 30 per cent to lower people’s blood pressure

• Manage hypertension: Get medicine to half of medium- to high-risk patients

• Target cardiovascular disease: Ensure that 70 per cent of those at high risk of heart disease get treatment

The report found that 80 per cent of global deaths from NCDs occur in developing countries, and that the prevalence of these diseases is expected to rise by 27 per cent in Africa over the next decade.

While certain interventions such as a tobacco tax have proved successful in some countries, it has been harder to reduce the risk of NCDs through diet and lifestyle changes, the report warns. Nugent points out that public health education campaigns, although useful, may not be the best way to tackle NCDs.

“A lot of people aren’t aware of what high blood pressure is, let alone where it comes from,” she says. “It can take decades to change this. People, however, do respond to the prices of things, so there will be a quick response to tobacco taxes.”

But Jared Odhiambo Owuor, a programme leader at the Nairobi-based African Institute for Health & Development’s Consortium for NCD Prevention and Control in Sub-Saharan Africa, believes education programmes can be effective as long as they are targeted and culturally sensitive.

“In some African countries, there’s the perception that a fat, married man is ‘well-fed’ and well taken care of. The wife is thus told she is doing a good job,” Owuor explains. “These perceptions are rooted in culture and can be tackled with targeted education programmes.”

The biggest hurdle to implementing these interventions is the weak health systems across developing countries, he says. While the report looks into the costs of delivering the suggested interventions, ranging from healthcare provision and drug research, it does not estimate how much it would cost to improve health systems.

“The heart of the issue is providing effective healthcare, and our health systems have always been underfunded,” says Owuor.

In the 2001 Abuja Declaration, African Union member states pledged to allocate at least 15 per cent of their national budgets to public health by 2015. But the vast majority of African nations have yet to meet this commitment.

> Link to the full report from the Copenhagen Consensus Center