Advancing the economics of noncommunicable diseases in the Americas.

The global health burden of noncommunicable diseases (NCDs) is large and growing, as this group of diseases already accounts for 70% of total deaths (1). Global evidence indicates that the high health burden of NCDs translates into significant economic and social costs that threaten to diminish the quality of life of millions of individuals, impoverish families, jeopardize universal health coverage, and increase health disparities within and between countries (2). On the other hand, less than 2% of global donor health funding is directed towards preventing these diseases (3). Recognizing the trends in NCDs and the global evidence on their multidimensional costs and their potential to hamper development, Goal 3 of the Sustainable Development Goals includes a specific target (Target 3.4) of reducing mortality from NCDs by one-third by 2030 (4).

NCDs are largely preventable, and proven solutions to reduce their burden exist at both the clinical and policy levels. In May 2017, the 70th World Health Assembly endorsed updates to the menu of cost-effective and feasible policy options for the prevention and control of NCDs, taking into consideration the emergence of new evidence of cost-effectiveness and new recommendations made by the World Health Organization (WHO) following the adoption of the Global Action Plan in 2013. Of the 88 interventions in the updated menu of policy options, 15 are highlighted as most cost-effective and most feasible for implementation (often referred to as “best buys”) (5). Of note, many of these cost-effective interventions require the involvement of government sectors beyond health. Evidence consistently shows that the NCD epidemic cannot be tackled through interventions and policies in the health sector alone. In particular, prevention measures that address NCD risk factors involve a range of sectors including finance, trade, education, agriculture, and transportation. As economics has become the common language among decision makers across sectors, it is imperative that health authorities of the Pan American Health Organization/World Health Organization (PAHO/WHO) Member States leverage economic information to more effectively communicate the urgency of tackling NCDs and related risk factors.

While PAHO/WHO Member States are committed to curbing the NCD epidemic, the limited and fragmented regional and country-specific information on the economic burden of NCDs undermines effective advocacy for the comprehensive development, financing, and implementation of multisectoral policies on NCDs. Currently, evidence is largely focused on the direct costs to health systems, as well as for specific disease or risk factors. This lack of information presents a barrier to advancing a comprehensive NCD agenda. Developing evidence at the country and regional levels on (a) the impact of NCDs on social and economic development, (b) the costs and benefits of implementing prevention and control measures in country-specific contexts, (c) the impact of NCDs on socioeconomic inequalities, and (d) the potential linkages between changing trade patterns and NCDs is essential for communicating the urgency of tackling NCDs, fostering evidence-based NCD policies, promoting NCD policy coherence across sectors, and ultimately, reducing the heavy burden of NCDs in the Region of the Americas.

PAHO/WHO is committed to strengthening its Member States’ capacity to use economic evidence on NCDs to advocate for a wholistic government approach to NCDs. Therefore, PAHO/WHO has been working with partners, including the United Nations Inter-Agency Task Force on NCDs (UNIATF), the Organization for Economic Co-operation and Development (OECD), the Economic Commission for Latin America and the Caribbean (ECLAC), the United States Centers for Disease Control and Prevention (CDC), and the Public Health Agency of Canada (PHAC), to support regional efforts to implement PAHO/WHO Action Plans for the Prevention and Control of Noncommunicable Diseases through policy-focused evidence on the economics of NCDs. This thematic issue of the Pan American Journal of Public Health is part of a continued collaboration between PHAC and PAHO/WHO to facilitate intragovernmental dialogue for a better understanding of NCD issues by making economic evidence available in the Americas, and to assist PAHO/WHO Member States in integrating economic approaches into their NCD prevention and control policies. It is our hope that national health authorities will use the evidence presented in this issue to more vigorously advocate for the comprehensive development, financing, and implementation of evidence-based multisectoral policies on NCDs and their related risk factors.