Rationale for Action
market failures:
The costs associated with chronic NCDs are likely to weigh more heavily on those least able to afford them.NCDs can hold back development and poverty reduction efforts in low-income countries. Empirical evidence is scant, but earlier projections suggested that over the following 10 years from 2005, deaths from heart disease, stroke, and diabetes might have been likely to lower GDP in India and Pakistan by 1 percent from what it would have been without that burden.
At the microeconomic level, if those are affected:
1. The main income earners or those rearing children,
2. NCD-related short- or long-term,
3. Disability, or premature death,
4. Can change consumption patterns hugely,
5. Including drastic reductions in nonmedical-related household expenditures on food and education.
From the health sector perspective, the future increase in burden and risk factors will both put a strain on services delivery and stress budgets. Programs and services need to be reoriented toward efficiently tackling NCD prevention and control while also addressing the substantial remaining burden from communicable diseases as well as maternal and child health, and nutrition issues.
To efficiently deliver services for NCDs, the health system infrastructure will need retooling, and human resources will need training and new skills. In addition, health financing strategies for many people needing lifelong treatment will be required.
Several compelling reasons are pushing countries toward tackling NCDs. From both a social and political standpoint, action is warranted. Compared to the rest of the world, South Asians are 6 years younger at their first heart attack. This unfair burden is especially tough on the poor, who after a heart attack, face a lifelong major illness, the need to finance substantial portions of their care out of pocket, and live at great risk for catastrophic spending and worsened impoverishment.
Social determinants also play an important role. Dramatic differences in health are closely linked to the degree of social disadvantage and poverty found within countries, and these inequities arise because of the circumstances in which people live, work, and age,
and the systems put in place to deal with health and illness.
Several issues support a strong economic rationale for public policies for NCDs, which is formulated on both efficiency and equity grounds: the former, when private markets fail to function efficiently; the latter, when the social objectives of equity in access or outcomes are unlikely to be attained.
Examples of inefficiencies include:market failures:
(i) market failures that have occurred, such as with tobacco consumption and public goods in the form of inaccurate (imperfect) information to citizens for making decisions about the harms of certain behaviors, lifestyles, environments, and unhealthy foods.
Externalities:(ii) externalities, that is, when a consumer does not bear all the costs or harms associated with a behavioral choice.
Non rational behaviors:
(iii) nonrational behaviors, such as when children and adolescents do not consider the future consequences of their choices, irrespective of whether they are informed of the future consequences.
Time inconsistent:
(iv) timeinconsistent preferences, that is, for some situations, individuals accept instant gratification at the expense of their long-term best interests, and would be better off if actively stimulated to act differently, as is the case with delaying smoking cessation—their choices conflict with their long-term best interests.
In terms of equity, treatment of chronic NCDs, even with inexpensive treatments available, can be expensive to individuals. Chronic NCDs, by definition, require treatment over a much longer period than acute communicable diseases. Given existing health financing patterns in many low- and middle-income countries (the poorer a country is, the more regressive the health care financing system tends to be and the higher the fraction of health costs borne by patients themselves through out-of-pocket payments)Non rational behaviors:
(iii) nonrational behaviors, such as when children and adolescents do not consider the future consequences of their choices, irrespective of whether they are informed of the future consequences.
Time inconsistent:
(iv) timeinconsistent preferences, that is, for some situations, individuals accept instant gratification at the expense of their long-term best interests, and would be better off if actively stimulated to act differently, as is the case with delaying smoking cessation—their choices conflict with their long-term best interests.
The costs associated with chronic NCDs are likely to weigh more heavily on those least able to afford them.NCDs can hold back development and poverty reduction efforts in low-income countries. Empirical evidence is scant, but earlier projections suggested that over the following 10 years from 2005, deaths from heart disease, stroke, and diabetes might have been likely to lower GDP in India and Pakistan by 1 percent from what it would have been without that burden.
At the microeconomic level, if those are affected:
1. The main income earners or those rearing children,
2. NCD-related short- or long-term,
3. Disability, or premature death,
4. Can change consumption patterns hugely,
5. Including drastic reductions in nonmedical-related household expenditures on food and education.
From the health sector perspective, the future increase in burden and risk factors will both put a strain on services delivery and stress budgets. Programs and services need to be reoriented toward efficiently tackling NCD prevention and control while also addressing the substantial remaining burden from communicable diseases as well as maternal and child health, and nutrition issues.
To efficiently deliver services for NCDs, the health system infrastructure will need retooling, and human resources will need training and new skills. In addition, health financing strategies for many people needing lifelong treatment will be required.
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