Rationale for Action(cont...)

In developed countries the poor and disadvantaged experience a larger NCD burden of risk factor and disease than do the rich. In South Asia, the disease burden may currently be greater in the rich, but it will be shifting and concentrating in the poor. Risk factors, such as tobacco use, are already more common among the poor.

Addressing social determinants requires not only health policies that are s
ensitive to the situation but also efforts from many other sectors. Education and social protection are the key human development areas alongside health. Most of the development agenda—economic opportunities; the distribution of power, money, and resources; and living conditions—all influence social determinants.

Economic and Development Perspective

Several issues support a strong economic rationale for public policies for NCDs (Appendix 2 gives further details). The economic rationale for public policy for health can be formulated on both efficiency and equity grounds—the former, when private markets fail to function efficiently; the latter, when the social bjectives of equity in access or outcomes are unlikely to be attained.

Examples of the former include:

* Market failures as with tobacco consumption where public goods in the form of accurate

information to citizens for making decisions are needed. Additionally, information on the harms

of certain lifestyles, environments, and unhealthy foods is required to make informed decisions.

* Externalities, that is, when a consumer does not bear all the costs or harms associated with a

behavioral choice (such as second-hand tobacco smoke, social problems from harmful alcohol

use, and unhealthy foods). These go beyond tobacco to include involuntary exposure to

environmental pollution, unsafe living conditions, and poor food quality, where vulnerable

populations (women, children, and the elderly) are at greatest risk.

* Nonrational behaviors such as when children and adolescents do not consider the future consequences of their choices, irrespective of whether they are informed of future

consequences (e.g., these acts are “myopic” and, hence, nonrational).

* Time-inconsistent preferences. In 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 longterm best interests.