February 9, 2011 - “The unfair burden of noncommunicable diseases (NCDs) is especially harsh on poor people, who, after heart attacks, face life-long major illnesses, have to pay for most of their care out of their savings or by selling their possessions, and then find themselves caught in a poverty trap where they can’t get better and they can’t work.” - Michael Engelgau, M.D., Lead Author and World Bank Senior Public Health Specialist for South Asia.
About the Report
South Asia is at a Crossroads
South Asia is home to a large, fast-growing population with a substantial proportion living in poverty. The population is relatively young and average life expectancy is now at 64 years and rising. Lifestyle changes associated with urbanization and globalization is increasing the risk factors and disease onset at younger ages. As a result, South Asians are becoming more vulnerable to heart disease, cancers, diabetes, and obesity, and creating significant new pressures on health systems to treat and care for them. The current health systems have failed to to adjust to people’s changing needs.
Over half of the disease burden is now attributable to Noncommunicable Diseases (NCDs), and therefore a larger share than communicable diseases, maternal and child health issues, and nutritional causes combined. This pattern is similar to that of high-income countries decades ago. Ischemic heart disease (IHD) is the leading cause of both deaths and forgone disability adjusted life years (DALYs) in working-age adults (15–69 years). By contrast, communicable diseases (e.g., tuberculosis, respiratory infections, and water- and vectorborne disease) still remain prominent in the total population creating what is referred to as a “double-disease burden.”
Tackling NCDs early on with better prevention and treatment would significantly spare poor people the crushing burden of poor health, lost earnings, deepening poverty, and the risk of disability and premature death, which are becoming all too common in the changing demographics of the region.
South Asia has to adopt and carry out a number of country and regional approaches to reduce both unhealthy risk factors in their general populations and control heart disease, diabetes, cancers, and other NCDs. Regional strategies such as harmonizing health policies and strategies at a regional level boosts effective NCD prevention and control efforts, especially for tobacco and food. Regional food labeling can also help local governments and their communities manage their rising obesity problems, through increasing awareness of calorie content, and, possibly, complement awareness campaigns for healthy foods.
Improving Health Systems
The report outlines four ways to improve the health systems to meet the challenges of the present and future:
- Collaborate on group purchasing of essential medications;
- Establish a health technology assessment institution;
- Synergize regional education and training capacity; and
- Establish a regional network of surveillance and burden assessment.