An Ounce of Prevention is worth a Pound of Cure: Investing in Non Communicable Disease (NCD) Prevention and Control in the Caribbean to Protect Our Future, by Dr. Kimberly-Ann Gittens-Baynes.
During the Global Week for Action on NCDs— 5th to 11th September 2022, the Healthy Caribbean Coalition (HCC) along with civil society organizations around the world seek “to ensure NCD prevention and care get the attention and action they deserve, everywhere, for everyone”. This year, the campaign’s theme is “Invest to protect” and highlights the need for increased and urgent investment in NCDs. This blog is written in support of this initiative.
Before the COVID-19 pandemic, Non Communicable Diseases (NCDs) were the major cause of death and disability in the Caribbean and during the pandemic, the high prevalence of NCDs became an accelerant of the health and economic impacts of COVID-19. As Caribbean countries engage in post-pandemic economic recovery, the continued health and economic costs of the NCDs cannot be sidestepped. To treat with the NCD epidemic successfully, measures that prevent, manage and control NCDs are needed which represent a long-term investment in population health (1). While governments in the region have taken action to mitigate against the impact of NCDs, the human and economic costs of continue to accumulate. There is some evidence to suggest that the bottlenecks observed with regard to prevention and control interventions have occurred due to implementation challenges with funding/financing being identified as a significant implementation barrier (2).
Even within the context of the valid arguments of limited donor funding and shrinking fiscal space, not adequately investing in NCD prevention and control is a Catch-22 situation. If countries do not adequately invest in NCD prevention and control, the health and economic costs of NCDs will continue to rise, accelerated by population ageing and the childhood obesity epidemic, placing countries in an even more precarious economic position over time.
Investing in prevention and control of NCDs can be cost effective, the WHO “NCD Best Buys”(3) have been shown to both reduce the health impacts of NCDs and provide a source of revenue (1). The rate of return of these measures are significant with the rate of return per US$1 invested being approximately US$12 for healthy diet interventions, US$7 for tobacco and US$8 for alcohol interventions (1). For two Caribbean countries, Barbados and Jamaica, the investment case for NCDs has been shown to be a viable one. According to a 2017 Barbados study, scaling up spending on prevention and treatment spending in the amount of BD$38 million (US$19 million) over a 5 year period and maintaining treatment coverage, would result in a BD$580 million (US$290 million) in increased productivity over a 15-year period (2015-2030) due to the health gains of reduced mortality and morbidity (3). There were similar findings for Jamaica where an investment in scaling up selected prevention and control measures along with alcohol and tobacco polices of J$37.8 billion (USD 297.5 million), over the 15-year period (2017-2032) yielded total economic benefits of J$81.3 billion (US$640 million) (5). It is clear in both cases that the returns on the investment outweigh the costs of investing in prevention and control.
As part of the package of best buy measures, fiscal policy is a viable tool Caribbean countries can utilise to finance NCD prevention and control. La Foucade et al (2018) found that if excise taxes on alcohol (beer and rum) and cigarettes were increased to recommended levels, the gain in revenue for the 15 CARICOM countries in the study would be an estimated US$86.3 million. This revenue would exceed the estimated cost of the NCD response in those countries by an estimated US$33.7 million (6). In this regard, Bermuda’s Sugar Sweetened Beverage (SSB) taxation was found not only to reduce consumption of taxed products but revenue from this measure for the thirteen month period (October 2018 to December 2019) amounted to US$5.4M (7).
A strong political commitment to population health is necessary to avoid implementation bottlenecks particularly where measures may yield long-term rewards but may be unpopular. In the case of Barbados, an SSB tax was implemented in 2015 at a time when it was among a handful of countries to do so. The tax was implemented at a rate of 10% as part of a broader plan to address unhealthy diets in the Barbadian population. Subsequent to its implementation, research showed that while the tax had been successful in reducing SSB consumption there was evidence that a substitution effect existed, some consumers had switched their consumption from higher priced SSBs to lower priced SSBs (8). In April 2022, in line with WHO recommendations on SSB taxation and despite industry opposition, the government of Barbados raised the tax to 20%.
Caribbean countries have also been exploring more efficient and innovative ways of financing health programmes. One such example is Jamaica which has utilised mixed funding to finance the National Health Fund (NHF)(9) . The NHF is funded through national insurance (5% of annual earnings up to $500K collected by the National Insurance Scheme) which provides the largest share of financing, the special consumption tax (20%) and tobacco excise taxes (5%) and (10). Flexibility and innovation will be key requirements to adequately and sustainably fund NCD prevention and control.
NCDs have a long-term impact on population health and economies. By prioritising the investment in NCD prevention and control, countries are ensuring that the health and economic costs of NCDs are reduced as the returns on this investment accrue both now and in the future.
Dr. Kimberly-Ann Gittens-Baynes holds a PhD in Economics and has over seventeen years of experience working in the area of Health Economics in the Caribbean. Her research over the years has included HIV/AIDS, sexual and domestic violence, poverty and vulnerability. More recently her research has focused on Non-Communicable Diseases and Economic Policy, Costing of Health Services/Disease Conditions and Health Behaviour and Health-related decision making. She is currently a researcher at the HEU, Centre for Health Economics, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago.
References
- World Health Organization (WHO). Saving lives , spending less: The case for investing in NCDs [Internet]. World Health Organization. 2021 [cited 2022 Sep 1]. Available from: http://apps.who.int/bookorders.
- Abdulkadri A, Floyd S, Mkrtchyan I, Marajh G, Gonzales C, Cunningham-Myrie C. Addressing the adverse impacts of non-communicable diseases on the sustainable development of Caribbean countries 100 STUDIES AND PERSPECTIVES ECLAC SUBREGIONAL HEADQUARTERS FOR THE CARIBBEAN [Internet]. 2021 [cited 2022 Aug 31]. Available from: www.cepal.org/apps
- The WHO NCD Best Buys are a package of 16 NCD interventions focused on the major NCD risk factors and the management of cardiovascular disease, diabetes and cervical cancer (1)
- Ministry of Health Barbados World Health Organization (WHO) and the United Nations Development Programme (UNDP). The Investment Case for Non-communicable Disease Prevention and Control [Internet]. 2017 [cited 2021 Mar 28]. Available from: https://apps.who.int/iris/handle/10665/259689
- Hutchinson Id B, Small R, Acquah K, Sandoval R, Nugent R, Davidson T, et al. The investment case as a mechanism for addressing the NCD burden: Evaluating the NCD institutional context in Jamaica, and the return on investment of select interventions. Jamaica Minist Heal [Internet]. 2019 [cited 2022 Sep 1]; Available from: https://doi.org/10.1371/journal.pone.0223412
- Foucade A La, Metivier C, Gabriel S, Scott E, Theodore K, Laptiste C. The potential for using alcohol and tobacco taxes to fund prevention and control of noncommunicable diseases in Caribbean Community countries. Rev Panam Salud Pública [Internet]. 2018 [cited 2022 Sep 1];42. Available from: /pmc/articles/PMC6386120/
- Case KK, Pineda E, Olney J, Segal AB, Sassi F. The ‘sugar tax’ in Bermuda: a mixed methods study of general population and key stakeholder perceptions. BMC Public Heal 2022 221 [Internet]. 2022 Aug 16 [cited 2022 Sep 2];22(1):1–14. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13945-9
- Alvarado M, Unwin N, Sharp SJ, Hambleton I, Murphy MM, Samuels TA, et al. Assessing the impact of the Barbados sugar-sweetened beverage tax on beverage sales: An observational study. Int J Behav Nutr Phys Act [Internet]. 2019 Jan 30 [cited 2021 Mar 28];16(1):13. Available from: https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-019-0776-7
- The NHF provides access to essential drugs for chronic illnesses for Jamaican residents and the elderly and public information and health promotion activities executed by public and private institutions.
- National Health Fund. Who we are – The National Health Fund [Internet]. 2022 [cited 2022 Aug 8]. Available from: https://www.nhf.org.jm/about-us/who-we-are