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Economic Dimensions of Noncommunicable Diseases in Latin America and the Caribbean DISEASE CONTROL PRIORITIES • THIRD EDITION Companion Volume Economic Dimensions of Noncommunicable Diseases in Latin America and the Caribbean EDITORS Branka Legetic Andre Medici Mauricio Hernández-Avila George Alleyne Anselm Hennis PAHO HQ Library Cataloguing-in-Publication Data ************************************************************************************* Pan American Health Organization. United States of America, University of Washington. Economic Dimensions of Non-Communicable Disease in Latin America and the Caribbean. Disease Control Priorities. 3. ed. Companion Volume. Washington, DC : PAHO, 2016. 1. Health Economics. 2. Chronic Disease. 3. Health Priorities. 4. Risk Factors. 5. Social Determinants of Health. 6. Health Evaluation. 7. Health Policy. 8. Americas. I. Title. II. University of Washington. III. Legetic, Branka (ed.). IV. Medici, Andre (ed.). V. Hernández-Avila, Mauricio (ed.). VI. Alleyne, George. VII. Hennis, Anselm (ed.). ISBN 978-92-75-11905-1 (NLM Classification: WT 500) © 2016 Pan American Health Organization and the University of Washington. All rights reserved. The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the Communications Department, Pan American Health Organization, Washington, D.C., U.S.A. (www.paho.org/permissions). The Department of Noncommunicable Diseases and Mental Health will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. Publications of the Pan American Health Organization and/or the University of Washington enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Pan American Health Organization and/or The University of Washington concerning the delimitation of it frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there amy not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization and/or the Univeristy of Washington in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the Pan American Health Organization and/or the University of Washington to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the Pan American Health Organization and/or the University of Washington be liable for damages arising from its use. DISEASE CONTROL PRIORITIES • THIRD EDITION Companion volume Economic Dimensions of Noncommunicable Diseases in Latin America and the Caribbean Washington D.C. 2016 Contents Foreword Abbreviations SECTION 1: INTRODUCTION 1. Noncommunicable Disease Prevention and Control in the Americas 3 Anselm Hennis SECTION 2: SOCIOECONOMIC DIMENSIONS OF THE IMPACT OF NCDs 2. The Burden of Noncommunicable Diseases in the Americas and the Social Determinants of Health 13 Jose A. Escamilla-Cejudo, Antonio Sanhueza, and Branka Legetic 3. Risk Factors in Americas: The Sources of the Burden 23 Adriana Blanco, Enrique Jacoby, Maristela Monteiro, Roberta Caixeta, Blake Smith, Ruben Grajeda, and Carlos Santos-Burgoa 4. The Social Determinants of NCDs 31 Kira Fortune, Nely Salgado de Snyder, Luis Augusto Cassabha Galvao, and Matthew Murphy 5. Indicators for Monitoring the Socioeconomic Dimension of NCDs: A Pilot Study in Chile 37 Cristóbal Cuadrado, Alain Palacios, Tim Miller, and Branka Legetic SECTION 3: ECONOMIC IMPACT OF NCDs IN LATIN AMERICA AND THE CARIBBEAN 6. Macroeconomics and Risk Factors for NCDs: A Policy Agenda 53 David Mayer-Foulkes and Ilana Mayer-Hirshfeld 7. The Equity Impact of Noncommunicable Diseases in Latin America 63 André Medici 8. The Cost-Effectiveness of Interventions and Policies for Noncommunicable Diseases and Their Risk Factors in the Latin America and Caribbean Region: A Systematic Literature Review 87 David Watkins, Rosana Poggio, Federico Augustovski, Elizabeth Brouwer, Andres Pichon Riviere, Adolfo Rubinstein, and Rachel Nugent SECTION 4: MEETING THE CHALLENGE OF NCDs: HOW TO ACHIEVE BEST SOLUTIONS 9. Noncommunicable Diseases: Challenges and Opportunities for Health System Response 109 Camilo Cid, Cristóbal Cuadrado, and Ricardo Fábrega 10. Policy Framework to Develop and Improve Government Actions for Prevention and Control of NCDs 115 Mauricio Hernández-Avila, Isabel Vieitez, Ana Bernal, Sofia Charvel, Carlos Santos Burgoa, Luz Myriam Reynales-Shigematsu, Laura Magaña, Juan Eugenio Hernández, Lina Sofia Palacio, Carlos Aguilar Salinas, and Lorena Viviana Calderon 11. Responding to NCDs under Severe Economic Constraints: The Links with Universal Health Care in the Caribbean 133 Karl Theodore, Stanley Lalta, Althea La Foucade, Anton Cumberbatch, and Christine Laptiste SECTION 5: CONCLUSIONS 12. Economic Dimensions of Noncommunicable Diseases in Latin America and the Caribbean: Policy Agenda Considerations 143 George Alleyne Article Authors and Section Editors 151 Acknowledgments 159 Foreword Economic Dimensions of Noncommunicable Diseases in Latin America and the Caribbean is a companion volume to Disease Control Priorities, Third Edition (DCP3). This volume explores the relationship between and the impact of noncommunicable diseases (NCDs) on development and economic growth in the countries of Latin America and the Caribbean (LAC). This collection of manuscripts examines the complex interplay among NCDs, health expenditures and financial investments in health, poverty, and inequities, using up-to-date information and evidence from the LAC region. There is compelling proof that NCDs are a major and growing problem for low- and middle-income countries, and that they consume increasingly greater proportions of health care budgets. NCDs are not simply a byproduct of higher incomes and declining infectious disease rates, but are also a major cause of disability and ill health and the leading cause of preventable and premature mortality in the Americas. NCDs are responsible for significant out-of-pocket health expenditures for individuals and families, as well as substantial health outlays in national budgets. During the last 20 years, many LAC countries have experienced unprecedented economic growth. And in spite of the recent global financial crisis, economic and health indicators have demonstrated overall improvements, especially at the national level. However, NCDs remain a threat to the economic growth and developmental potential of many countries. This is particularly true for low- and middle-income countries that face a greater increase in the NCD burden as a result of rapidly growing and aging populations. These diseases drive inequity; contribute to poorer economic outcomes for individuals, communities, and societies; and create significant challenges to development. The economic impact of NCDs must be better understood, and their negative consequences for societies mitigated. The impact of NCDs is recognized in the Sustainable Development Goals (SDGs), which include a target of a one-third reduction in premature mortality from NCDs by 2030. Achieving that will require an innovative, health-in- all-policies approach linking global health, efforts to reduce inequity, the world economy, and national development. The Plan of Action for the Prevention and Control of Noncommunicable Diseases in the Americas 2013–2019 of the Pan American Health Organization (PAHO) emphasizes multisectoral initiatives that will contribute to this target through collaboration with relevant sectors of government and society, and also through integrating those initiatives into development, academic, and economic agendas. Economic Dimensions of Noncommunicable Diseases in Latin America and the Caribbean recognizes the relationship between NCDs and sociodemographic trends in the LAC region. These include unprecedented rates of urbanization, globalization, rapid population aging, and inadequate health system responses to these changes. This volume provides health planners and decision makers with relevant information about how NCDs contribute to economic development and makes a case for greater investments in the prevention and control of chronic conditions. This book also builds on previous evidence and assesses new empirical work, with the goal of influencing NCD policies, program design, and resource allocation at the regional and country level. The volume also recommends specific, concrete actions and calls for an all-of-society approach to address NCDs as both an urgent economic concern and a development issue. With these objectives in mind, Economic Dimensions of Noncommunicable Diseases in Latin America and the Caribbean has been written by PAHO technical advisors and a range of other, specially selected experts, for an audience that ranges from academics and health professionals to policy makers and program managers, as well as the media, lawmakers, and the
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