Журнал тропических болезней и общественного здравоохранения

Абстрактный

Non-Communicable Diseases in Developing Countries: Causes and Health Policy/Program Assessments

Tetsuji Yamada, Chia-Ching Chen, I-Ming Chiu and Syed W Rizvi

Objectives: This study focuses on non-communicable diseases (NCDs) and evaluates the effectiveness and efficiency of government public health policies on cardiovascular diseases and diabetes deaths per 100,000 population with age-standardized estimate of adults aged 25 and above of 30 South Asian and 46 African countries. Findings suggest that government policy implementation with focus on the reduction of deaths from NCDs is more efficient than general public health policy.

Methods: The study employed theoretically well founded PRECEDE-PROCEED model to assess effectiveness of public health programs. Three causal factors of NCDs and three policy issues constituted the core of this model. The causal factors included: body mass index (BMI) 30 & over; systolic blood pressure; and total cholesterol. The policy issues included: health-related economics; health-related infrastructure; enabling, reinforcing and predisposing factors. Multiple regressions with robust method were used to assess effectiveness and concentration index for efficiency. The data for this study was taken from World Heath Statistics: 2008-2010.

Results: One percentage increase in BMI 30&more raises 3.829 deaths from NCDs per 100,000 populations by country and the increase in NCDs depend on the size of population. One dollar per capita per year increase in government healthcare expenditures reduces NCDs by about 791 persons per 100,000 per year. An increase of 10% in government healthcare expenditures leads to 0.54% reduction in deaths from NCDs. The cost of this reduction in deaths from NCDs is $12.15 per capita per year.

Implementation of key activities related to NCDs management reduces deaths from NCDs by 0.073 persons per 100,000 populations. An increase of 10% in NCD management expenditures leads to a 0.21% reduction in deaths or a decrease of 8.921 million deaths from NCDs. It costs $25.72 per person per year. The estimated effect of cardiovascular diseases and diabetes management plan is 113.828 less NCD deaths per 100,000 populations than in countries without a plan to fight against NCDs. For efficiency, the concentration indices reveal that the NCDs management is more cost efficient than the government general healthcare expenditures.

Conclusions: In general, government policies and programs are found effective against NCDs. However, policies and programs focused on the reduction of NCDs are more efficient than general public health initiatives. A wellconstructed tax system for financing policy/program to deal with NCDs and related deaths is required.