Here Are The 16 ‘Best Buys’ To Tackle Non-Communicable Diseases

Everyone likes a bargain, right? Of course, many bargains probably don’t save lives like that that big screen TV that you MMA’d other people for on Black Friday. However, the World Health Organization (WHO) has identified 16 interventions that can save lives, should reduce suffering, and are big-time bargains. They call them NCD Best Buys and have detailed these in a new report entitled Saving Lives, Spending Less: The Case for Investing in Noncommunicable Diseases.

What’s a bargain? How about around $230 billion in economic gains, seven million lives saved, 10 million heart attacks and strokes averted, and 50 million healthy life years gained from investing just an additional $0.84 per person per year? That would equate to about a $7 return for every dollar invested. All of these values are in U.S. Dollars but could be easily converted into European Euros, Japanese Yen, British Pounds, Chinese Yuan, Swiss Francs, Dogecoin, NFTs of recorded farts, or whatever may be your currency of choice. The seven-to-one return would still hold.

All of this would stem from further investment into preventing and controlling NCDs. In this case, NCD stands for “non-communicable disease” and not “nacho cheese dip” in snacking parlance or “needless character death” in video game parlance. A non-communicable disease is one that is not typically passed from person-to-person via an infectious pathogen. Examples of NCDs include diabetes, heart disease, cancer, chronic respiratory diseases, and stroke. You may have heard of these health conditions as collectively they’ve become the leading killers of humans around the world, claiming around 41 million lives each year. That’s about seven out of every 10 deaths around the world. And many of these deaths are way premature, with over 15 million folks between the ages of 30 to 69 years passing before their time. Kelly Henning, MD, Public Health Program Lead for Bloomberg Philanthropies, pointed out that “85% of such premature deaths are in lower and middle income countries. The impact of NCDs on lower income countries has been underrealized. The fact that this is underappreciated is one of the principles for [Bloomberg Philanthropies] to support this work.”

“Noncommunicable diseases take a terrible health and economic toll, especially on countries that can least afford it” said Michael R. Bloomberg, founder of Bloomberg Philanthropies and WHO Global Ambassador for NCDs and Injuries, in a statement. “We know the prevention measures that work best, and hopefully this new report leads more governments to take the smart, cost-effective actions that can help save millions of lives around the world.”

In many ways, the term “needless character death” might apply to non-communicable diseases. A big chunk of premature deaths from NCDs would have been preventable by reducing tobacco and harmful alcohol use, making diets more healthy, increasing physical activity, and better managing disease. That’s why the 16 NCD Best Buys are as follows in the words of the WHO:

1. Increase excise taxes and prices on tobacco products.
2. Implement plain/standardized packaging and/or large graphic health warnings on all tobacco packages.
3. Enact and enforce comprehensive bans on tobacco advertising, promotion and sponsorship.
4. Eliminate exposure to second-hand tobacco smoke in all indoor workplaces, public places and public transport.
5. Implement effective mass-media campaigns that educate the public about the harms of smoking/tobacco use and second-hand smoke.
6. Increase excise taxes on alcoholic beverages.
7. Enact and enforce bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media).
8. Enact and enforce restrictions on the physical availability of alcohol in sales outlets (via reduced hours of sale).
9. Reduce salt intake through the reformulation of food products to contain less salt, and the setting of maximum permitted levels for the amount of salt in food.
10. Reduce salt intake through establishing a supportive environment in public institutions such as hospitals, schools, workplaces and nursing homes, to enable low-salt options to be provided.
11. Reduce salt intake through behavior change communication and mass-media campaigns.
12. Reduce salt intake through the implementation of front-of-pack labelling.
13. Implement community-wide public education and awareness campaigns for physical activity, including mass-media campaigns combined with other community-based education, motivational and environmental programmes aimed at supporting behavioral change around physical-activity levels.
14. Provide drug therapy (including glycemic control for diabetes mellitus and control of hypertension using a total-risk approach) and counselling for individuals who have had a heart attack or stroke and for persons with high risk (≥ 30%) of a fatal or non-fatal cardiovascular event in the next 10 years.
15. Vaccination against human papillomavirus (two doses) of girls aged 9 to 13 years.
16. Prevention of cervical cancer by screening women aged 30 to 49 years, either through visual inspection with acetic acid linked with timely treatment of precancerous lesions; pap smear (cervical cytology) every 3 to 5 years, linked with timely treatment of precancerous lesions; human papillomavirus tests every 5 years, linked with timely treatment of precancerous lesions.

As you can see, these are far from the costliest of interventions. Some of them are simply about getting certain companies to stop doing bad stuff to make money like convincing people to put little chimneys in their mouths. Some involve getting more accurate scientific information to the public so that they actually know things like when their food is drowning in salt. In fact, some of these interventions can serve as new revenue sources such as taxes on tobacco products and alcoholic beverages.

Of course, low cost doesn’t necessarily mean not complex. While many of these NCDF Best Buys may seem simple, they can have complex, reverberating effects. “Complex problem that require complex medical interventions,” Henning emphasized. She also indicated how many of these are “low cost” but also will require “best practice data analytics” to implement properly.   

These 16 interventions aren’t completely new. The World Health Assembly already endorsed them back in 2017. The WHO report does include examples of how some of these have already been successfully implemented in various countries around the world. For example, after enacting tobacco advertising bans, increasing tobacco tax rates, and putting in place other tobacco control measures, Brazil saw its smoking prevalence decrease from 23.9 % in 2000 to 13.1% in 2020. The tobacco taxes have also raked in billions of dollars in revenue. As another example, South Africa in 2013 passed laws to limit the amount of salt in certain products, which seems to have helped lower the average salt intake among young adults by 0.82 grams per day.

“With the right strategic investments, countries that bear a significant amount of the NCD burden can change their disease trajectory and deliver significant health and economic gains for their citizens.” WHO Director-General Dr Tedros Adhanom Ghebreyesus explained in a statement. “In a world filled with uncertainty, one thing we can be certain of is that without action, NCDs will continue to be a significant threat to global health. Investing in these evidence-based policies is an investment in a healthy future.”

Speaking of uncertainty, the Covid-19 coronavirus pandemic (you know that thing that’s still going on right now) has in many ways torn the cover off many of our society’s long existing problems. “The issue of NCDs in low and middle income countries has come to the forefront with the pandemic,” said Henning. “It seems like a very important moment to revisit this.” Henning credited the Norwegian government as “the first donor country to launch [major investments into controlling NCDs] with their 2019 international development strategy on NCDs.” Perhaps other countries will use the WHO report to launch similar initiatives. “Countries, governments, and donors want to think of this in terms of dollars and cents,” Henning added. “For a small investment can achieve important outcomes.” After all, who doesn’t like a bargain?