A new World Bank report warns that the demographic transition is well underway in Sri Lanka and that the country faces escalating health care costs with rising rates of non-communicable diseases (NCDs) such as heart disease, diabetes, cancers, and asthma, as well as their risk factors such as obesity, smoking, high sugar and salt diets, and alcoholism.
Improving lifestyle and reducing risk factors while concurrently improving the quality of health services will promote healthier aging and reduce the impact of NCDs on Sri Lanka’s development.
“Sri Lanka needs a healthy and productive population to sustain its transition to a Middle Income Country, which will be challenged by two other transitions that are already under way, namely the rapid aging of the population and the increasing burden of NCDs. Effectively managing the latter transitions will therefore be a critical pre-requisite for the former” said Diaretou Gaye, World Bank Country Director for Sri Lanka and the Maldives. According to the new report―Prevention and Control of Selected Non-Communicable Diseases in Sri Lanka― NCD’s have already become the largest contributor to disease burden in Sri Lanka, accounting for 85% of ill health, disability and early death. A South Asia regional study found that South Asians suffer their first heart attacks six years earlier than other groups worldwide. This burden of NCDs will rise in the future, in part, due to further aging of the population with the doubling of the population over the age of 65 from 12.1% to 24.4% over the next thirty years. While life expectancy for women has made steady gains since 1920, it has stalled for men since 1980 due to risk factors such as smoking and excessive drinking and delays in seeking health care. The burdens of NCDs are also increasing shifting towards the poor. “This undue burden is especially harsh on poor people, who, after heart attacks or chronic lung diseases including asthma, face life-long major illnesses, and then find themselves caught in a poverty trap where they can’t get better and they can’t work,” says co-author Michael Engelgau, a World Bank Senior Public Health Specialist on secondment from the U.S. Centers for Disease Control and Prevention.
Aging and shifting disease patterns
The new report says that with average life expectancy in Sri Lanka now at 74 years and rising, and increasing urbanization and the accompanying life style changes, people are increasingly exposed to risk factors for NCDs. People have become more sedentary, consumption of alcohol and cigarettes has increased, and diets have become less healthy. As a result, Sri Lankans are becoming more vulnerable to NCDs, creating significant new pressures on the health system to treat and care for them.
“Reducing risk factors as tobacco use and excessive alcohol consumption along with an active lifestyle and improved diet will go a long way towards healthy aging. Importantly, this work highlights the cost-effective policy and health system interventions which if prioritized now, can help mitigate the longer term financial impact of NCDs ,” says Julie Mclaughlin, World Bank South Asia’s Health Manager.
Given the relatively low health spending of 4% of GDP in 2008, NCD care in Sri Lanka is increasingly financed by out of pocket spending by the general public. World Bank’s Director for Human Development in South Asia, Michal Rutkowski says “Tackling NCDs in South Asia 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.”
Options for better managing NCDs.
The new report encourages Sri Lanka to adopt a number of population based and individual patient based approaches to reduce unhealthy behaviours in the general population and control heart disease, diabetes, cancers and other NCDs. These efforts, such as more effective legislation on the use of Trans fats and tobacco as well as public education to reduce salt intake would help delay the onset of these diseases. At the clinic level, aspirin and beta-blockers for high risk individuals could reduce the chances of cardiovascular diseases. These initiatives have the potential to reduce mortality by 23% (38,000 deaths) of what otherwise can be expected in the next 10 years in Sri Lanka.
In terms of policy options, the report recommends creating a scaled up national NCD program with sufficient resources and authority to focus on cardiovascular disease, diabetes, asthma, and cancer, and an appropriate institutional home that can implement the activities in a coordinated manner. It also recommends increased use of lower-level and more decentralized health facilities allowing for increased Public-Private Partnerships in both financing and provision of NCD care while improving human resources to better screen, and treat NCDs.