Act now for healthy future

THE road to becoming a developed country is riddled with portholes. Perhaps the greatest challenge that Sri Lanka will have to face in the future is finding quality healthcare for its ageing population. A World Bank report launched on Monday shows that the challenge is more multidimensional with Non-Communicable Diseases (NCDs) growing exponentially thanks to changes in consumption patterns and lifestyles.

NCDs include heart disease, cancers, diabetes and asthma as well as their risk factors such as obesity, smoking, high sugar and salt diets and alcoholism. All of these are brought about by changes in lifestyle that happen with increasing living standards. As people move towards more service-oriented jobs with less physical activity and higher income, the change in their consumption patterns come at a high cost – both to themselves and the State.

The World Bank has cautioned Sri Lanka to address these trends, which are already spreading rapidly to maintain the country’s development goals. They recommend improving lifestyles and making consumers choose better by heightening their awareness. Organisation experts insist that policy makers and public need to work together so that more long-term decisions are made for the benefit of citizens.

NCDs cause all the more concern because their burden is slowly shifting to the poor. Despite Sri Lanka’s middle-income status, the middle aged and old are still significantly vulnerable both in terms of knowledge and funding. 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 new pressures on the health system to treat and care for them.

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, notes the World Bank. This means that stronger prevention methods need to be implemented to reduce the burden of poor health and lost earnings that will result in deeper poverty, disability and premature deaths. 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 transfat 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% that roughly translates into saving 38,000 lives.

In terms of policy options, the report recommends a scaled-up national NCD programme with sufficient resources and authority to focus on cardiovascular diseases, diabetes, asthma and cancer and an appropriate institutional base that can implement the activities in a coordinated manner is essential.

It also recommends increased use of lower level and more decentralised 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 them. The implementation of these policies will promote healthcare for Sri Lanka’s future if the steps are taken now.