In this series, Bjorn Lomborg explores the smartest investments to respond to global challenges such as hunger, chronic and infectious disease, sanitation, climate change, and global conflict. See the other articles here. And find out which investments are currently at the top of the Slate readers’ priority list. Have your say by voting at the poll at the end of each article.
Chronic diseases such as heart disease, stroke, and cancer are problems that we associate with rich countries, while infectious diseases such as malaria and HIV/AIDS are more commonly seen as the problems afflicting the poor. But 80 percent of global deaths from chronic diseases occur in low-income and middle-income countries. Cardiovascular disease in low- and middle-income countries killed more than twice as many people in 2001 as did AIDS, malaria, and TB combined.
Yet, according to a recent review of donor health funding, chronic disease receives the smallest amount of donor assistance of all health conditions, having lost ground since 1990 relative to infectious diseases. Donor assistance for health was estimated at almost $26 billion in 2009. The amount allocated to chronic disease was $270 million, or a miniscule 1 percent of the total.
In Copenhagen Consensus 2012, specialist academics produce new research on the smartest responses to global challenges, and then Nobel laureate economists prioritize the best policies. In a research paper released today on chronic disease, Prabhat Jha and a team of researchers argue that chronic diseases already pose a substantial economic burden, and this burden will evolve into a staggering one over the next two decades.
Although high-income countries currently bear the biggest economic burden of chronic diseases, developing countries (especially those that are middle-income) will assume an increasing share as their populations grow and the effects of the tobacco epidemic take greater hold.
And the costs for governments of achieving maximal adult survival are rising, in contrast to declines in the costs of achieving child survival. This divergence is chiefly a consequence of the lack of tobacco control in most low and middle-income countries (while smoking rates are declining in many developed countries, they are on the rise in the developing world), the lack of sustained investments in new drugs, and gaps in the strategies and in the program implementation for chronic diseases.
Jha and his team argue that addressing chronic disease in poor countries requires a rethinking of developmental assistance and possibly new delivery approaches.
They identify five key priority interventions where the costs are relatively low compared to the benefits.
The most important action is tobacco taxation. Estimating conservatively that tobacco causes about one-third of the vascular disease, half of all cancerns cancers and 60 percent of chronic respiratory diseases, the researchers estimate a total economic loss from tobacco of about $12.7 trillion over the next 20 years—or about 1.3 of global GDP annually. Already, tobacco kills up to 6 million people a year, including about 1 million each in China and India. Without increased cessation efforts, , tobacco use could account for about 10 million deaths per year by 2030, with most of these occurring in low- and middle-income countries. With no change to current patterns, 1 billion tobacco deaths might occur this century, in contrast to 100 million in the 20th century.
Reducing tobacco deaths in the next few decades requires current smokers to quit, and tobacco taxation is particularly effective at raising cessation rates: a 10 percent increase in price leads to a 4 percent ot 8 percent drop in consumption. France, for example, tripled the price of cigarettes quickly (over a decade or so), and this cut consumption per adult in half, while more than doubling tax revenue in real terms. Lung cancer rates for young men in France have fallen sharply since. Tax hikes need not cost anything except the political will to overcome vested interests. Generously estimating a comprehensive tobacco control program including a tobacco tax rise to cost $500 million annually, such a program would avert more than 1 million deaths each year. Put into economic terms, the benefits would be 40 times higher than the costs.