The recently completed World Bank report on 'Prevention and Control of Selected Chronic Non-Communicable Diseases in Sri Lanka: Policy Options and Action' released at a conference held Monday at the Taj Samudra Hotel in Colombo provides important evidence and recommendations on this major issue.
In Sri Lanka, the demographic and epidemiologic transitions are now well underway and 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 are a major health issue affecting the population, the World Bank says.
The threat of rising NCDs has led the Sri Lankan government to take active measures and expand its available services through the curative sector and providing policy directions with the recently approved National Chronic NCD Policy.
"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," the report observed.
Diaretou Gaye, World Bank Country Director for Sri Lanka and the Maldives says Sri Lanka needs a healthy and productive population to sustain its transition to a Middle Income Country (MIC).
Rapid aging of the population and the increasing burden of NCDs will challenge the country's transition to a Middle Income Country (MIC) and effectively managing those two will therefore be a critical pre-requisite for the transition, Ms. Gaye observes.
According to the new report the NCDs 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 has found that South Asians suffer their first heart attacks six years earlier than other groups worldwide.
The World Bank predicts the NCDs to 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. The burdens of NCDs are also increasing shifting towards the poor, the report says.
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," the report says.
Julie McLaughlin, the World Bank Sector Manager, in Health, Nutrition and Population for South Asia Region says 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," she says.
According to the World Bank, with the low allocation for healthcare in Sri Lanka most people are spending out of pocket for their health services and rising NCDs can lead to deepening poverty and the risk of disability and premature death. Sri Lanka only spent 4% of GDP in 2008 for the healthcare.
The new report encourages Sri Lanka to adopt a number of population-based and individual patient-based approaches to reduce unhealthy behaviors in the general population and control heart disease, diabetes, cancers, and other NCDs.
The reports also recommends more effective legislation on unhealthy use of trans fats and tobacco as well as public education to reduce salt intake to 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, it suggests.
"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," the report said.
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.
Read the full report.
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