Foreword xi
Acknowledgments xiii
Abbreviations xv
Executive Summary xvii
Chapter 1 Introduction 1
Objective 1
Scope and Audience 3
Trends in NCD Outcomes and Possibilities for
Improvement 4
Key Messages 13
Notes 14
Chapter 2 Improving NCD Outcomes: A Public
Policy Perspective 15
Economic Burden of NCDs 17
Economic Rationale: Efficiency, Equity, and Budget
Implications 21
Value for Money 29
Implementation of NCD Services 33
v
Summary: A Matrix of the Economic Rationale
for NCD Interventions 39
Key Messages 41
Notes 43
Chapter 3 The Agenda for the World Bank 45
NCDs in the World Bank’s Portfolio 45
Agenda for Action 50
Key Messages 56
Notes 57
Appendix 1 The Basis for Public Intervention in the Control of
Noncommunicable Diseases 59
Accelerated Mortality Reduction Scenario for
Noncommunicable Diseases 59
Evidence on the Economic Burden of NCDs 60 Extent to Which NCDs Matter to the Poor 64
NCDs and Health Financing 70
Notes 72
Appendix 2 The Evidence Base for the Prevention and Control
of Noncommunicable Diseases 73
Premature Mortality 74
Public Policy 77
Incorporating Prevention into Primary Care 100
Conclusion 114
Notes 115
Appendix 3 Challenges of Design and Implementation:
Three Country Cases 117
Indonesia: Forecasting and Financing Health Care Demand in a Middle-Income Country—Disease Transitions in East and Central Java 119 Georgia: Diabetes and Systemic Constraints 126 India: The Value of Information about NCD Status 131
Notes 136
Appendix 4 Selected Noncommunicable Disease Indicators 137
Glossary of Selected Health Terms 147
vi Contents
References 153
Index 181
Boxes
3.1 Regional Focus: Epidemiological Surveillance Systems in
the Europe and Central Asia Region 46
3.2 Country Focus: Addressing the Challenges of NCDs
in Brazil 47
A2.1 Trends in Mortality Due to Smoking 79
A2.2 Basic Inputs for an Organized Cancer Screening Program 106
Figures
1.1 Share of the Disease Burden Attributable to NCDs
by World Bank Region, 2002 3
1.2 Projected Deaths due to NCDs by Country Income
Level, 2005 and 2030 5
1.3 Decomposing NCD Mortality Trends by Country
Income Level, 2002–30 6
1.4 NCD Mortality Reduction Scenarios, 2005–15 8 2.1 How Strong Is the Chain That Links Public Spending on
NCDs to Better Outcomes? 16
2.2 Expenditure Incidence for Primary and Hospital Care,
Selected Countries, Various Years 38
3.1 Document Search Methodology 49
A1.1 Annual Change in Age- and Gender-Specific NCD
Death Rates, 2005–15, Alternative Scenarios 61 A1.2 Causes of Death by World Bank Income Group, 2005 67 A1.3 World Income Percentiles and NCDs as a Percentage of
Excess Deaths by World Bank Region, 2005 68 A1.4 Ratio of Age-Standardized Death Rates in Low- and
Middle-Income Countries to Those in High-Income
Countries, 2005 69
A1.5 Income Percentile and NCD Risk Factors 70 A1.6 Potential Changes in Total Health Spending as a
Percentage of Gross Domestic Product, Regional Averages 71 A2.1 Premature Mortality among Adults Aged 15–59 According to
Gross National Income Per Capita in 162 Countries, 2004 75 A2.2 Premature Mortality: Disability-Adjusted Life Years
(DALYs) Lost Attributable to the Most Frequent
Risk Factors for Disease, by World Bank Region, 2001 76
viii Contents
A2.3 Premature Mortality: Disability-Adjusted Life Years (DALYs) Lost Attributable to Most Frequent Risk Factor for Disease, by World Bank Regions
excluding Sub-Saharan Africa, 2001 78
A2.4 Reverse Transparency Index and Estimated Smuggling as a Share of Tobacco Consumption, Selected Countries, 2000 82 A2.5 Prevalence of Overweight and Obesity and Underweight by
Household in Three Large Countries: Evidence of
the Double Burden of Disease 91
A2.6 Pathways to Cardiovascular Risk 101
A3.1 Distribution of Total Cases
by Disease Group, East and Central Java, 2005 and 2020 121 A3.2 Total Private Spending on Outpatient and Inpatient Care
by Disease Group, East and Central Java, 2005 and 2020 123 A3.3 Number of Hospital Bed Days in the Context of Current
Capacity with an Occupancy Rate of 90 Percent, East
and Central Java, 2005 and 2020 124
A3.4 Cumulative Public Sector Spending and Total Cost of Infrastructure Investment Needed between 2005 and 2020
by Scenario, East and Central Java 125
A3.5 Reporting of Chronic and Acute Illnesses by Income
Group, Delhi 132
A3.6 Self-Medication in the Institute of Socioeconomic
Research on Development and Democracy Sample 134
Tables
2.1 Share of Disease Burdens Falling on Those between the Ages of 15 and 69 in Low- and Middle-Income
Countries, 2005 19
2.2 Selected Cost-Effectiveness Ratios for Interventions
against NCDs 33
2.3 Illustrative Matrix on the Economic Rationale for Public
Intervention in NCDs 40
A1.1 Cost of Illness Studies for Noncommunicable
Diseases and Risk Factors 62
A1.2 Estimates of the Annual Per Capita Burden of Cardiovascular
Disease, Selected Countries, 2000 64
A1.3 Estimated Prevalence of Diabetes among Those aged 20–79 and Direct Medical Costs Attributable to
Diabetes by Region, Selected Years 64
A1.4 Household Impacts of Chronic Diseases and Risk Factors 65 A2.1 Expected Decrease in Cigarette Consumption per 10 Percent
Rise in the Real Price of Cigarettes, Selected Developing
Countries, Circa 2000 81
A2.2 Cost-Effectiveness of Interventions to Control Tobacco
Addiction 85 A2.3 Cost-Effectiveness of Interventions to Reduce High-Risk
Alcohol Use by World Bank Region 89
A2.4 Incremental Cost-Effectiveness Ratios for Legislation Substituting 2 Percent of Energy from Trans Fat with
Polyunsaturated Fat, by World Bank Region 96 A2.5 Cost-Effectiveness Ratios for Interventions Aimed
at Preventing Cardiovascular Conditions Compared
with No Treatment 105
A2.6 Cost-Effectiveness Ratios for Different Cervical Cancer Screening Tests, Selected Developing Countries 107 A3.1 Total Number of Outpatient Visits and Inpatient
Bed Days by Disease Group, East and Central Java,
2005 and 2020 122
