risk of developing both NCDs and NCD-related disabilities. Approximately 75 per cent of NCD deaths in LMICs occur in people over 60 (UN, 2011a). People with disabilities are also at risk of premature ageing. Older persons are not the only population affected by NCD-related disabilities. NCDs are a cause of disability throughout the life course and can start in infancy. There is now evidence that indicates many of the risks leading to NCDs originate in the early stages of life, influenced by maternal health, birth weight and post-natal environment. Young people are also affected by a range of NCDs, including childhood cancers – a leading cause of illness and death for children that can cause chronic health problems and disability years after treatment; and type two diabetes – which is steadily increasing in the young and is associated with a range of complications, including amputations, kidney failure and blindness. Both children and older people with NCD-related disabilities seldom receive adequate attention in health policy and service provision, and often face diminished quality of life. Implications for human development The NCD epidemic and associated disability across the life course have a significant impact on the three dimensions that sustain human development – economic growth, social equity and environmental protection. Economic growth: NCDs and disability impede economic growth by impacting on labour productivity and result in reduced gross domestic product. Over the next 20 years, NCDs will cost more than US$47 trillion globally, having represented 75 per cent of the global GDP in 2010 (WEF and Harvard School of Public Health, 2011). In LMICs, NCDs (including mental illness) are estimated to cause a cumulative economic loss of $21 trillion by 2030 (ibid). Demographic ageing will be a major factor in increasing health expenditure, particularly due to the increased prevalence of NCDs among older persons. At the household level, NCDs, disability and poverty reinforce one another. Disability limits employment and economic participation, can cause increased out-of-pocket payments for health care and is associated with higher rates of catastrophic expenditure and poverty. Social equity: People with NCDs and disabilities experience numerous barriers to social equity, including lack of access to health care and services, and limited access to quality education N o n - c ommu n i c a b l e d i s e a s e s a n d d i s a b i l i t i e s Dementia Civil society response Civil society organisations (CSOs) have been the strongest responders to the dementia challenge in the past and they have done that by creating support structures for those living with dementia and their relatives, gathering and providing information about many different aspects of dementia, advocating for improvements in the health and social care system, and raising money for research funding. A directory of CSOs can be found at www.alz.co.uk/associations Accessed 1 April 2015. National policy responses Most governments are woefully unprepared for the dementia epidemic, with only 20 countries having funded and sought to implement a national dementia plan. Without a plan, the risk is that health and social care systems will not cope with the increase in numbers and operate in crisis mode, escalating costs even further. Alzheimer’s Disease International (ADI) and the World Health Organization (WHO) have, in their joint report Dementia: A Public Health Priority (WHO, 2012) called upon all governments to make dementia a public health priority and recommended national plans. A key online resource for national plans is www.alz.co.uk/alzheimer-plans Accessed 1 April 2015. These high-level plans can promote the creation of infrastructure and accountability necessary to build dementiacapable programmes for the growing number of people with the disease. A comprehensive government plan to address the needs of people with dementia provides a mechanism to consider collectively a range of issues, including: • Promoting broad public awareness of Alzheimer’s and combating stigma • Identifying dementia-capable support services at all stages of the disease • Quantifying the number of individuals with dementia • Assessing and improving the quality of health care, social care, and long-term care support and services • Assessing availability and access to diagnostic services • Public health efforts to conduct surveillance and promote brain health Some Commonwealth nations have been in the forefront of the development and implementation of national government Alzheimer’s plans, with Australia and the UK each having delivered significant policy-altering strategies in their respective countries. New Zealand, Mauritius, Malta and Singapore have had significant policy activity short of a national plan and, at the time of writing, Barbados, Trinidad and Tobago, and Jamaica were in the early stages of information gathering about dementia issues in their countries. Michael Splaine, policy advisor, and Marc Wortmann, executive director, Alzheimer’s Disease International 92 Commonwealth Health Partnerships 2015 Dementia as a women’s health issue There is growing data and appreciation for the fact that women are more likely to be affected by dementia than men, as both the number of people who will develop dementia and as carers for those with dementia; women currently make up the overwhelming majority of family and professional carers. This has ripple effects in the social and economic development of countries that are only now being quantified and possibly accounted for in the revision of the MDGs and other global policy dialogue.
Commonwealth Health Partnerships 2015
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