choices were not exclusive to industrialised nations, and recommended that prevention of NCDs must include a strong focus on adolescents and youth. Unhealthy behaviours are hard to change once they are established. Young people need to be protected from four main behavioural risk factors that contribute to NCDs: tobacco use, physical inactivity and/or lack of exercise, poor eating habits/unhealthy diets (foods containing high levels of saturated fats, trans-fats, sugar and salt) and harmful use of alcohol. Rapid urbanisation is a driving force behind some risks, as insufficient physical activity and unhealthy diets are quickly emerging in many LMICs. A focus on adolescents in national health programmes in every country is essential for preventing NCDs (WHO, 2002). Health care delivery systems can and should provide individualised, tailored prevention interventions, as evidence clearly demonstrates the effectiveness of certain clinical preventive services. In addition, advocacy by multiple stakeholders is required, including parents, teachers, youth leaders, non-governmental organisations, and political and religious leaders. Awareness and education regarding NCD prevention needs to include school and community-based programmes. Effective interventions include those imparting skillsbased learning, such as WHO/Unicef/UNFPA-designed life-skills education programmes, which develop peer educators to support and propagate healthy lifestyles. N o n - c ommu n i c a b l e d i s e a s e s During adolescence, health services should include careful attention to health promotion and prevention, as this is a time when young people can reduce their risks for many chronic conditions. Adolescents undergo many changes, both physically and socially, as they transition from childhood into adulthood. To realise their full potential, adolescents require support from their families, health care providers and communities to reduce threats to their health. Thus, preventive health strategies require collaborative efforts, involving guidance and support to promote healthy choices and healthy decisions. Treatment and care systems for children and adolescents Adopting a life-course approach to NCD prevention is imperative, but ensuring child health care systems have adequate detection, treatment and management services for children living with NCDs is also essential. Out-of-pocket spending can be enormously high when a child in the family has a chronic condition. Without a social safety net and in the absence of UHC, many families are pushed into a cycle of poverty if one of their members has an NCD. There are vast inequities in the level of care and survival rates for NCDs between high-income countries and LMICs. For example, while some childhood cancer is curable and survival rates of 80–90 per cent are seen in high-income countries, in LMICs comparable diagnoses survival rates are only ten to 30 per cent (Gupta et al., 2014). Similar disparities exist for type one diabetes; while clinical management significantly reduces deaths and the risk of complications, access to insulin and access to care for management varies greatly across countries. Some NCDs affecting children are not as common, but nevertheless impose a great burden on the affected children. These include diseases such as congenital adrenal hyperplasia (CAH), osteogenesis imperfecta and other chronic illnesses. These illnesses have a significant impact on the families and in many countries health systems do not provide access to the supportive services needed to allow these young people to live productive lives. Good health is both an outcome and a determinant of successful health care systems and health-in-all policies. Childhood NCDs are complex and may require a broad spectrum of care services, including health care, schools and social assistance. UHC financing and service provision should be prioritised and equitable health care systems should leverage inter-sectoral action to address the prevention, treatment and management of NCDs at all stages of life. Additionally, health care systems can and should engage young people and their families as equal partners in the fight against NCDs by empowering them to be active agents in their treatment and care, and supporting them to advocate for themselves and others. Young people impart innovative and energising ideas and solutions, and help bridge the gap between policy discourse and community implementation. They should be included in decisions and actions that identify, address, and allocate solutions and resources to the fight against NCDs. A call to action As the ministries of Commonwealth member states engage in the post-2015 development agenda, they must ensure that the needs Commonwealth Health Partnerships 2015 97 Coverage for cancer When it comes to cancer care, many insurance policies do not cover it or they might charge high premiums, rendering it too costly for many to obtain proper health coverage. This is the case for Jordan, a middle-income country. In many countries, Jordan included, adolescents tend to be regarded as a demographic that does not need cancer care coverage. To offset the risk of many teenagers not being able to obtain necessary treatment due to financial limitations or lack of a proper insurance coverage, the King Hussein Cancer Foundation developed a unique Cancer Care Program (CCP). The CCP is a non-profit coverage programme that provides cancer care coverage and guaranteed treatment at the King Hussein Cancer Center (KHCC) – a Joint Commission International-accredited cancer centre. There is a minimal annual subscription fee (premium), but no other insurance company in Jordan provides guaranteed treatment at KHCC. The programme offers a diverse range of premiums for different cancer coverage ceilings that start at US$18 a year for a policy with coverage up to $14,124 for children, teenagers and adults up to age 34. The premiums charged by the programme are used to support its operation. From an actuarial perspective, the premiums collected from teenagers subsidise the treatments costs of adults. The programme has no age limit or restrictions on subscriber nationality, provided there is no previous history of cancer. The ease and flexibility of the programme has allowed many to be insured and has driven corporations to insure their employees and families to insure their children. The programme has more than 120,000 subscribers and is growing.
Commonwealth Health Partnerships 2015
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