The Challenge of Non-Communicable Diseases and Road Traffic ...
The Challenge of Non-Communicable Diseases and Road Traffic ...
The Challenge of Non-Communicable Diseases and Road Traffic ...
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4. THE RATIONALE FOR<br />
PUBLIC INTERVENTION<br />
This section describes the rationale for public intervention<br />
on NCDs <strong>and</strong> RTIs, under the following<br />
headings:<br />
• Economic rationale<br />
• Human capital rationale<br />
• Development rationale.<br />
4.1. Economic Rationale<br />
Experiences from different countries suggest that<br />
NCDs <strong>and</strong> RTIs may impose a huge financial <strong>and</strong><br />
social burden on government <strong>and</strong> society [156-157].<br />
As detailed in Box 2, recent assessment conducted<br />
in the Russian Federation <strong>and</strong> in China clearly illustrates<br />
the magnitude <strong>of</strong> this burden.<br />
Interventions for the prevention <strong>and</strong> control <strong>of</strong><br />
NCDs have been identified which are highly cost-effective<br />
[160]. Investment in their implementation is<br />
justified in economic terms in that the potential welfare<br />
gains <strong>and</strong> economic losses that could be averted<br />
are considerably larger than the investments themselves<br />
[161]. Justification can also rely on a rightsbased<br />
argument for NCD services: the raison d’etre<br />
<strong>of</strong> a health system is to address health conditions<br />
prevalent in the community, <strong>and</strong> health systems <strong>and</strong><br />
governments need to be responsive to the needs <strong>of</strong><br />
their citizens.<br />
While the largest share <strong>of</strong> costs <strong>of</strong> disease are borne<br />
by the individual concerned, the economic case for<br />
government action relates to ‘market failures’. <strong>The</strong>se<br />
are areas where the market alone fails to achieve socially<br />
optimal outcomes [162]; namely:<br />
• Externalities: <strong>The</strong>re are substantial external costs<br />
resulting from second-h<strong>and</strong> smoke <strong>and</strong> alcohol-induced<br />
RTIs <strong>and</strong> fatalities. NCDs also impose<br />
costs on health care <strong>and</strong> the social insurance<br />
system <strong>and</strong> hence on “third parties”.<br />
• Imperfect information: People are not always fully<br />
aware <strong>of</strong> the health (<strong>and</strong> other) consequences <strong>of</strong><br />
unhealthy lifestyle choices such as smoking, alcohol<br />
abuse, physical inactivity, <strong>and</strong> poor diet.<br />
<strong>The</strong>y may also be misled by deliberately distorted<br />
information promoted by the food, alcohol, <strong>and</strong><br />
tobacco industries. Government intervention in<br />
the form <strong>of</strong> the provision (<strong>and</strong> production) <strong>of</strong> NC-<br />
D-related health information (such as the health<br />
consequences <strong>of</strong> smoking) provides a public good<br />
that generally is undersupplied compared to the<br />
social optimum. This also includes the role for a<br />
government to engage in research about the health<br />
consequences <strong>of</strong> unhealthy behavior.<br />
• <strong>Non</strong>-rational behavior: Children <strong>and</strong> adolescents<br />
(<strong>and</strong> even adults) tend not to take into account<br />
the future consequences <strong>of</strong> their current choices,<br />
irrespective <strong>of</strong> whether they are informed about<br />
them or not. <strong>The</strong>ir current choices may well conflict<br />
with their long-term best interests. This provides,<br />
in principle, a justification for government<br />
to support interventions to prevent people from<br />
harming themselves in situations where they do<br />
not fully appreciate the consequences <strong>of</strong> behaviors<br />
that pose health risks.<br />
<strong>The</strong>re are two distinct rationales for public policy<br />
intervention to achieve a net improvement in social<br />
welfare, one equity-based <strong>and</strong> one efficiency-based<br />
[163]. Regarding NCD prevention <strong>and</strong> treatment in<br />
low- <strong>and</strong> middle-income countries, these could be<br />
framed as follows [160]:<br />
• For primary prevention, which is mainly through<br />
population-level <strong>and</strong> non-clinical interventions, a<br />
regulatory <strong>and</strong> fiscal framework is needed to limit<br />
externalities relating to tobacco (such as harm<br />
<strong>and</strong> associated costs resulting from second-h<strong>and</strong><br />
smoke) <strong>and</strong> alcohol (such as social harm <strong>and</strong> RTIs<br />
<strong>and</strong> deaths). Information can be provided in culturally<br />
appropriate formats about the various risk<br />
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