The Challenge of Non-Communicable Diseases and Road Traffic ...

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