Silent killer, economic opportunity: rethinking non-communicable disease

Non-communicable diseases (NCDs) are a major global challenge, one that causes most of the deaths and disability among humans. These diseases are not transmissible from one person to another. They include cardiovascular disease, cancer, chronic respiratory disease, diabetes and mental health disorders, but exclude injuries. Together, they caused 36 million deaths in 2008, more than three out of five deaths worldwide, and accounted for half of global disability. About one-quarter of deaths occur before the age of 60, mainly in low- and middle-income countries. Without preventive action, the number of deaths under 60 in poor countries will rise from 3.8 million each year to 5.1 million by 2030.1 For low-income countries, the challenge of NCDs compounds the difficulties of addressing infectious diseases, creating a double burden that causes poverty and slows development. The World Economic Forum predicts that NCDs will result in a cumulative loss in global economic output of $47 trillion, or 5% of GDP, by 2030, principally through heart disease, stroke, alcohol misuse and depression in high-and upper-middle-income countries

Global health funding: how much, where it comes from and where it goes.

Global health funding has increased in recent years. This has been accompanied by a proliferation in the number of global health actors and initiatives. This paper describes the state of global heath finance, taking into account government and private sources of finance, and raises and discusses a number of policy issues related to global health governance. A schematic describing the different actors and three global health finance functions is used to organize the data presented, most of which are secondary data from the published literature and annual reports of relevant actors. In two cases, we also refer to currently unpublished primary data that have been collected by authors of this paper. Among the findings are that the volume of official development assistance for health is frequently inflated; and that data on private sources of global health finance are inadequate but indicate a large and important role of private actors. The fragmented, complicated, messy and inadequately tracked state of global health finance requires immediate attention. In particular it is necessary to track and monitor global health finance that is channelled by and through private sources, and to critically examine who benefits from the rise in global health spending.

Salaries and incomes of health workers in sub-Saharan Africa.

Public-sector health workers are vital to the functioning of health systems. We aimed to investigate pay structures for health workers in the public sector in sub-Saharan Africa; the adequacy of incomes for health workers; the management of public-sector pay; and the fiscal and macroeconomic factors that impinge on pay policy for the public sector. Because salary differentials affect staff migration and retention, we also discuss pay in the private sector. We surveyed historical trends in the pay of civil servants in Africa over the past 40 years. We used some empirical data, but found that accurate and complete data were scarce. The available data suggested that pay structures vary across countries, and are often structured in complex ways. Health workers also commonly use other sources of income to supplement their formal pay. The pay and income of health workers varies widely, whether between countries, by comparison with cost of living, or between the public and private sectors. To optimise the distribution and mix of health workers, policy interventions to address their pay and incomes are needed. Fiscal constraints to increased salaries might need to be overcome in many countries, and non-financial incentives improved.