The investment case as a mechanism for addressing the NCD burden: Evaluating the NCD institutional context in Jamaica, and the return on investment of select interventions

RESEARCH ARTICLE The investment case as a mechanism for addressing the NCD burden: Evaluating the NCD institutional context in Jamaica, and the return on investment of select interventions Brian Hutchinson ID1*, Roy Small2, Kofi Acquah3, Rosa Sandoval4, Rachel Nugent1, Delia Itziar Belausteguigoitia4, Nicholas Banatvala ID5, Douglas Webb2, Dudley Tarlton6, Alexey Kulikov5, Elisa Prieto7, Karin Santi8 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Hutchinson B, Small R, Acquah K, Sandoval R, Nugent R, Belausteguigoitia DI, et al. (2019) The investment case as a mechanism for addressing the NCD burden: Evaluating the NCD institutional context in Jamaica, and the return on investment of select interventions. PLoS ONE 14 (10): e0223412. https://doi.org/10.1371/journal. pone.0223412 Editor: Muhammad Jami Husain, Centers for Disease Control and Prevention, UNITED STATES Received: October 20, 2018 Accepted: September 5, 2019 Published: October 4, 2019 Copyright: © 2019 Hutchinson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant information are within the paper and its supporting information files. In addition, the authors have uploaded the OneHealth Tool file used for analysis, which contains the epidemiological inputs used in the analysis. Funding: This publication was supported by Grant or Cooperative Agreement number NU2GGH001873, funded by the Centers for 1 Center for Noncommunicable Diseases, RTI International, Seattle, Washington, United States of America, 2 HIV, Health and Development Group, United Nations Development Programme, New York, New York, United States of America, 3 Social Policy, Health and Economics Research (SPHERE), RTI International, Research Triangle Park, North Carolina, United States of America, 4 Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, D.C., United States of America, 5 UN Interagency Task Force on the Prevention and Control of Noncommunicable Diseases, World Health Organization, United Nations, Geneva, Switzerland, 6 Bureau Policy and Programme Support, United Nations Development Programme, New York, New York, United States of America, 7 Noncommunicable Diseases and Mental Health, Caribbean Subregional Program Coordination, Pan American Health Organization, Bridgetown, Barbados, 8 HIV, Health and Development Group, United Nations Development Programme, Panama City, Panama * Abstract Noncommunicable diseases (NCDs) are a broad challenge for decision-makers. NCDs account for seven out of every 10 deaths globally, with 42 percent occurring prematurely in individuals under age 70. Despite their heavy toll, NCDs are underfunded, with only around two percent of global funding dedicated to the disease set. Country governments are responsible for funding targeted actions to reduce the NCD burden, but among other priorities, many have yet to invest in the health-system interventions and policy measures that can reduce the burden. This article examines “investment cases” as a potential mechanism for catalyzing attention to—and funding for—NCDs. In Jamaica, using the UN inter-agency OneHealth Tool, we conducted an economic analysis to estimate the return-on-investment from scaling up strategic clinical interventions, and from implementing or intensifying policy measures that target NCD risk factors. In addition, we conducted an institutional and context (ICA) analysis, interviewing stakeholders across sectors to take stock of promising policy pathways (e.g., areas of general consensus, political appetite and opportunity) as well as challenges to implementation. The economic analysis found that scaling up clinical interventions that target CVD, diabetes, and mental health disorders, and policy measures that target tobacco and alcohol use, would save over 6,600 lives between 2017–2032, and avert JMD 81.3 billion (USD 640 million) in direct and indirect economic costs that result from mortality and morbidity linked to NCDs. The ICA uncovered government economic growth targets and social priorities that would be aided by increased attention to NCDs, and it linked these targets and priorities to the economic analysis. PLOS ONE | https://doi.org/10.1371/journal.pone.0223412 October 4, 2019 1 / 11 The investment case as a mechanism for addressing the NCD burden Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, the Department of Health and Human Services, The Task Force for Global Health, Inc. or TEPHINET. If there are any queries please contact salsop@plos. org. Competing interests: The authors have declared that no competing interests exist. Introduction Encompassing a wide range of diseases and mental and substance use disorders, non-communicable diseases (NCDs) account for seven out of every 10 deaths globally, with 42 percent of all NCD deaths occurring prematurely (among individuals under the age of 70) [1]. Moreover, the NCD burden is driven by a complex array of factors, including increasing life spans, and changes in urbanization, trade, and globally integrated markets that have increased populations’ exposure to environmental and behavioral risk factors [2] (e.g., air pollution, chemicals, tobacco and alcohol use, unhealthy diets, and physical inactivity). Cost-effective interventions to address NCD risk factors exist. However, many of these interventions require the meaningful engagement of sectors beyond health (e.g., ministry of finance collaboration to increase tobacco or alcohol taxes). Achieving multisectoral NCD action can be complex, especially when commercial and public-private interests linked to NCD risk factors lead to real or perceived incentive conflicts on whether to implement—and how to structure—policy measures. An additional challenge is oft competing perspectives, amongst both decision-makers and the general public, on the role of the individual versus the state in addressing the problem, particularly in relation to behavioral risk factors. As part of broader efforts to accelerate progress on SDG Target 3.4 to reduce premature mortality from NCDs by one-third by 2030, the World Health Organization (WHO) and United Nations Development Programme (UNDP)—in partnership with ministries of health —began conducting a series of national investment cases that examine the costs of NCDs, not only to human health, but also to health systems and national economies. The investment case initiative arose from national authorities’ expressed interest in economic arguments that can be used to advocate for NCD action to ministries of finance and other economic sectors of government, and supp (...truncated)