Holidays for me have always been about family and food. A time to relax, catch-up with loved ones and eat good food. When it’s our turn to cook, my husband and I take time to plan the menu. A central part of our meals are vegetables and fresh fruits but we have also learnt over the years that a good meal needs fresh ingredients, all procured as close to the preparation of the meal as possible.
Sri Lanka has not disappointed in its array of fruits and vegetables. I am still discovering the names of many; some of which I will never be able to pronounce for sure. Despite that, I love eating them!
Amongst my favourites are papaya, mangoes and kankun, the last for which I share a passion with my two pet turtles. But getting these vegetables and fruits from the same supplier on a constant basis is a challenge. Even common produce like onions, tomatoes, and cucumbers can be discoloured or squishy – not at all appetizing or conducive for a salad or other such type of fresh dish.
The price, of course, is the same whatever the quality. Fresh produce can be expensive, and regularly buying a variety of fruits and vegetables does strain the budgets of many families in Sri Lanka. Needless to say, this shouldn’t be the case in a country with such rich soils and plentiful sunshine.
The question of access to fresh and healthy food goes beyond our holiday tables. According to the World Health Organisation, 1 in 5 premature deaths in Sri Lanka are due to a non-communicable disease (NCD) such as diabetes, cardiovascular disease or cancer. Tobacco use, unhealthy diets, harmful use of alcohol and physical inactivity have all been identified as risk factors.
The real cost of smoking is high, especially high on your health. According to the World Health Organization (WHO), tobacco kills around 6 million people each year, out of which 600,000 are the results of non-smokers being exposed to second-hand smoke. The cost of smoking is also high on the global economy, as smoking burdens global health systems, hinders economic development, and deprives families of financial resources that could have been spent on education, food, shelter, or other needs.
Tobacco use is the world’s leading underlying cause of preventable death. It contributes to a great number of non-communicable diseases (NCDs), which account for 63% of all deaths. Prevention of tobacco use can significantly decrease the number of preventable deaths worldwide, encourage economic development, reduce poverty, encourage healthy lifestyle choices and support Sustainable Development Goals.
In order to prevent and reduce youth tobacco use, in February 2014 the U.S. Food and Drug Administration (FDA) put forward a national public education campaign titled “The Real Cost.” The following video is a part of this campaign:
2012 is off to a sobering start for those of us in the global health community, against a backdrop of continuing global financial volatility coupled with complex reforms at the Global Fund to Fight AIDS, Tuberculosis and Malaria. New research from the Institute for Health Metrics and Evaluation (IMHE) shows a slowdown—and perhaps a plateauing—of the historical growth in global health funding to which we have been accustomed during the past decade. This new reality is, rightly, leading to questions about whether substantial—if not radical—changes are needed in the highly fragmented global health ecosystem. And yet, at the same time, there are signs of new initiatives.
I believe the slowdown in global health funding requires adjusting our expectations in the coming years. Last fall, after participating in a number of inspiring discussions during the UN General Assembly, I reflected about each one of the critical global health priorities to which we have all pledged our support in recent years: the Millennium Development Goals (MDGs) for nutrition, child and maternal health, and HIV/AIDS, TB, and malaria, as well as non-communicable diseases. It struck me that while most of these health interventions are destined to help the same mother or child, we have created very separate initiatives and institutions to deliver on each. We have been able to elevate the awareness and commitments for each of these priorities, but now the challenge is, like Humpty Dumpty, how do we now put them all back together again?
Health systems are under pressure in Asia. Epidemiological and demographic transitions are taking place much faster than in Europe and America, in the span of a single generation. With the transition comes the non-communicable disease (NCD) epidemic that requires more sophisticated and expensive interventions provided by hospitals, inpatient or outpatient. Rapid economic development in Asia has lifted millions out of poverty and raised peoples’ expectations for services. Between China, India, Thailand, Philippines, Indonesia and Vietnam, expansion of health insurance coverage during the last decade has reached an additional one billion people, making services more affordable and thus increasing demand. Advancing medical technology eagerly awaited by specialist doctors sitting on top of health professional hierarchies further expands possibilities for treatment. The middle class votes with their feet and takes their health problems to medical tourism meccas like those in Bangkok and Singapore, voiding their own countries of additional income to health care providers. Policymakers are scrambling to expand hospital capacity, boost the pay of health professionals, and encourage investment to meet the demand.
But governments do not wait. They are exploring hospital autonomy, decentralization, user fees and private sector participation. These policies often pose risks that need to be mitigated by policies and institutional arrangements. For example, health care providers sometimes order unnecessary procedures to earn additional revenue, thanks to the powerful incentive of the fee-for-service payment mechanism and information asymmetry between the patient and health care provider. This can mean financial ruin for both the patient and new, relatively weak health insurance agencies.
Despite these challenges, hospitals aren’t high on the international health development agenda, save a few initiatives to improve quality and provider payment reform.
As a World Bank staff member, I feel privileged to have participated in two landmark global public health events.
In June 2001 at a UN General Assembly Special Session, world leaders collectively acknowledged—for the first time—that a concerted global response was needed to arrest the HIV/AIDS pandemic. This led to the establishment of the Global Fund and bilateral initiatives such as PEPFAR, which helped fund a scaled-up response to HIV/AIDS, as well as to malaria and tuberculosis. The net result for the most part has been impressive: a dramatic expansion in access to treatment that has saved millions of lives, a significant reduction in the vertical transmission of HIV (mother to child), technological progress resulting in cheaper, more effective treatments, and better knowledge about HIV transmission to guide prevention efforts—while highlighting the need to revamp health systems to make the effort sustainable.
I’m in New York this week at the UN Summit on Non Communicable Diseases (NCDs), where more than 30 heads of state, 100 ministers, international agencies, and civil society organizations are discussing a pressing global health issue: NCDs. This is a policy nod in the right direction, as NCDs have been largely ignored in development circles even though they cause two-thirds of all deaths in the world (most of them prematurely) and long-lasting ill health and disability, and due to NCDs’ chronic nature, increase the risk of impoverishing millions of people who lack or have limited access to health systems.