1. Phuza
HealthWize
Supplement to the JuMail & Guardian July 29 to August 4 2011 1
Supplement to the November 11 to November 17 2011
April 15 to 20 2011
Prevention matters for a healthier SA
supermarket, the local fast food out- projected to increase by 40%.
Prevention is the
cure for a number of
let and the school cafeteria. For
example, two-thirds of households
In the Western Cape, there are
three to four amputations a week
Rising cost of non-communicable diseases
in rural SA now buy their food from from preventable diabetes compli- Total estimated cost of scaling up “best buy” population-based interventions
diseases which supermarkets, where access to cations. These numbers are made in all low- and middle-income countries
plague South cheap nutritious food remains a worse by the fact that many patients
$-billion (in 2008 dollars)
challenge. die prematurely without ever know-
Africans Therefore, even as people have ing they were suffering from one of 14 Cost of NCD risk-factor interventions
Tobacco, alcohol, diet, physical activity
access to a wider variety of foods, these silent killers.
Karen Hofman and their choices are limited to highly In South Africa, 35% of these Cost of interventions for NCDs
Stephen Tollman processed products, which carry the deaths occur before the age of 60. Cardiovascular disease,
very ingredients that cause non- The economic toll of this epidemic 12 diabetes, cancer
L
communicable diseases. Other risk on the healthcare system and on
ast month’s United Nations factors for conditions like diabetes, families is already tremendous.
session on non-communi- cancer, heart disease and chronic
cable diseases (NCDs) has lung disease include poor diet, lack Creative approaches 10
finally alerted the world to of physical activity, smoking and the We need urgent solutions for South
the threat posed to social harmful use of alcohol. Africa to reach its stated life expec-
and economic development by four tancy goals of 58 years for men and
major NCDs: cancer, heart disease, Preying on the poor 60 for women by 2015. At a time 8
$-bn
diabetes and chronic lung disease. Still, the most important risk factor when there are competing pressures
Not only do the costs of managing is poverty. For most poor people, for scarce healthcare resources, we
these so-called lifestyle conditions cheap, nutritious foods and safe need to focus on finding creative
(because they are a result of life- areas to exercise, walk, bike or play approaches that provide good value 6
style) disproportionally affect are in short supply. Recreational for money.
household savings for individuals, centres and swimming pools are off At the same time that government
but they also impact the next gener- the radar entirely. officials are improving primary care
ation, which undermines income While heart disease is often to better treat non-communicable
4
security. thought of as a disease of the diseases, we must invest resources
The intergenerational impact of wealthy, in South Africa stroke into preventing these conditions in
NCDs is most pronounced for fami- resulting from hypertension is more the first place. While the healthcare
lies in low and middle income coun- strongly linked to poverty. system itself is important to fighting
2
tries like South Africa. The potential This is largely because many these diseases, there are a number
future costs are daunting and with- people living in rural and informal of reasons to look beyond the tradi-
out serious attention are set to urban areas remain undiagnosed tional tools of hospital, doctors and
balloon. and untreated. Sadly, the risk nurses.
While strong health systems will of stroke for an untreated hyper- First, building fully functioning 0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2012 2022 2023 2024 2025
be critical to ward off this growing tensive patient is triple that of and efficient health systems will
epidemic, fortifying the health care someone who is on the necessary take time. Non-communicable diseases are non-infectious diseases or medical
infrastructure will take several medications. Second, interventions outside the conditions such as heart disease or cancer. Graphic: JOHN McCANN Source: WHO
years. We cannot afford to wait to In a country where roughly half of healthcare infrastructure allow pol-
address an epidemic that is as seri- all individuals are living below the icy makers to engage in large-scale
ous as HIV/AIDS. We must start by poverty line, the impact of these dis- prevention measures for a relatively
focusing on prevention efforts that eases is particularly pronounced. small amount of money. individually targeted interventions. correspond with the percentage of
target actors outside the healthcare Close to 25% of all schoolchildren in For example, the WHO puts the (Population-based measures are fat in a product. Brazil’s “Zero
system. SA are now overweight. Many of price tag for NCD population-based typically instituted outside the Hunger” programme features subsi-
Some NCDs are caused by invisi- them are poor and the majority of measures for upper middle income health care system and target dised produce markets and state-
ble viruses that lead to liver and cer- them are female — despite persist- countries like South Africa at groups of people, while individual- sponsored low-cost restaurants.
vical cancer, but many are visible in ing under-nutrition in some com- approximately R150-million per based measures are typically deliv-
our daily lives. The vectors of this munities. In the next 20 years, year. This is a mere fraction of the ered in primary health care settings Progress?
epidemic can be purchased in the deaths from heart disease alone are estimated annual R1 125-billion for and target a single patient). South African policy makers have
With a raging HIV/ TB epidemic developed a number of promising
and high rates of child and maternal strategies along these lines,
mortality, policymakers face tough especially with regard to tobacco
What is a best buy?
choices in terms of how to invest control. Over the past two decades,
scarce resources. legislation which raised tobacco
taxes and banned indoor smoking
led to a significant drop in smoking
and concomitant reductions in ill-
A best buy can be defined in two ways: Best Buys for tackling diet, physical activity and Management across all ness and premature death. Unfor-
• If you had a million rand for health what would be the best obesity ( Lancet – Cecchini et al 2010) sectors can promote tunately, tax rates are not keeping
pace with market demand and a
way to spend it? How many lives could be saved? OR
healthy habits through
• Identifying low cost effective interventions to prevent death Cost in rand per head shocking 25% of 15-25 year olds are
and disability, strategically planning how and where to (2010)
the workplace now smokers.
invest scarce health care resources There is still much more to be
Fiscal measures ( e.g. taxes) R 0.20 Thinking beyond the health sys- done. Food industry chiefs need to
Note: A best buy can be in the health system and focused on Food advertising regulation R 0.90 tem itself, our prevention efforts explore ways to engage with the gov-
the individual or may be population-based and outside the Food labeling R 2.50 must focus on the nexus between ernment and to deliver products to
health system NCDss and agriculture, education stem the tide of non-communicable
Worksite interventions R 4.50 the workplace and the political diseases. This may not be so simple.
Mass-media campaigns R 7.50 arena. A number of countries have For example, a move by the French
HIV Best Buys: Copenhagen Consensus Center – already begun to do just that. government to impose a tax on soft
School-based interventions R 11.10
September 2011 Successful policies to tackle popula- drinks has met with resistance from
• Safer blood supplies cheapest and most cost-effective Physician counseling R 11.80 tion-wide prevention include bans the beverage industry. In the pack-
intervention on food adverts that target children aged food industry, because the top
• Mass infant circumcision Top best buys in sub-Saharan Africa and instituting nutritious school 10 food companies only account for
• Preventing mother to child transmission (Laxminarayan R et al 2008 – Using Best Buys to food policies. 15% of sales, corporate leaders may
• More investment in vaccine research advance Global Health ) In the UK and Australia, industry need to build a coalition of multi-
• Maximising treatment coverage for people with low CD4 • Childhood immunisation is spearheading an effort to gradu- nationals and smaller enterprises to
counts • Prevention of traffic crashes ally reduce salt in processed foods. produce healthier products.
• Malaria prevention In 2011 Denmark imposed a “fat tax” We must also engage teachers and
Note: Over the next five years, neither treatment nor prevention • Prevention of cardiovascular diseases on fatty foods in an effort to con- principals in the fight against NCDs
alone will have sufficient impact on new infections. • HIV/AIDS prevention vince Danes to eat more healthily. in schools. This means doing more
The tax is structured so that rates to page 2

2. 2 Supplement to the Mail & Guardian November 11 to November 17 2011
Phuza Wize Sponsored feature
The role of a health promotion
from page 1
than just providing healthy options
in the cafeteria. Educators need to
create a curriculum that produces a
foundation in SA
generatio n t ha t un de rstands
nutrition.
Bosses and managers across all
sectors can promote healthy habits
through the workplace. They must
provide healthy food choices in can-
teens and breaks to encourage phys-
ical activity. Studies suggest that chance of being admitted to hospital with positive blood alcohol levels. ing is normal”; “Alcohol is used by
Professor Sebastian van As
putting in place innovative health with an injury then a child growing Of all homicides – the most common attractive, successful and healthy
policies like these boost morale and up in Birmingham, UK. cause of non-natural death (44% people who are sexy, popular, charm-
C
improve the reputation of the ontrary to common belief, At the trauma unit approximately as opposed to 27% for transport- ing, independent and strong”;
business. disease is a rather fluid con- 10 000 children are treated annually, related injuries) – again more than “Drinking is safe; otherwise why
Executives should also establish cept influenced by societal of which 3 000 are seriously injured 50% were alcohol-related. Of these, would so many people drink?” and
facilities for working mothers to and cultural attitudes that and require to be admitted. 89% had blood alcohol levels of more “Drinking is relaxing”.
express breast milk. This would go a change with time and in response One of the most prominent activi- 0.05g/100ml. Of all firearm-related However, it is sad to know that a
long way to improving outcomes for to new scientific and medical ties of Childsafe was the support deaths, 43% were alcohol-related, great percentage of children who
the next generation. Research shows discoveries. for the child-friendly new Firearms with 77% of all deaths due to sharp start drinking young will end up as
that breast-fed children are much Commonly also, a duality is intro- Bill which has reduced the number objects having positive alcohol levels, alcoholics (especially when starting
less likely than their formula-fed duced regarding one’s health status: of gunshots in children treated in compared to 54% for assaults with a to drink before the age of 14), that
counterparts to grow into obese one is either sick or healthy. our hospital by 70% since 2000. It blunt instrument, 26% for strangula- alcohol-related accidents are one of
adults. The function of the health care also had a drastic effect on national tion and 45% for burns. the main killers of young people and
systems (public health, hospitals, mortality as a result of gunshots, that up to 70% of interpersonal and
Engage on all levels clinics, general practitioners, mid- reducing it by 50%. Childsafe fur- domestic violence is alcohol induced.
Finally, policy makers need to fully wives) is predominantly seen as thermore contributed significantly The success of efforts to curb the
engage in this crisis. They need to being active in the sphere of “treat- to the World Report on Child Injury
Exposure to alcohol ill-effects of alcohol abuse on society­
build governance structures that ing” disease. Prevention published by the WHO advertising and alcohol seems to depend on the ability of
allow multi-sectoral engagements to However, the relation between in December 2008. Whereas there
enjoyment in the media health professionals to step outside
occur. For example, the national health and disease is a complex are significant campaigns to increase of their safety zones and reconcile
planning commission could ensure entity and at least four different vaccinations for infectious diseases, predict more frequent rather than compromise scientific
that all relevant ministries – from concepts are used. In the first one, child accident prevention is seriously and heavier drinking exactitude with the grim realities of
sports and recreation to trade and one is either sick or healthy. The cat- neglected in the third world. Too South African society, in which the
industry – coordinate around egories are mutually exclusive; one often it is forgotten that child health among young people lives of many are under a continuous
needed prevention interventions. is either sick or healthy and there and safety is a matter for adults. and great threat as a result of almost
is nothing in between. In a second Recently, the strong correlation exclusively preventable causes.
concept, there is an additional kind Children suffer more between intimate partner abuse and Recently, there have been strong
SA needs a focus of “neutral” area between health South Africa suffers particularly alcohol abuse by a male partner has voices by the provincial minis-
and sickness. One is either “sick”, heavily from negative consequences also been reported. Alcohol is also an ter, Theuns Botha, as well as the
on prevention and “healthy” or “normal”. In a third associated with the use of alco- important co-factor for risky sexual national Minister of Health, Aaron
non-health sector concept, health and disease are hol. Trauma is the leading cause of behaviour and HIV transmission, a Motsoaledi, for a more integrated
distinctive categories, but not each
interventions that target other’s antagonists. There is a kind
lifestyle conditions of overlap, in which one can be sick
and healthy. Finally, in a fourth
Equally important, policy makers concept, health and disease are
will need evidence on which to extremes on a sliding scale. There is
launch their policies. While global no absolute difference between dis-
and regional research on best buys ease and health, but only a gradual
in the fight against NCDs provides difference and there is a fluent tran-
some guidance, we need data spe- sition from health into disease.
cific to South Africa.
Not all prevention is cost effective What is disease?
or effective; we need to build a con- Disease is often defined as failure of
text-specific evidence base for pre- the adaptive mechanism of an organ-
vention interventions. These must ism to counteract adequately, nor-
be informed by local realities and mally or appropriately the stimuli
drivers that include demographic and stresses to which it is subject,
changes, the rising demand for food resulting in a disturbance in the
and competing economic develop- function or structure of some part of
ments in the region. Effective pre- the organism.
vention of obesity, for example, may There is no doubt that from a polit-
need to account for post-apartheid ical point of view too much stress has
internal migratory patterns or the been directed at the management of
impact of food products that are the burden of disease, rather than on
sold in the informal sector. the promotion of health.
As health minister Aaron According to the World Health
Motsoaledi has noted, we face tough Organisation (WHO), health has
choices and tackling NCDs cannot been defined as “a state of com-
be done by the health sector alone. plete physical, mental, spiritual and
Just as the causes of these diseases social well-being, and not merely the
are found in our supermarkets, our absence of disease and infirmity”.
cafeterias and our kitchens – indeed, What can society do to promote
in all sectors of society– so too are health?
the solutions. According to the predictions of
While we cannot forget the role of the WHO, trauma will be the big- Child safety is an adult responsibility
the health sector, we must also look gest killer by 2020 since other causes
beyond to identify efficient such as infectious diseases and cardi- admission to hospitals in all South wide range of social problems within approach to injury prevention. The
approaches. By focusing on preven- ovascular diseases will decline in the African provinces and the leading the welfare system and violent medical profession is often at the
tion and non-health sector interven- next decade. cause of childhood deaths between crimes affecting all departments in very forefront of treating the results
tions that target lifestyle conditions, Globally, trauma is a leading cause the ages of one and 18 years. A South the justice and protection cluster. of the persistent onslaught on the
South Africa can achieve good bang of childhood death between the ages African multi-centre study demon- innocents (many of them children)
for its buck. While these diseases of one and 18 and each year approxi- strated that over half of all patients Do more than advertise within our society and therefore
may be non-communicable, by join- mately one million children die from presenting to trauma units were vic- Since the effects of alcohol on the should also be at the forefront of a
ing forces to address them, the solu- the three big killers: motor vehicle tims of violent injuries. Across sites South African society are enormous, health promotion foundation.
tions can be contagious. accidents, drowning and burns. and for each respective year of the there is reason to believe that pres- A health promotion foundation
South Africa, with approximately survey, between 35.8% and 78.9% of sure from society can go long way to will be able to make a major contri-
Karen Hofman and Stephen Toll- 40% of its population being children, patients tested positive for alcohol. It alleviate this scourge. For instance, bution, in a unified and organised
man are based at Wits University’s is no exception. was concluded that efforts to combat research indicates that young chil- voice, from health professionals as a
School of Public Health and lead an In South Africa each year at the abuse of alcohol are paramount dren respond to adver­ ising on an
t broad-based and authoritative advo-
initiative on priority cost-effective least 6 500 children between the in reducing the burden of injuries on emotional level, and as a result do cate for health and safety. It will be
lessons for systems strengthening. ages of one and 14 die as a result health care services. change their beliefs and expecta- the key to elevate injury prevention
Contact Karen.Hofman@wits.ac.za of unintentional injuries. This is According to the third annual tions about alcohol. The alcohol from its dubious current status to its
approximately 10 times more than report of the national injury mortal- beverage industry is extremely rightful place as a national health
in Western European countries. ity surveillance system, over 50% of sophisticated in developing market- priority.
Where generally the world is a patients dying in a transport-related ing. Exposure to alcohol advertising
dangerous place for children, this incident had elevated blood alcohol and alcohol enjoyment in the media Professor Sebastian van As is head
is even more so in low and middle content. The majority of these cases predict more frequent and heavier of the Trauma Unit at the Red Cross
income countries. Our own research (over 90%) were at levels greater drinking among young people. War Memorial Children’s Hospital
shows that a child growing up in than 0.05g/100ml. Pedestrians and Alcohol advertising continues to in Cape Town and president of Child-
Cape Town has a 25 times higher drivers had the greatest percentage spread untruths: “Alcohol drink- safe South Africa www.childsafe.com

3. Supplement to the Mail & Guardian November 11 to November 17 2011 3
Phuza Wize Sponsored feature
Vic Health: A
global pioneer
Persistence and and be a much stronger public voice
and advocate for key health issues
patience are key than government agencies.
factors in successful There is little doubt that even
stronger voices will need to be heard
health promotion in the next decades, as so much of
our health (or ill health) will be
determined by the actions of power-
By Rob Moodie ful commercial interests such as the
tobacco, alcohol, junk food and bev-
V
icHealth was established erage industries.
by an Act of Parliament in In partnership with leading NGOs
late 1987. But it was not a such as the Cancer Council, National
rapid process. It had taken Heart Foundation, Diabetes
Dr Nigel Gray, the then director of Australia and the Australian Drug
the Cancer Council of Victoria, over Foundation, VicHealth has pro-
19 years to bring his idea to fruition. moted active transport, pushed for
It took eight state health ministers changes in urban planning, tobacco
before he found one, David White, legislation, the regulation and
sympathetic and able to implement granting of alcohol licences, the pro-
his idea of using an earmarked tax motion and pricing of alcohol and
on tobacco to buy out tobacco spon- has been a global leader in the pro- Vic Health supported changes in urban planning to encourage physical activity
sorship, decrease tobacco consump- motion of mental health, to name
tion and fund other forms of but a few areas of activity. ing and convening power, health held in September in New York, a
­ lcohol, let alone mental health
tobacco control, health promotion promotion foundations can “play NCDs are now as much, or more, of issues and the inequities that under-
and health promotion research. Build capacity well above their weight”. a problem in low and middle pin all of these problems.
Ten years later, the legislation was VicHealth has had 24 years of This has been admirably shown by income countries as they are in high And what better way to fund these
changed with the result that only the investment in building the capacity other HPFs such as Healthway, income countries. NCDs like diabe- programmes than by using highly
federal government was mandated of these major non-governmental ThaiHealth, Health Promotion tes, cancers, cardio vascular and res- targeted and effective taxes or sur-
to collect excise taxes, thus prevent- organisations as well as in thou- Switzerland and Malaysian Health piratory diseases strike harder and charges on tobacco and/or alcohol,
ing states from collecting such taxes. sands of much smaller community Promotion Board. earlier in lower income countries which in turn reduce harmful con-
But the 10 years of support from all groups. In addition it has helped In Australia, the work of Health­ and hit the poorest hardest. The sumption of unhealthy products? It
political parties meant that build a cadre of epidemiologists, way and VicHealth has greatly con- World Health Organisation predicts may take a while to establish, but as
VicHealth continued unchanged. social scientists and health promo- tributed to the development of the that they will be the major cause of we have seen from the work of Dr
In 1998 I was lucky enough to be tion researchers through designated national preventative health strat- death in Africa by 2030. Nigel Gray, persistence and patience
appointed CEO, inheriting a highly research funding. egy and the recent establishment of Not only will greater advocacy be are key factors in successful health
respected and effective organisation. Health promotion foundations the Australian National Preventive needed, but greater levels of promotion.
can work across all levels of govern- Health Agency. research, work force development
Lean machines ments (national, state, provincial and programme implementation Rob Moodie is Professor of
Health promotion foundations and local) with ease while also Staring death in the face and evaluation will be required if we Global Health at the University
(HPFs) are by nature relatively lean working across many disciplines As was demonstrated at the United are to be able to effectively deal with of ­ elbourne’s Nossal Institute
M
and supple organisations that can and sectors. By virtue of this inde- Nations high level meeting on non- the epidemics of tobacco, obesity and was CEO of VicHealth from
understandably act faster, innovate pendence and their strong network- communicable diseases (NCDs) and harmful consumption of 1998-2007.
Rationale for establishing a Health Promotion Foundation
Professor Davison Munodawafa
outcomes are produced by a com- Health promotion situation mation giving / awareness crea- Globally, examples and evidence
plex mix of social, economic, envi- and challenges tion and little efforts that seek to exists regarding innovative financ-
ronmental and political factors that The landmark decision to adopt address enabling and reinforcing ing health promotion options and
H
ealth promotion is a core often exist outside the domain of the health promotion was taken at the factors influencing behaviors and their efficacy and effectiveness.
function of public health. It health sector. 1st Global Conference on Health health outcomes of individuals and South Africa stands on the verge
is a cross-cutting, cross-sec- The required interventions to pro- promotion organised by World communities. of taking a lead in demonstrating
toral and cross-disciplinary mote health are built on sound stra- Health Organisation in 1986. It These actions are evident across that innovative financing of health
action applicable across all public tegic actions, policies, legislations, was agreed that health promotion preventable conditions such as promotion is feasible even under
health conditions. content and skills derived from disci- should involve other players (com- HIV/AIDS, malaria, tuberculosis, these difficult economic periods.
Health promotion enables people plines such as education, marketing, munities, civil society and private maternal and child health issues The Health Promotion Foundation’s
to increase control over the health social sciences and the arts among sector) to promote, support and and injuries among others. role would be to (a) manage and
risks and their determinants, and other fields. Therefore, these inter- protect health through policies and To date, there is no country in coordinate funds; (b) ensure
thereby improving their health out- ventions should adopt multisectoral legislations, human and infrastruc- Africa with a sustainable mecha- a
­ dequate and sustainable financing
comes. In that regard, health promo- and interdisciplinary approaches ture capacity building, financial nism for financing health promo- arrangements; (c) increase aware-
tion is a public good and ultimately to effectively and comprehensively resources mobilizing and generat- tion such as a Health Promotion ness about health gains; (d) produce
a justifiable social investment which address potential causes of illness, ing evidence. Foundation. country-specific evidence; (e) ­ reate
c
produces desired health (well-being) disability and premature deaths The body of health promotion However, Thailand, Australia, the demand for health promotion;
and development outcomes across across disease-­pecific issues or
s knowledge related to content, prac- Tonga, Singapore and Fiji are (f) ensure broad participation and
population groups. However, health popu­lation groups. tice skills and evidence is widely among the countries with success- commitment; and (g) providing
embraced in the African coun- ful Health Promotion Foundations effective stewardship.
tries as is the case in other regions. funded using a tax levy on alcohol, A national social dialogue on
Countries considering innovative Primary health care is also widely
considered the cornerstone of all
tobacco or road use. There is ample
evidence to demonstrate that health
establishing Health Promotion
Foundation using tobacco and
­financing of health promotion should: health systems in Africa, however,
there has been a slow shift from
promotion works.
Ideally, the national health budget
a
­ lcohol tax should be opened at
all levels. This debate should take
curative to preventative services. allocation should provide adequate place at the political and decision-
• Integrate health promotion in all policies and translate the health promotion
Concerted efforts to strengthen financial resources to support making levels, civil society and with
financing policy options into action.
health promotion actions at the health promotion. parliamentarians focusing on legis­
• Forge partnership, alliances and networks with parliamentarians, civil society, individual, family and community However, due to the numerous lative action, policy options and
public and private sectors, academic/research institutions, development levels continue to be hampered public health needs competing innovative financing respectively.
partners including WHO and communities in order to open a national social by limited financial and technical against limited financial resources,
dialogue on financing health promotion policy options. resources. most of the national health budget The views expressed here are
• Identify leadership and delineate roles and responsibilities for establishing a To compound the problem, there goes for curative services and not solely those of the author.
Health Promotion Foundation as well as setting up legislative and regulatory is a lack of policies or legislative health promotion. Professor ­ avison Munodawafa
D
frameworks. frameworks to remedy the resource- Given that most causes of disease is the Co-ordinator of the Deter­
• Organise study tours to established health promotion foundations e. g. Thai gap situation. and premature death are prevent- minants and Risk Factors Unit in
Health Promotion Foundation, Thailand. Member States should seek technical Due to limited resources, we able through health promotion, it the Health Promotion Cluster at the
support from UN agencies such as the World Health Organisation. c
­ ontinue to witness activities that is prudent that other innovative World Health Organisation’s
predominantly focus on infor- financing options are explored. Regional Office for Africa

4. 4 Supplement to the Mail & Guardian November 11 to November 17 2011
Phuza Wize Sponsored feature
Lessons from Thailand
These frequently asked questions about Although this was in place for Some of these funds are set up What was the position of the
many years, there was no other within the government depart- Thai ministry of finance on a
health promotion foundations help SA to request by any other sector for a ments, while others are created for dedicated tax?
learn from the Thai experience similar surcharge. It is Parliament ‘s service or charity purposes. Most The ministry of finance opposed a
decision to enact other similar laws of these funds are set up by execu- dedicated tax because it is against
if it sees fit. tive order or decree and lack over- the ministry’s traditional practice.
Why is a health promotion not to have a surcharge or dedicated sight by the public or other auditing The health group then proposed
foundation needed? tax before the Thailand Health What is the alternative to a agency. changing from a “dedicated tax”
The main reason to establish a Promotion Act was enacted in 2001. health promotion foundation? They also fail to secure long-term (asking for 2% of all tobacco and
health promotion foundation is to A similar situation exists in SA. The real question is what other funding to support their activities alcohol taxes collected by the excise
address the need for securing sus- mechanism is there to ensure that and there are other issues concern- department) to a “surcharge tax”
tainable funding for health promo- What added value does a health promotion is incorporated ing transparency in the use and instead. This would require the
tion programmes, including alcohol health promotion foundation into the health system? administration of many of the exist- tobacco and alcohol industries to
and tobacco control. This budget bring? Either we retain the existing ing funds. pay an additional 2% of excise taxes
line is lower in the priority agenda a) Health promotion programmes financial procedure – which to the ministry of finance and to
and is under-resourced under the require collaborative partnership neglects health promotion – and How will good governance be divert this revenue into the health
national budget. from both government andnon- face the consequences of a growing ensured? promotion foundation.
Setting up a health promotion governmental sectors and pro- healthcare burden, or we impose The health promotion foundation’s Such an approach would enable
foundation is the most cost-effective mote inter-sectoral action and a surcharge tax on the alcohol and objectives and governance require- the ministry of finance to collect the
strategy for government to secure inter-organisational partnerships tobacco industries, with the oppor- ments should be clearly stipulated full amount of excise taxes paid and,
long-term funds for supporting at all levels, including commu- tunity to gain additional govern- in the legislation, specifically: at the same time, the extra 2% sur-
health promotion and tobacco con- nity engagement charge tax is channeled to the health
trol activities. in planning and promotion fund. In addition, effec-
Previously, there was also no decision- making. The real global cost of non-communicable diseases tive health promotion would save the
budget line or agency responsible b) The existing fund- government money by limiting
63% 9-million
for prevention and control of other ing system is tobacco and alcohol use, which
non-communicable disease risk fac- focused primarily would decrease the disease burden
tors such as alcohol control, traffic
accident control and promoting
physical activity.
on health care ser-
vices, with much
less emphasis on
36-million of all global deaths are due to NCDs people die too young from NCDs
(before the age of 60)
and health care expenditure. It
would also provide desirable and
sustainable funding for a broad
$1 to 3 58%
people die annually from NCDs
Many countries have reaped enor- health promotion range of health promoting initiatives
90%
mous benefits from the establish- programmes. that could clearly continue to bring
ment of a health promotion founda- c) A health promotion is the estimated annual Premature deaths among women immediate and major benefits.
tion. These include Australia, fund will be used cost a head of delivering due to NCDs range from as high as The Thai ministry of finance agreed
of these premature deaths because
Switzerland, Austria and Singapore. to support imple- essential NCD interventions 58% in low-income countries to to this new proposal and has since
of NCDs occur in developing countries
mentation of gov- in low-income settings as low as 6%, in high-income been collecting the 2% extra taxes for
countries. This leads to growing
$-billions
Why doesn’t the ministry of ernmental health- inequalities between countries the Thai Health Promotion Fund.
health request a bigger budget related policies and and populations
and conduct health promotion priorities in the What was the response of the
Hundreds of billions of dollars: It is the estimated cost of inaction due to current losses
activities? country. The only
in the national product ofdeveloping countries resulting from NCDs and shrinking workforce
general public to a health
It is not always possible or feasible to difference is that that curtails economic growth promotion foundation?
request additional funds to support the source of fund- Graphic: JOHN McCANN Source: WHO In Thailand, a public poll revealed
health promotion through the con- ing is derived from that the general public strongly
ventional budgeting system because a surcharge tax on tobacco and ment revenue to fund health promo- a) Objectives of this foundation supported the government’s pro-
of systemic issues such as complex- alcohol products, collected directly tion. The tax can be used to support b) Financial controls posal to set up a health promotion
ity and bureaucracy. The current from tobacco and alcohol produc- short and long-term health promo- c) Transparency and accountabil- foundation funded by additional
small health promotion budget var- ers and transferred directly to the tion and alcohol and tobacco con- ity procedures tobacco and alcohol taxes that
ies annually and is subject to policy health promotion fund. trol programmes, resulting in the d) Funding Sources focuses on main health promotion
changes with each new government. d) The health promotion fund is health and well-being of the public areas including tobacco and alcohol
In the case of Thailand, the budget managed differently from govern- improving over time, while the con- How does the Thai foundation control, road safety, exercise and
for the health promotion fund that ment agencies, but is audited by current health care expenditures link to the National Health nutrition. The poll also showed that
has been proposed is only about 1 to designated government agencies decline. Insurance Scheme? civil society and non-governmen-
2% of the national health budget. and Parliament. While the Thai government was tal organisations fully supported
Why do we need new funds? proposing a bill on universal health tobacco control and other health
Isn’t a surcharge tax or levy Won’t a special levy on alcohol Many existing funds do not care (insurance) coverage for all promotion initiatives.
against financial discipline and and tobacco set a precedent work well. How can anyone Thais, the health group simulta-
traditional practice? for more requests? guarantee that it is going to neously advocated for the health *This article is modified from
An additional or surcharge tax can The argument that imposing a sur- work in SA? promotion bill to government and content in Southeast Asia Tobacco
be viewed as a new mechanism, charge will set a precedent and may This argument is based on the Parliament, arguing that setting Control Alliance’s (SEATCA), “Lessons
and in the case of Thailand it is not disrupt the country’s financial disci- premise that there are various types up a health promotion fund is nec- Learnt in Establishing a Health
against any financial regulation. pline has not been the experience of of funds which are generally small essary to deal with the escalating Promotion Fund”, September 2011
It was a “financial discipline” or Australia, which implemented a sin but with the same objective of gen- health care costs that the universal and can be accessed on their website
“traditional practice” in Thailand tax for health promotion. erating funds for its cause. coverage scheme has to shoulder. www.seatca.org