Every year, 40 million people around the world die from noncommunicable diseases (NCDs), including heart and respiratory ailments, diabetes, and cancer. Major NCD risk factors, such as tobacco smoking, harmful alcohol use, and obesity are increasing worldwide, including among adolescents. Two-thirds of premature NCD deaths among adults can be traced back to behaviors initiated during young age and adolescence (between the ages of 10 and 19. From a “life course” perspective, a multi-pronged approach to tackling NCD risk among adolescents has the potential to offer a high return on investment to countries looking to reduce NCD burden and increase their population’s productivity and overall well-being. We conducted an economic analysis to determine the potential costs and return on investment for implementation of interventions for adolescent NCD risk reduction globally.
Population-level economic analyses have been conducted on NCD risk reduction, but these have largely been focused on adults. Our research sought to analyze the potential global health impact and costs of implementing NCD risk reduction interventions among adolescents. We identified six preventative interventions targeted at three NCD risk factors:
- Adolescent tobacco smoking (increase in excise tax and point-of-sale advertising ban)
- Heavy episodic drinking (increase in excise tax and complete ban on alcohol advertising)
- Obesity (excise tax on sugar-sweetened beverages and school-based physical activity and nutrition programs)
These interventions are validated with effectiveness and cost-effectiveness evidence. We assessed the potential deaths averted globally from fully implementing these interventions over 2020-2070 in 70 countries which represented 86 percent of the total global population in 2015.
Our findings show that full implementation of all six of the evidence-based interventions we reviewed would reduce premature mortality among today’s adolescents by almost 10 percent. This translates into 21 million avoided premature deaths from NCDs over the next 50 years and about US$400 billion in cumulative economic benefits. Cumulatively, the required costs to implement this package of interventions for the 70 countries we studied would be about US $75 billion. This suggests that for every US$1 invested in tobacco, alcohol and obesity interventions targeting adolescents, there would be an increase of US$5 in the form of human capital. Dollar for dollar, and in terms of total population benefits, tobacco control generates the most gains in human capital, with more modest gains from alcohol and obesity interventions.
Adapting interventions to local needs
Though tobacco shows the greatest gains in human capital per dollar spent, an in-depth analysis of three countries (Indonesia, India, and Kenya) illustrated the potential for different priorities—such as alcohol control—to emerge. In our country analyses, we worked with local experts to adapt this six-intervention package to their country contexts, and variations emerged when applying these recommendations to local contexts. For more information, read our published research briefs on the investment case for Indonesia, India, and Kenya NCD risk factor reduction. Other countries can use this package as a starting point for local analysis and development of a customized implementation plan for adolescent NCD-related interventions.
Opportunities for research in low- and middle-income countries
Globally, in 2016 the number of overweight children under the age of five was estimated to be over 41 million. Almost half of all overweight children under 5 lived in Asia and one quarter lived in Africa. In light of these concerning worldwide trends in child and adolescent body-mass index, more evidence is urgently needed on approaches to reducing obesity that are scalable and cost-effective. Scores of published, effective programs for school-based obesity prevention are now available as templates for designing local programs. However, most adolescent obesity research is still being conducted in high-income countries. This warrants more research on scalable models of obesity-related behavior change in diverse country settings, especially in low- and middle-income countries with careful assessments of costs.
Focusing on adolescents brings long-term benefits
Tackling NCDs can seem like an insurmountable goal for many low- and middle-income countries who currently have limited fiscal and implementation capabilities and other competing priorities, such as infectious disease control. Our analysis provides a strong, quantifiable justification for prioritizing adolescent health and well-being within the global NCD agenda and for prioritizing NCD prevention as a long-term development issue in the adolescent age group. By intervening now and implementing these policies, countries can significantly reduce premature mortality from NCDs at reasonable costs, contributing to their country’s productivity and longevity.The authors acknowledge the support of Plan International UK, who commissioned this work through a charitable grant made by the AstraZeneca Young Health Programme (YHP).