Tag Archives: world health organization

Social Media and Suicide Prevention

In 2017, a 15-year-old girl from Bedford, PA, was trying to live an ordinary teenage life until her classmates began bullying her. They attacked her on social media sites like Facebook and Kik about her red hair and braces, some going as far as telling her that she should kill herself. Her mother remembers finding the young girl sobbing for hours because of what people were saying about her in school and online. Even though her mother took her phone and tried to comfort the girl, less than a week later she would die by suicide.

While the rate of death by suicide among teenage girls is at an all-time high, they’re not the highest risk demographic of the more than 40,000 people who die by suicide in the U.S. each year. According to the CDC, seven of 10 suicides in 2015 were men, making men 3.5x more likely than women to die by suicide. Now the third-leading cause of death among adults age 15-44 worldwide, the global rate of suicide will hit 1.53 million per year by 2020, which constitutes one death by suicide every 20 seconds, according to the World Health Organization.

Children as young as 11 are dying by suicide as a result of experiences on social media, and we know of at least three examples of children broadcasting their own death to live audiences using social media tools such as Facebook live, Twitter and YouTube.

How are leaders responding?

In response to these disturbing trends, Facebook has partnered with organizations like the National Suicide Prevention Lifeline to develop a set of tools intended to help individuals find resources and support who are considered “at risk” for self-harm.

The first of these tools is a new suicide-prevention feature on Facebook that uses artificial intelligence (AI) to identify posts indicating suicidal or harmful thoughts. The AI scans the posts and their associated comments, compares them with others that merited intervention and, in some cases, passes them along to its community team for review. The company plans to reach out to users it believes are at risk, showing them a screen with suicide-prevention resources including options to contact a helpline or contact a friend.

While in some cases the artificial intelligence software will notify the Facebook community if it flags a situation as “very likely urgent,” in most cases it will simply work in the background to offer messaging and advice to the friends and family of a person in need.

See also: Blueprint for Suicide Prevention  

Dr. John Draper, of the National Suicide Prevention Lifeline, said that he feels that the software sounds promising. “If a person is in the process of hurting themselves and this is a way to get to them faster, all the better,” he told BuzzFeed News. “In suicide prevention, sometimes timing is everything.”

Facebook is also making certain suicide prevention organizations available via Facebook Messenger, its instant messaging app. Facebook users will be able to flag posts that they feel indicate “at risk behavior,” which Facebook will respond to with an on-screen option to receive suicide-prevention resources.

Can we use social media to predict suicide?

New research out of Korea suggests that we might be able to begin using social media to predict suicidal behavior.

The three-year study looks at the social and environmental factors that contribute to suicidal behavior and describes correlations between public mood and suicide and how data from social media sources and weblogs (blogs) might be used to predict that behavior; their primary hypothesis being that social media variables are meaningfully associated with nationwide suicide numbers.

At the end of the study, the research team concluded that, “We found a significant association of social media data with national suicide rate, resulting in a robust, proof-of-principle predictive model,” and the team suggests social media data be used in future predictive modeling.

How suicide prevention advocates are using social media.

Sites like the Suicide Prevention Coalition of Colorado, the Mighty and To Write Love on Her Arms are also using social media to engage audiences with messages of help and hope.

The Suicide Prevention Coalition of Colorado, an organization of which the author of this article is a member, uses Facebook, Twitter and email newsletters as educational and communications tools to promote events, raise awareness of mental health legislation and bridge the gap between service providers across the state of Colorado that might not have the resources they need as solo practitioners.

To Write Love On Her Arms (TWLOHA) is a site that offers hope and help to those struggling with depression, addiction, self-injury and suicide.

With a Facebook following of more than 1.5 million and a Twitter following of nearly 300,000, they share individual stories of hope and recovery and work to destigmatize suicide and self-harm.

The Mighty is a blog with more than 5,000 contributors and 150 million readers that also gives people suffering from mental health disabilities a place to find resources, encouragement and support.

This site, like TWLOHA, focuses on shared experiences. Individuals struggling with disability, disease and mental illness write in and share their stories of hope and recovery.

Bell Canada, a telephone company in Canada, is running a “Let’s Talk” campaign dedicated to raising $100 million for mental health programs by 2020 and encouraging people to find the strength to come out and talk to someone if they find themselves struggling with thoughts of self-harm.

See also: 6 Things to Do to Prevent Suicides  

What you can do to get involved today.

Twitter is a wonderful conversation tool where you can do a search for keywords like #SuicidePrevention and become a part of the conversation with leaders, educators, individuals struggling and those with experience. A continued effort to destigmatize mental health issues helps those struggling realize that there is help.

You can use social media to interact with your legislature. Most politicians today are active on social media, and some even have live events on social media, giving us the opportunity to ask them where they stand on issues such as mental healthcare as well as share our opinions on the issues.

You can share resources on social media, especially around the death of a celebrity, to help further the conversation online and help someone find resources who might not have the strength to ask for help.

Finally, if you or anyone you know is struggling with thoughts of suicide and need to talk to someone right away, reach out to the National Suicide Prevention Lifeline at 1-800-273-8255 or visit online at http://suicidepreventionlifeline.org/talk-to-someone-now/.

If you need support for suicide grief or suicidal thoughts but are not in crisis, the National Suicide Prevention Lifeline offers resources on how to help either yourself or a loved one.

How Many Steps Mean Longer Life?

Fitness trackers can be a convenient way to monitor the number of steps taken every day. Some insurers have even started using them as a proxy for good health, selling life cover to people who are already fit and who track their steps. Insurers may even reward policyholders’ physical activity with lower premiums and other incentives.

The assumption is that regular exercise, especially the number of steps taken, is a predictor of lower mortality. Exercise is known to confer health benefit by improving mental health, reducing cardiovascular risk and lowering cancer mortality. The question is, how many steps might lead to a longer life?

Adult walking cadence is 100 steps per minute, a rate that demarks the lower end of moderate-intensity exercise. The World Health Organization suggests an ambitious minimum of 150 minutes of “moderate-intensity” aerobic physical exercise throughout the week, or 75 minutes of vigorous-intensity or a combination (setting aside recommendations for muscle strengthening). Public health authorities across the world have adopted these guidelines to help people improve health, build stamina and burn excess calories.

See also: Wearables: Game Changer or a Fad?  

Manufacturers of fitness trackers and wearable technology, ever since the Japanese pedometer that came out for the 1964 Olympics, have commonly set the goal at 10,000 steps a day, a marketing ploy not rooted in science or WHO guidelines. Although this “10,000 steps” goal varies greatly by leg length and gait, it translates into roughly five miles a day for the average person and remains a considerable distance, especially considering that the average British adult walks 3,000 to 4,000 steps daily. The figure encourages sedentary people to move but isn’t a magic number on a doorway to health nirvana. Even 5,000 steps a day could be too high for some older adults or people with chronic illness, but small increases will confer health benefits.

It’s also important to distinguish between incidental and session-based physical exercise. Incidental exercise is the result of steps taken during the course of the day to get us from A to B, but it neither accounts for the pace nor intensity of the exercise or the true level of fitness. A three-hour workout “session” requires a much higher level of fitness than just walking, not to mention a significant level of motivation.

Insurance products that discount for steps walked each day are likely to have broader appeal than those that mandate “session-based” exercise. Asking additionally for, say, three hours per week of sweat-inducing exercise could literally be a step too far. Those unaccustomed to such levels of exercise are likely to conclude that this insurance product is not designed with them in mind.

Recent evidence suggests activity tracking brings no immediate measurable health benefit but this misses the point. Regular exercise has benefits that are not necessarily related to easily measurable variables such as weight and blood pressure. It’s important to understand that long-term outcomes are what are important for insurers.

See also: Wearable Tech Raises Privacy Concerns  

Although the WHO recommends 150 minutes of moderate-intensity exercise a week for ages 18 to 64, a critical review of the literature indicates that just half this level still brings marked health benefits. This suggests insurers could lower the bar and design life insurance programs that would also appeal to older people or those with chronic disease or restricted mobility, who may otherwise rule out buying a policy explicitly linked to fitness.

Healthcare: Asking the Wrong Question

Imagine this: Healthcare — the whole system — for half as much. Better, more effective. No rationing. Everybody in.

Because we all want that. And because we can. This can be done. Let me tell you how.

I’m an industry insider, covering the industry for 37 years now, publishing millions of words in industry publications, speaking at hundreds of industry conferences, writing books, advising everyone from the U.N.’s World Health Organization, the Defense Department and the Centers for Disease Control and Prevention to governments around the world to, probably, your local hospital, your doctor, your health plan.

The economic fundamentals of healthcare in the U.S. are unique, amazingly complex, multi-layered and opaque. It takes a lot of work and time to understand them, work and time that few of the experts opining about healthcare on television have done. Once you do understand them, it takes serious independence, a big ornery streak, and maybe a bit of a career death wish to speak publicly about how the industry that pays your speaking and consulting fees should, can, and must strive to make half as much money. Well, I turn 67 this year, and I’m cranky as hell, so let’s go.

The Wrong Question

We are back again in the cage fight over healthcare in Congress. But in all these fights we are only arguing over one question: Who pays? The government, your employer, you? A different answer to that question will distribute the pain differently, but it won’t cut the pain in half.

There are other questions to ask whose answers could get us there, such as:

  • Who do we pay?
  • How do we pay them?
  • For what, exactly, are we paying?

Because the way we are paying now ineluctably drives us toward paying too much, for not enough and for things we don’t even need.

See also: Healthcare Reform IS the Problem  

A few facts, the old-fashioned non-alternative kind:

  • Cost: Healthcare in the U.S., the whole system, costs us something like $3.4 trillion per year. Yes, that’s “trillion” with a “T.” If U.S. healthcare were a country on its own, it would be the fifth-largest economy in the world.
  • Waste: About a third of that is wasted on tests and procedures and devices that we really don’t need, that don’t help, that even hurt us. That’s the conservative estimate in a number of expert analyses, and based on the opinions of doctors about their own specialties. Some analyses say more: Some say half. Even that conservative estimate (one third) is a big wow: more than $1.2 trillion per year, something like twice the entire U.S. military budget, thrown away on waste.
  • Prices: The prices are nuts. It’s not just pharmaceuticals. Across the board, from devices to procedures, hospital room charges to implants to diagnostic tests, the prices actually paid in the U.S. are three, five, 10 times what they are in other medically advanced countries like France, Germany and the U.K.
  • Value: Unlike any other business, prices in healthcare bear no relation to value. If you pay $50,000 for a car, chances are very good that you’ll get a nicer car than if you pay $15,000. If you pay $2,200 or $4,500 for an MRI, there is pretty much no chance that you will get a better MRI than if you paid $730 or $420. (Yes, these are real prices, all from the same local market.)
  • Variation: Unlike any other business, prices in healthcare bear no relation to the producer’s cost. None. How can you tell? I mean, besides the $600 price tag on a 69-cent bottle of sterile water with a teaspoon of salt that’s labeled “saline therapeutics” on the medical bill? (Yes, those are real prices, too.) You can tell because of the insane variation. The price for your pill, procedure or test may well be three, five, even 12 times the price paid in some other city across the country, in some other institution across town, even for the person across the hall. Try that in any other business. Better yet, call me: I have a 10-year-old Ford F-150 to sell you for $75,000.
  • Inefficiency: We do healthcare in the most inefficient way possible, waiting until people show up in the Emergency Department with their diabetes, heart problem, or emphysema completely out of control, where treatment will cost 10 times as much as it would if we had gotten to them first to help them avoid a serious health crisis. (And no, that’s not part of the 1/3 that is waste. That’s on top of it.)

So who’s the chump here? We’re paying ridiculous prices for things we don’t necessarily need delivered in the most inefficient way possible.

Why?

Why do they do that to us? Because we pay them to.

Wait, this is important. This is the crux of the problem. From doctors to hospitals to labs to device manufacturers to anybody else we want to blame, they don’t overprice things and sell us things we don’t need because they are greedy, evil people. They do it because we tell them to, in the clearest language possible: money. Every inefficiency, every unneeded test, every extra bottle of saline, means more money in the door. And they can decide what’s on the list of what’s needed, as long as it can be argued that it matches the diagnostic code.

That’s called “fee-for-service” medicine: We pay a fee for every service, every drug, every test. There’s a code for everything. There are no standard prices or even price ranges. It’s all negotiated constantly and repeatedly across the system with health plans, employers, even with Medicare and Medicaid.

We pay them to do it, and the payment system demands it. Imagine a hospital system that bent every effort to providing health and healthcare in the least expensive, most effective way possible, that charged you $1 for that 69-cent bottle of saline water, that eliminated all unnecessary tests and unhelpful procedures, that put personnel and cash into helping you prevent or manage your diabetes instead of waiting until you show up feet-first in diabetic shock. If it did all this without regard to how it is paid it would soon close its doors, belly up, bankrupt. For-profit or not-for-profit makes little difference to this fact.

If we want them to act differently, we have to pay them differently.

Paying for Healthcare Differently

But wait, isn’t that the only way we can pay? Because, you know, medicine is complicated, every body is different, every disease is unique.

Actually, no. There is no one other ideal way to pay for all of healthcare, but there are lots of other ways to pay. We can pay for outcomes, we can pay for bundles of services, we can pay for subscriptions for all primary care or all diabetes care or special attention for multiple chronic conditions, on and on; the list of alternative ways to pay for healthcare is long and rich.

See also: Fixing Misconceptions on U.S. Healthcare  

There are now surgery centers that put their prices up on the wall, just like McDonald’s — and they can prove their quality. There are hospital systems that will give you a warranty on your surgery: We will get it right, or fixing the problem is free.

Look: You get in an accident and take your crumpled fender to the body shop. Every fender crumples differently, maybe the frame is involved, maybe the chrome strip has to be replaced, all that. So there is no standard “crumpled fender” price. But it is not the first crumpled fender the body shop has ever seen. It’s probably the 10,000th. They are very good at knowing just how to fix it and how much it will cost them to do the work. Do you pay for each can of Bondo, each disk of sandpaper, each minute in the paint booth? No. They write you up an estimate for the whole thing, from diagnosis to rehab. Come back next Thursday, and it will be good as new. That’s a bundled outcome. It’s the body shop’s way of doing business, its business model.

There are new business models arising now in healthcare (such as reference prices, medical tourism, centers of excellence, “Blue Choice” and other health plan options) that force hospitals and surgical centers to compete on price and quality for specific bundles, like a new hip or a re-plumbed heart.

Healthcare is a vast market with lots of different kinds of customers in different financial situations, different life stages, different genders, different needs, different resources, yet we have somehow decided that in pretty nearly all of that vast market there should be only one business model: diagnostic-code-driven fee for service. Change that, and the whole equation changes. It’s called business model innovation. If we find ways to pay for what we want and need, not for whatever they pile onto the bill, they will find ways to bring us what we want and need at prices that make sense. That’s called changing the incentives.

Already Happening

Is this pie in the sky? No, it’s already happening, but in ways that are slow and mostly invisible to anyone but policy wonks, analysts and futurists like me. The industry recognizes it. Everyone in the healthcare industry will recognize the phrase “volume to value,” because it is the motto of the movement that has been building slowly for a decade. It’s shorthand for, “We need to stop making our money based on volume — how many items on the list we can charge for across how many cases — and instead make our money on how much real value, how much real health, we can deliver.”

Self-funded employers, unions, pension plans and tribes are edging into programs that pay for healthcare differently with reference prices, bundled prices, onsite clinics, medical tourism, direct pay primary care, instant digital docs, team care, special care for those who need it most, all kinds of things. The Affordable Care Act set up an Innovation Center in the Centers for Medicare and Medicaid Services, and the government has been incrementally pushing the whole system more and more into “value” programs.

Are We There Yet?

So why hasn’t it happened yet? Why aren’t we there yet?

Because it’s hard, it’s different and it hurts. And there is a tipping point, a tipping point that we have not gotten to yet.

It is very hard to loosen your grip on a business model as long as that business model pays the bills. We built this city on fee for service, these gleaming towers, these sprawling complexes, these mind-bending levels of skill and incomprehensible technologies. To shift to a different business model requires that everybody in the healthcare sector change the way they do everything, from clinical pathways to revenue streams to organizational models to physical plants to capital formation, everything all the way down. And it’s all uncharted territory, something the people who run these systems have not yet done and have little experience in. It’s guaranteed to be the end of the line for some institutions, many careers, many companies.

So far, the government “volume-to-value” or “value-based-payment” programs are incremental, baby steps. They typically add bonus payments to the basic system if you do the right thing or cut payments a few percentage points if you don’t. My colleague health futurist Ian Morrison calls these programs “fee for service with tricks.” They do not fundamentally change the business model.

Private payers such as employers have only gradually been getting more demanding, unsure of their power and status as drivers of change in this huge and traditionally staid industry. Systems such as Kaiser that have a value-based business model (so that they actually do better financially if they can keep you well) still have to compete in a system where the baseline cost of everything they need, from doctor’s salaries to catheters, is set in the bloated fee-for-service market. So movement is slow, and we are not yet at the tipping point.

Back to Who Pays

This is not a libertarian argument that everyone should just pay for their own healthcare out of their own pocket and let the “free market” decide. The risks are far too high, and we are terrible at estimating that risk, financial or medical. All of us are; even your doctor is; even I am. A cancer can cost millions. Heck, a bad stomach infection that puts you in the hospital for 10 days could easily cost you $600,000. Bill Gates or Warren Buffet can afford that; you and I can’t.

We need insurance to spread that risk not only across individuals but across age groups, across economic levels and between those who are currently healthy and those who are sick. For it to work at all, the insurance has to be spread across everyone, even those who think they don’t need it or can’t afford it. You drive a car, you have to have car insurance, even if you are a really safe driver. You buy a house, you must have fire insurance, even though the average house never burns down. You own and operate a human body, same thing, even though at any average time you hardly need medicine at all.

If we are to have insurance for everyone, we need to subsidize it for those who have low incomes — and this has nothing to do with whether they “deserve” help, or even with whether healthcare is a right. It’s about spreading the cost of a universal human risk as universally across the humans as possible. At the same time, such subsidies need to be given in a way that helps people feel that they are spending their own money, that they have a stake in spending it wisely. This is not simple to do, but it can be done.

This is also not necessarily an argument for a single-payer system. Single payer, by itself, will not solve the problem. It doesn’t change the incentives at all. It just changes who’s writing the check. What the system needs most is fierce customers, people and entities who are making choices based on using their own money (or what feels like it) to pay for what they really need. This forces competition among healthcare providers that drives the prices down. That means the system needs variety, a lot of different ways of paying for a lot of different customers. If we can figure out how to do that in a single-payer system, well then we’re talking.

Obviously the ultimate customer in healthcare is the individual, because medicine is about treating bodies, and we have exactly one to a customer. But the risk is too high at the individual level, and the leverage is too low.

See also: 5 Breakthrough Healthcare Startups

So employers, pension plans and specialized not-for-profit mutual health plans whose interests really line up with the interests of their employees or members can act as proxies. They can force providers of healthcare (hospital systems, medical groups, labs, clinics) to compete for their business on price and quality. They can refuse to pay for things that the peer-reviewed medical literature shows are unnecessary. They can pay for improvements in your health rather than just fixing your health disasters. They can help their members and employees become fierce customers of healthcare with information and with carefully titrated incentives.

Here’s one example of an incentive: A payer says to its members, “You need a new knee? Great, fine. Here are all the high-quality places you can get that done in your area. You can choose any that you like. But here’s a list of high-quality places in your area that do it for what we call a “reference price” or even less. Choose one of those places, and we will pay for everything from diagnosis to rehab. You can choose a place with a higher price if you like, but you’ll have to pay the difference yourself.” With reference prices, the employee or member partners with the payer in becoming a fierce, demanding customer, and prices for anything treated this way come crashing down.

Both payers and individuals, by being fierce customers, can force the healthcare providers in turn to become fierce customers of their suppliers, forcing pharmaceutical wholesalers and device manufacturers to bid on getting their business. “This knee implant you are asking us to pay $21,000 for? We see you are selling it in Belgium for $7,000. So we’ll pay $7,000, or we’ll go elsewhere.” The “price signals” generated by fierce customers reverberate through the entire system.

What’s the look and feel?

“Healthcare for half” sounds to most people like a Greyhound bus station with stethoscopes, like flea market surgeries and drive-through birthing centers. Paradoxically, though, a lean, transparent system catering to fierce customers of all types would feel quite the opposite, offering more care, even what might feel like lavish care, but earlier in the illness or more conveniently. It might mean a clinic right next door to your workplace offering private care on a walk-in basis, no co-pay, even your pharmaceuticals taken care of — or you could choose to go elsewhere to another doctor that you like more, but you have to schedule it and pay a copay for the visit. Why will providers make healthcare so convenient and personal? Because if they are paid to be responsible for your health it’s worth the extra effort and investment to catch a disease process early, before it gets expensive.

It might mean, when your doctor says you need an MRI on that injury, getting on your smart phone to conduct an instant spot auction that allows high-quality local imaging centers to bid for the business if they can do it in the next three hours. It might mean, if you are in frail health or have multiple chronic diseases, being constantly monitored by your nurse case manager through wearables and visited when necessary or once a week to help keep you on an even keel. It might mean your health system not being so quick to recommend a new knee, and offering instead to try intensive physical therapy, mild exercise and painkillers to see if that can solve the problem first (Pro tip: It often does).

Changing the fundamental business model of most of healthcare will be difficult and painful for the industry. But if we look to other countries and say, “Why do their systems cost so much less than ours? Why can’t we have what we want and need at a price we all can afford?” — this is the answer.

Change the way we pay for healthcare, not just who pays, and we can rebuild the system to be at the same time better and far cheaper.

Employers’ Role in Preventing Suicide

American adults working full time spend an average of 47 hours per week at their workplace (Gallup 2013). For those dealing with a mental health issue or thoughts of suicide, employers have an important opportunity to create safeguards to protect those who may be at risk.

There are many reasons why an employee may keep concerns about his or her mental health private. Stigma, fear of losing one’s job, and lack of awareness can prevent an individual from seeking help. It can also prevent someone who is concerned about a co-worker from reaching out when they may be needed most.

Research shows that 70% of those who die by suicide tell someone or give warning signs before taking their own life. Coworkers see each other every day and are more apt to notice changes in mood and behavior. For this reason, they play a key role in identifying potential suicide risk and mental health crises in their peers.

See also: Blueprint for Suicide Prevention  

Mental health education and awareness programs can help to create an environment where employees feel comfortable reaching out for help and should be a primary component of workplace wellness initiatives. Employers can implement the following strategies that not only connect their employees with help but also promote a culture of mental health awareness:

Health Promotion

Health promotion programs enable employees to take action to better their health. While employers often use health promotion to encourage physical health changes, employers can use health promotion to discuss mental health issues and encourage a culture of employee engagement and connection, as well. National Depression Screening Day, held on Oct. 6 this year, raises awareness for depression and related mood and anxiety disorders. The annual campaign provides employers with an opportunity to start the conversation with employees about mental health.

Online Screenings

Anonymous online screenings are a proven way to reach those in need and help direct them to appropriate assistance. Employees can take a screening to determine if the symptoms they are experiencing are consistent with a mental health disorder (i.e., depression, generalized anxiety disorder, bipolar disorder, post-traumatic stress disorder, an eating disorder or a substance use disorder). Upon completion of a screening, employees are provided with immediate results and linked back to employee assistance program or local community resources. If your organization does not currently have an online screening program, a more general anonymous screening can be taken here.

Suicide Prevention Awareness

The Centers for Disease Control and Prevention recently released data showing a 24% increase on average of suicide rates from 1999 to 2014. It is critical that employees learn how to talk with someone about mental health, understand how to recognize warning signs of suicide and know the actions to take to get themselves or a coworker the help they need.

The National Action Alliance for Suicide Prevention’s Workplace Task Force champions suicide prevention as a national priority and cultivates effective programming and resources within the workplace. The task force provides support for employers and motivates them to implement a comprehensive, public health approach to suicide prevention, intervention and “postvention” in the workplace. Programs like the Workplace Task Force are important sources of knowledge and assistance for employers.

See also: 6 Things to Do to Prevent Suicides  

Employers can provide resources such as Stop a Suicide Today, which educates individuals about the warning signs of suicide and steps to take if they are concerned about a coworker or loved one. There are also other lifesaving resources, like the National Suicide Prevention Lifeline (1-800-273-TALK (8255)).

The World Health Organization estimates that depression will be the second leading cause of disability by 2020. Employers have the option to act as catalysts for early detection and prevention when it comes to mental health disorders and suicide, which can lead to improved quality of life for individuals, as well as for the organization itself.

Health Issues: a Rising Economic Threat

Heart disease, lung cancer and other non-contagious health issues, many of which are at least partially avoidable through changes in lifestyle, are costing the economy hundreds of billions of dollars every year. Today, non–communicable diseases (NCDs) are already responsible for half of all deaths worldwide – and this figure is projected to increase by 17% over the next decade.

Of particular concern for businesses: More than half of those affected by NCDs are of working age. This is why this isn’t just a human tragedy, it’s an economic one — which is why combating the rise of NCDs should not only concern public health authorities.

It could even be a sensible investment for encouraging future economic growth: The World Economic Forum estimates that costs related to NCDs will account for as much as 4% of annual global GDP by 2030. That is a staggering $47 trillion.

Perhaps surprisingly, these silent illnesses are affecting more people in the developing world than in the developed. The greatest increase, 27%, is projected in Africa, with sub-Saharan countries stuck with the worst predictions. In lower-income countries, it is primarily respiratory diseases that are the biggest killer, often linked to smoking and poor air quality, while heart disease and stroke, associated with sedentary lifestyles, are the biggest killers in richer countries, according to WHO data.

The rise of NCDs is increasingly undermining the productivity of workers all over the world and has devastating effects on the economic potential of the poorest of nations. Boosting the health levels of employees and participating in public-private partnerships to reduce the impact of NCDs in wider society should be seen as a profitable strategy, not a burden.

In Depth

Two myths surround non-communicable diseases: that they primarily affect people in wealthy countries and that they are a disease of the old.

Historically, that was the case. Cancer, diabetes, respiratory or heart diseases were an illness of the developed world, largely caused by risk behaviors such as smoking, drinking, living a sedentary lifestyle and having a bad diet. Today, of the 38 million people who die each year from NCDs, 28 million live in developing countries. That is a 40% increase since 1990.

“While it may seem easy for businesses to ignore this trend, especially in markets with government-centric health systems,” says Jim Winkler, chief innovation officer of Aon Health, “organizations need to focus on the adverse impact poor health has in the ability for working people to do their jobs effectively.”

Business leaders are beginning to take notice. The World Economic Forum’s Global Competitiveness Report shows that about half of all business leaders worry that at least one of the four biggest NCDs (heart disease, cancer, diabetes and lung disease) will hit their company’s bottom line, especially where the quality of local healthcare is poor.

A disproportionate 80% of deaths from NCDs are premature, taking the lives of people during their most economically productive years. The WHO says that 23% of Indonesian people between the ages of 30 and 70 are expected to die from NCDs. In the U.S., this figure is 14%.

“Chronic and complex diseases such as heart disease, diabetes and other obesity-related conditions lead to declines in physical output, mental acuity and emotional resiliency,” Winkler warns. All of these will affect productivity — which is why this is a growing crisis not just for people’s health but also for the global economy.

The Economic Burden of NCDs

Hundreds of studies have linked individual NCDs with economic losses. The World Economic Forum and the Harvard School of Public Health estimate that people dying of heart disease in India (26% of all deaths) will cost the economy $2.7 trillion from 2012 to 2030. Along with other NCDs and mental illnesses, the total economic loss — measured by taking into account money spent by health providers on treatment and the reduction in the number of working people due to deaths — will be two and a half times the country’s GDP in that period.

Productivity losses for businesses due to NCDs can be measured by calculating the cost of Disability Adjusted Life Years (DALYs), sick leave, unemployment and days lost by caregivers. In Nigeria, more than half of stroke survivors take a year and a half to return to work. A comprehensive study by the European Journal of Epidemiology found that the workplace productivity of stroke victims’ caregivers also continues to fall one to two years after they become carers. The same study found that, in the U.S., absenteeism one year after a cancer diagnosis costs the economy $20.9 billion annually. Aon’s European Sick Leave Index report, meanwhile, found the average direct cost per individual sick leave day was at least €160.

How Can Business Help?

The WHO has put combatting NCDs at the forefront of its agenda, with businesses playing an important role in helping stop the spread of the epidemic. The 2013–20 Global Action Plan for the prevention and control of NCDs calls for a collaboration between states, NGOs and the private sector to develop affordable strategies that would help prevent the continued rise of these diseases.

The cost of inaction far outweighs the potential economic benefit of taking action on NCDs. The WHO calculates that implementing its Global Action Plan proposals would come in at just $1.20 per person per year.

Business leaders are increasingly aware of the benefits that health programs bring to the organization. Aon’s 2015 Health Care Survey found that the top change U.S. employers want to implement in their rewards system to appeal to the 2020 workforce is “more opportunities and support to connect health and wealth.”

The spread of NCDs is a trend that businesses should not ignore. They are increasingly taking the lives of people during their most productive years and have a huge impact on productivity before, during and after their development. The question is not whether businesses should act upon this global epidemic, but how.

These initiatives not only save lives but help businesses reduce healthcare costs and productivity losses. For instance, Johnson & Johnson’s health and wellness program saved the company $250 million on health care costs over 10 years. The return on investment was $2.71 per dollar spent on tackling smoking and physical inactivity.

To tackle this growing global crisis, targeting the risk behaviors that increase the chances of dying from NCDs is key. This is where businesses can have a significant impact — by improving availability of healthy food, promoting physical activity, setting up programs to help employees quit smoking and giving better access to preventative healthcare.

Talking Points

“The challenge… goes beyond health ministries… Non-communicable diseases undermine productivity and result in the loss of capital and labor. These costs are unbearable and clearly call for innovative solutions and an all-of-society approach, with strong partnerships between government, the private sector and civil society.” – David Bloom, member of the World Economic Forum Global Health Advisory Board and professor at the Harvard School of Public Health

“Creating an effective, collaborative response against NCDs requires cross-sector and cross-industry action – it can’t be achieved by any one business, nor one sector alone.” – Dr. Fiona Adshead, chief wellbeing and public health officer at Bupa

“We should encourage individuals to make the smart choices that will protect their health.  Exercise, eat well, limit alcohol consumption and stop smoking. We can do more than heal individuals — we can safeguard our very future.” – Ban Ki-moon, secretary-general of the United Nations

This article originally appeared on TheOneBrief.com, Aon’s weekly guide to the most important issues affecting business, the economy and people’s lives in the world today.”

Further Reading