Thomas J. Bollyky is a senior fellow for global health, economics, and development at the Council on Foreign Relations, in Washington, D.C.
Tara Templin is a graduate student in the Department of Health Research and Policy, Stanford University, in Palo Alto, California.
Health Aff (Millwood). 2017 Nov;36(11):1866-1875. doi: 10.1377/hlthaff.2017.0708.
Demographic and epidemiological changes are shifting the disease burden from communicable to noncommunicable diseases in lower-income countries. Within a generation, the share of disease burden attributed to noncommunicable diseases in some poor countries will exceed 80 percent, rivaling that of rich countries, but this burden is likely to affect much younger people in poorer countries. The health systems of lower-income countries are unprepared for this change. We examined the shift to noncommunicable diseases and estimated preparedness for the shift by ranking 172 nations using a health system capacity index for noncommunicable disease. We project that the countries with the greatest increases in the share of disease burden attributable to noncommunicable disease over the next twenty-five years will also be the least prepared for the change, as they ranked low on our capacity index and are expected to have the smallest increases in national health spending. National governments and donors must invest more in preparing the health systems of lower-income countries for the dramatic shift to noncommunicable diseases and in reducing modifiable noncommunicable disease risks.
人口结构和流行病学变化正在将低收入国家的疾病负担从传染病转向非传染性疾病。在一代人的时间内，一些贫穷国家归因于非传染性疾病的疾病负担份额将超过 80%，与富裕国家相当，但这种负担可能会影响到较贫穷国家的年轻人。低收入国家的卫生系统对此变化毫无准备。我们研究了向非传染性疾病的转变，并通过使用非传染性疾病卫生系统能力指数对 172 个国家进行排名，来评估其应对这一转变的准备情况。我们预计，在未来 25 年内，非传染性疾病负担份额增长最大的国家也将最不准备应对这一变化，因为它们在我们的能力指数中排名较低，预计国家卫生支出的增长幅度也最小。各国政府和捐助者必须加大投资，为应对非传染性疾病的巨大转变，以及降低可改变的非传染性疾病风险，来准备低收入国家的卫生系统。
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