A tax on tobacco and alcohol in the Philippines resulted in a sixfold increase in the country’s health budget as well as a drop in consumption of the harmful products, Ted Herbosa, the country’s health secretary, told a meeting on non-communicable diseases (NCD) and financing on Thursday.

“It increased the health budget by six times from 1.8% to 5.8% of GDP, so we were able to infuse money into the healthcare system to be able to care for the poorest populations,” Herbosa told an international financing dialogue for NCDs and mental health, hosted by the World Health Organization (WHO) and the World Bank in Washington DC. 

The two-day meeting aims to generate consensus about how best to finance effective strategies to tackle NCDs and mental health. It is part of the build-up to the United Nations High-level Meeting on these issues in 2025.

Excise taxes on harmful products is one of the WHO’s package of 88 “best buys” to tackle NCDs – but countries should prioritise which of these will work best for the NCDs they face, said Bente Mikkelsen, WHO director for NCDs.

However, Mikkelsen appealed to countries to focus on diagnosing hypertension, a major cause of cardiovascular disease (CVD), which causes around a third of global deaths. Less than half of those living with hypertension have been diagnosed, yet testing is cheap and easy to do, she added.

Despite three prior high-level meetings on NCDs, only a handful of countries are on track to meet global targets to reduce these. A mere six countries are on track to reduce NCD mortality, for example.

In some countries, death rates due to NCDs have increased and millions of people, especially in lower-income settings, lack access to interventions that could prevent or delay NCDs, mental health conditions, and their consequences. 

Phased approach

Countries at the meeting shared some of their insights and experiences, stressing political will, multi-sectoral collaboration and the importance of sustainable domestic financing for NCD prevention and care services. 

In 2018, Egypt started to phase in universal health care (UHC) starting with a pilot of one million people in a single city with all citizens contributing to a special health insurance fund based on their income.

Some six million Egyptians are covered out of the total population of 100 million, and the country expects to cover all citizens by 2030.

“My advice is not approaching everything at once,” said Radwa Iman from Egypt’s health promotion department.

“Actually 85% of our mortality rate was due to NCDs in 2018. Now all our chronically ill patients [covered by UHC] get monthly medications from the primary healthcare facilities. They have medical files. They have regular checkups, and we have annual checkups for the citizens to screen earlier for any medical problems so we can find them in the early stage instead of getting complications.”

Ala Nemerenco, Moldova’s health minister, said that her ministry was largely funded by health insurance contributions, which enabled flexibility as money could be redirected fairly easily.

“Moldova was coming from a post-Soviet system, where for mental health, everything was about hospitalisation,” said Nemerenco. Over several years, the country has  integrated mental health care into primary health care, where family doctors work with nurses and social workers to address mental health.

However, Moldova’s health facilities are being strained by Ukrainian refugees who are in need of mental health support as they flee Russian aggression.

“One year ago, we approved one year ago a national programme on mental health care services. We approved by the government programme on NCDs, including cardiovascular, cancer and diabetes. We now are working on a cancer registry and early detection, screenings and programmes,” she added.

Fiji, with a high burden of NCDs in its population of about one million scattered over 300 islands, has invested in health promotion in schools to prevent NCDs.

Mental health out in the cold

Devora Kestel, WHO Director of Mental Health and Substance Use, appealed for the mental health focus to cover the full spectrum of life – from child and adolescent mental health to dementia in old age.

Kestel described investment in mental health as “totally inadequate”, usually comprising 1-2% of the health budgets in low and middle-income countries, with “70% of that budget in many countries going to old fashioned [mental] institutions”. 

“Even in high-income countries, 50% of the people affected by depression will not have access to care. In low-income countries this is 90%,” she said.

“We need health system financing reforms that are part of a universal health coverage approach and that need to be adequately targeted to answer to the mental health and NCD agenda. 

“We have evidence, we have good ideas, we know what works and what doesn’t. We need to make sure that they become a common practice everywhere.”

The meeting continues on Friday.