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Submitted by Patricio V Marquez on
Greetings from Angola. Good points overall. However, as argued on previous blogs in this site, I would caution falling into the traditional false dichotomy between prevention vs. medical care, as both complement and reinforce each other. Rather, given the dual burden of disease, there is a need to think how a health system is structured following a continuum of care approach, anchored on a strong and well functioning primary care level--indeed, given technological developments in the medical field, many conditions that required in the past lengthy hospitalization now can be dealt effectively on an ambulatory basis at a lower cost and more comfort for the patient. Also, we need to keep in mind that often in spite of all the prevention efforts, some people are going to have heart attacks or develop a cancer, which requires medical care at the hospital level. And, let's not forget that if you diagnose a condition at the primary care level--for example, cervical cancer, and if this condition is advanced then you need to refer the patient to be treated at more specialized levels of care--otherwise why to diagnose a condition in the first place? In addition, it is important to be clear that life style behaviors and their social determinants require multisectoral interventions that are beyond the health system. As you suggested, "sin taxes" are effective fiscal measures among other multisectoral interventions but the goal in adopting them is to make, for example, tobacco products unaffordable--only in that way they will generate the expected public health benefits. So this requires not only a high level of excise taxation on tobacco products (e.g., 70-80% of the total price of the product), but also careful assessment of the type of excise tax to be adopted in accordance to the goal to be pursued, and strong tax administration, complemented by regulatory and education measures such as smoke-free public spaces, media campaigns, and smoking cessation counseling at the health facility. The attached further elaborates some of the above points: Ending the Communicable and Non-communicable Disease Divide in Africa http://blogs.worldbank.org/africacan/ending-the-communicable-and-non-communicable-disease-divide-in-africa Sub-Saharan Africa: How can we avoid the disease silos trap? http://blogs.worldbank.org/health/sub-saharan-africa-how-can-we-avoid-the-disease-silos-trap