1. Projected Non-Communicable Diseases Update 20 June 2011 National Health Insurance Policy Brief 19

2. GLOBOCAN Cancer Incidence Rates Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update GLOBOCAN 2008 completely replaces GLOBOCAN 2002. More age bands are now used at middle and older ages. The World rates for 2008 are shown for comparison.

3. Cancer Projections South Africa Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update The old projection was for 93,060 cases in 2025. The new projection gives 109,956 in 2025, an increase of 18.2%.

4. Projected Incidence of Cancers in South Africa Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update

5. Projected Cancer 2010 Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update

6. Need for Chronic Medicine Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update Significant increase in people expected to be on chronic medicine by 2025. Old projection was 6.6 million; new projection gives 8.6 million people by 2025, an increase of 31%. There is a 10% increase in those on treatment for the 25 CDL chronic diseases and a doubling of those needing ARVs.

7. Numbers needing Treatment for CDL Diseases Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update

8. CDL Chronic Diseases, Cancer and HIV/AIDS in South Africa Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update Old projections gave 11.3 million people being treated for a CDL chronic disease or being HIV+ by 2025. New projections give 12.3 million people, a 9% increase. Increase in numbers on ARVs has corresponding decrease in those HIV+ not on treatment.

9. Conclusions The key issue remains for planning in South Africa – that the number of elderly people is expected to increase rapidly and that chronic disease and cancer prevalence and need for hospital facilities are strongly related to age. While the extent may be difficult to quantify precisely, there is no doubt that there will be an increasing burden on the health system in future. Add to this the well-documented and modelled HIV/AIDS epidemic and related epidemics of sexually-transmitted infections and tuberculosis, and the immense challenges for a sustainable National Health Insurance system become apparent.” The revised figures show that that burden of chronic disease on the health system is going to be greater than expected. This is an important consideration for planning future financing for healthcare in South Africa. Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update Source: IMSA NHI Policy Brief 6: Costing and Long-term Modelling of NHI

10. Provincial Analysis

11. CDL Chronic Disease by Province Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update The age and gender differences by province result in different levels of chronic disease and different trajectories over time.

12. Incidence of Cancer by Province Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update Western Cape and Gauteng likely to have the highest incidence.

13. Expected Births by Province Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update A decline in births as a proportion of the total population is expected for all the provinces. Fewer births in Gauteng and Western Cape than in the other provinces due to the older age structure.

14. ARVs by Province Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update Figures extracted directly from ASSA2008.

15. AIDS Sick (no ARVs) by Province Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update Figures extracted directly from ASSA2008. This might mean a decline in hospital beds needed but is very dependent on the pace of the ARV roll-out and maintenance of supply.

16. Conclusions for Provincial Planning and Analysis There are very different age and gender profiles by province. The need for health services will not only be different by province but will evolve differently in each province. This argues strongly for planning which takes account of the demographic differences between the provinces. It is also critical when comparing results by province to take into account the expected differences due to the different age and gender structures. If not, false conclusions about equity and access to treatment might well be reached. Source: IMSA NHI Policy Brief 19: Projected Non-Communicable Disease Update

17. Innovative Medicines South Africa (IMSA) is a pharmaceutical industry association promoting the value of medicine innovation in healthcare. IMSA and its member companies are working towards the development of a National Health Insurance system with universal coverage and sustainable access to innovative research-based healthcare. Contact details: Val Beaumont (Executive Director) Tel: +2711 880 4644 Fax: +2711 880 5987 Innovative Medicines SA (IMSA) Cell: 082 828 3256 PO Box 2008, Houghton, 2041. South Africa val@imsa.org.za www.imsa.org.za

18. Material produced for IMSA by Heather McLeod hmcleod@integratedhealingmbs.com www.integratedhealingmbs.com