Rethinking and redefining the definitions and how we measure availability and affordability of medicines and technologies for non-communicable diseases

Non-communicable diseases (NCDs) include cancers, cardiovascular diseases, diabetes, chronic respiratory disease and mental health. This group of conditions is the leading global cause of morbidity and mortality worldwide, with 74% of all deaths globally due to NCDs. Although primary prevention is an essential component of the global health response, there is a need to ensure access to health services and medicines for the millions of individuals with an NCD. Targets related to NCDs and access to medicines are included in the Sustainable Development Goals (SDGs) and are key components to achieving universal health coverage (UHC).Included in the language of SDG Target 3.b is the notion for people of ‘access to the affordable, high-quality medicines and technologies they need’. In exploring the leading causes of inefficiencies in implementing UHC, the WHO reports that many of these relate to the procurement and use of medicines.

Studies have shown the importance of looking at availability and affordability together, as both factors must be combined for people to access the medicines and technologies they need. When examining accessibility to food and housing, concepts of availability and affordability are also included. In discussing availability and food security, Bushara and Ibrahim7 highlighted the link with affordability, stating that food might be physically available but remain inaccessible to individuals because of physical and economic barriers. Swope and Hernandez, in looking at the affordability of housing, defined it as “whether residents can pay the cost of the housing without burden”, including the notion that paying for housing should not result in impoverishment and that rent should remain within 30% of low-income households’ expenses. Niëns et al used the concept of impoverishment to explore how expenditure on medicines affects the poverty of households. Within the SDGs, 3.8.2 notions of catastrophic and impoverishing out-of-pocket expenditure are included.

Clearly, such targets are essential; however, they raise many questions as to how we define availability and affordability, which, when combined, are often referred to as ‘accessibility’, assign quantifiable objectives to these concepts and measure them. Given the current and increasing burden of NCDs and the need for continued access to available and affordable medicines and technologies, rethinking and redefining these concepts is necessary.