Health inequalities, healthcare demand and waiting times

Globally, non-communicable diseases (NCDs) are the leading causes of mortality and morbidity placing a large burden on individuals, families and health systems, especially in low- and middle-income countries (LMICs). This burden is expected to continue rising due to ageing populations and an increasing prevalence of NCD risk factors such as smoking, harmful alcohol consumption, unhealthy diet, and physical inactivity. Evidence tells us that reducing the burden of NCDs can be best achieved by a combined, coordinated approach of population-wide prevention and individual-level interventions targeting the major NCDs and their underlying risk factors. Importantly, the distribution of disease and risk factors can vary across socioeconomic groups within societies as well as across countries at different levels of economic development. Understanding this distribution of risk and disease is essential for targeting those with greatest need and making progress towards the Sustainable Development Goal 3.4 of a one-third reduction in premature deaths from NCDs by 2030. While the supply side of health care must work to jointly deliver prevention, diagnosis and treatment, this thesis focuses on prevention. On the demand side, how people with NCDs decide to seek healthcare, from which providers, and the outcomes of these choices also matters. Waiting times, which lie at the intersection of the demand and supply of health care, are another topic that this thesis addresses. The overarching objective of this thesis is to advance evidence on socioeconomic inequalities and health seeking behaviour in NCDs, with a particular focus on cardiovascular disease in LMICs. In a separate contribution, it evaluates the impact of hospital spending on waiting times in a high-income setting. This research underlines the importance of governments efficiently allocating resources, strengthening health systems, intervening to reduce NCD risk factors and addressing the underlying social and commercial determinants of health.