City Research Online

Essays on the Economics of Non-Communicable Diseases

Kalansooriya, C. W. (2023). Essays on the Economics of Non-Communicable Diseases. (Unpublished Doctoral thesis, City, University of London)


This doctoral thesis is a collection of three papers that study topics related to Non-Communicable Diseases (NCDs) - the key cause of death globally, challenging health systems and economies.

First, we analyse the dietary changes, a major risk factor of NCDs in Low and Middle-Income Countries (LMICs) and examine the role of education as a mechanism to improve healthy food demand. We use the food consumption data of Sri Lanka. Using the demand elasticities estimated from the Almost Ideal Demand System (AIDS), we prove that the enhancement of the living standards of the people has led them towards a rather unhealthy diet. This adds economic evidence to the literature on the occurrence of nutritional transition leading to the growth of NCDs in LMICs. Further, the study fills the dearth of evidence in the literature on the role of education in dietary choices in LMICs. We show that education plays a significant role in enhancing healthy food demand, however, it does not help to discourage the demand for unhealthy food. Yet, education helps to improve diet quality when individuals have diet-related diseases, i.e. diabetes. We show the possibility of effective use of price policies to encourage healthy consumption and discourage unhealthy consumption in LMICs.

Second, we investigate the household consumption impact of out-of-pocket healthcare expenditures arising from chronic NCDs (C-NCDs) and how it changes according to the shifts in public health expenses. We use a matching method to estimate the crowding-out effect and a Matched Difference-in-Difference (MDID) method to identify the changes in the crowding-out effect according to changes in public healthcare expenses. We use the data of Sri Lanka, an LMIC, and show that the out-of-pocket healthcare expenses arising from C-NCDs have grown faster than such expenses of other health conditions during the last two decades. We show that public healthcare provision plays a significant role in C-NCD care, and a reduction in public spending leads to a further increase in the household burden of the treatment cost. The increasing out-of-pocket expenses due to C-NCDs are crowded-out on households’ basic needs, such as food and clothing, particularly in low and middle- income households. Accordingly, the study highlights that the lessening of public spending and the absence of health insurance to cover healthcare costs of C-NCDs care generate adverse impacts on household welfare.

Third, we provide novel evidence on how the livelihood of people with NCDs was affected by COVID-19. We explore the impact of COVID-19 on the labour market outcomes of individuals with NCDs using the data from the Understanding Society COVID-19 Study in the UK. The difference-in-difference estimates reveal that the pandemic negatively affected the likelihood of engaging in work and the work duration of people with NCDs. We show that their probability of engaging in work negatively relates to the severity of the pandemic, whereas the amount of work hours gradually decreases throughout the pandemic resulting in a significant gap between the pre and post-Covid work amount. The work loss is higher for the upper age group of the workforce and the individuals with riskier health conditions to Covid-19. Although the pandemic did not cause it to deteriorate further, the low mental and physical health of individuals with NCDs may lead them to exit the labour market, raising concerns about their welfare during the post-covid period.

Publication Type: Thesis (Doctoral)
Subjects: H Social Sciences > HG Finance
J Political Science > JZ International relations
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: School of Policy & Global Affairs > Economics
School of Policy & Global Affairs > School of Policy & Global Affairs Doctoral Theses
Doctoral Theses
[thumbnail of Kalansooriya Thesis 2023 PDF-A.pdf] Text - Accepted Version
This document is not freely accessible until 30 September 2026 due to copyright restrictions.


Add to AnyAdd to TwitterAdd to FacebookAdd to LinkedinAdd to PinterestAdd to Email


Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login