December 1st, 2011

Mental illness contributes to huge economic burden

Disease is typically described in human terms such as diagnosis, prevalence and mortality. But the World Economic Forum took a fiscal approach in a report released this past September that says the global economic burden of five major non-communicable diseases – cancer, diabetes, heart disease, respiratory illness and mental illness – could approach $47 trillion over the next 20 years, with mental illness accounting for $16 trillion. The total represents four percent of annual global gross domestic product (GDP) over that time span, or considered in 2010 alone, a whopping 75 percent of global GDP.

Non-communicable diseases (NCDs) kill 36 million people every year, about 63 percent of all deaths worldwide and the rate is only expected to increase as the global population ages and as NCD risk factors – poor diet, sedentary lifestyle, tobacco use and alcohol abuse – spill into developing countries.

Even now, 80 percent of NCD deaths in 2010 were among working-age people in low- and middle-income countries. Consequently, the fiscal burden of NCDs, which used to be considered diseases of affluence, will continue to shift to developing countries as their economies grow and populations urbanize.

“This study shows that families, countries and economies are losing people in their most productive years,” says Olivier Raynaud, WEF’s senior director of health, in a statement. “The numbers indicate that NCDs have the potential to not only bankrupt health systems but to also put a brake on the global economy.”

A study quantifying the economic burden of disease worldwide has never been done before, says co-author Elizabeth Cafiero, M.S., a researcher at the Harvard School of Public Health, which produced the report.

“To reach the people who make the tough economic decisions, such as finance ministers and foundation advisers, they need information in their own language to decide how to allocate scarce resources in the health arena,” Cafiero says. “Yes, there’s a human suffering story, but to affect decision making, especially at the international level, we needed to quantify the burden of disease.”

The precedent to this approach, Cafiero says, was research lead author David Bloom, Ph.D., conducted in the early 2000s that viewed HIV/AIDS through an economic lens and helped steer needed resources, such as screenings and medications, where they were most needed, particularly to Africa.

For the current WEF study, researchers used existing data sets and applied three different methodologies to analyze the fullest scope of costs and impacts, a complex undertaking. The “cost of illness” (COI) approach adds up all the direct and indirect costs associated with a disease from procedures and medications to research and awareness campaigns. The “value of lost output” macroeconomic approach shows how disease depletes economic inputs, such as labor and capital, to the detriment of economic output. The “value of statistical life” approach reflects society’s willingness to pay to reduce the risk of disability or death.

The results showed that mental illness (including depression, schizophrenia, dementia, substance abuse, PTSD, OCD) tops the economic burden chart using the value of statistical life approach, representing $8.5 trillion out of $22.8 trillion in 2010 and $16.1 trillion out of $43.4 trillion in 2030, with higher-income countries assuming the lion’s share of the cost. Heart disease was a close second.

Using the macroeconomic approach, mental illness and heart disease together account for 70 percent of lost output from 2011 to 2030. This approach projected the greatest overall global loss of nearly $47 trillion.

Conversely, the COI for mental illness was the lowest of the five NCDs, estimated at $2.5 billion in 2010 and projected to more than double to $6 billion in 2030, with high-income countries bearing the brunt of the burden.

Respiratory disease cost the most, expected to surge from $2.1 trillion in 2010 to $4.8 trillion in 2030 with about half the costs coming from developing countries.

Despite the demonstrated impact of mental illness on loss of overall well being, it is not typically included on the list of NCDs. In fact, the United Nations’ High-Level Meeting on NCDs in New York, convened the day after the WEF report was released and only the second time a high-level meeting has been held on a health issue (the first was HIV/AIDS), excluded mental illness from the agenda (except for alcohol abuse).

Dan Chisholm, Ph.D., a health economist in the Department of Mental Health and Substance Abuse at the World Health Organization, acknowledges that the mental health community might “feel hard done by” in being left out. But focusing meeting attendees and WHO’s member states on the four physical diseases and the four main risk factors provides “short, sharp, powerful points that people can rally behind,” Chisholm says. And it’s not as if the U.N. and WHO don’t address mental health and its “never-ending stigma and discrimination,” Chisholm says.

Chisholm and Cafiero both point to the WHO Mental Health Gap Action Program designed to scale up services and interventions for mental, neurological and substance abuse disorders in low- and middle-income countries.

“WHO does mental health; it’s an acknowledged priority,” Chisholm says.

From Cafiero’s perspective, mental illness was included in the WEF report not only because the economic burden is significant but also because the connection between mental illness and the four physical diseases is “strong and prevalent.”

“This is the first time we’ve seen, at a global level, mental health conditions put on the same plane as other NCDs,” Cafiero says. “No matter which way you measure it, the economic burden is huge, and mental illness is a major contributor to that burden.”

By Nan Shnitzler

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