The economic burden of diseases translates, in monetary terms, to the cost and consequences an individual and a nation needs to bear due to diseases. India is a developing country with one of the fastest growing health sectors in the world. Yet, India’s population has to incur a heavy economic burden of disease, in terms of cost of treatment and loss of livelihood. As a country, there is loss of productivity, and impoverishment. There is a need for a multi-pronged approach through investments in nutrition schemes, awareness programs, and health insurance systems which would contribute to the holistic development of the people, thus reducing the economic burden of diseases.
Economic burden of diseases is estimated as the total cost incurred to the economy due to a disease or a condition. The cost is in terms of medical resources to treat disease, non-medical resources to treat disease and the loss in productivity due to the disease. Although the economic burden of diseases may be subjective in nature, using indicators like mortality, morbidity, quality of life, disability-adjusted life expectancy and healthy-days equivalent are widely accepted. In a study done by David Stuckler, Professor of Political Economy and Sociology at University of Oxford, it was found that in low-income countries, higher levels of country income per capita, population urbanization, foreign direct investment, and market integration were associated with greater mortality rates of heart disease and chronic noncommunicable disease, less increased or sometimes reduced rates in middle-income countries, and decreased rates in high-income countries. In the low income countries, the burden of communicable diseases is already very high; increase in lifestyle and chronic diseases make the situation more complicated. Technology driven health infrastructures are gradually coming up but its still a long way from providing universal health coverage.
AT HOUSEHOLD LEVEL
Diseases affect the population economically on two levels: household and national. On an individual household level, if a family member suffers from a disease, the burden is borne by all, and if the earning member falls sick, the household may fall into a state of poverty and debt traps. The economic burden of an illness for an individual manifests itself in the form of costs of treatment, loss of livelihood, reduced quality of life, and social stigmas (especially in the case of diseases like Tuberculosis, HIV-AIDS, etc). Although the government offers various schemes under its targeted programs like National Tuberculosis Programme (NTEP), National AIDS Control Programme (NACP), National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS), etc., socio-economically disadvantaged people may not be aware of the benefits that can be availed under them due to limited outreach of the same. The patient is forced to spend their savings and if need be, also take loans, to avail treatment. If a patient needs to be diagnosed, get tests done or collect medicines, they need to visit the Public Health Centres (PHCs) or District Hospitals. The patients would have to miss a day’s work to travel to the health center and get treated. Most of them live on a hand-to-mouth basis and thus this severely affects them and their family. The worst part is that due to the already existing burden on the health centers, many times the patients aren’t attended to and are asked to return another day; this causes the loss of more wages and work days, not to mention that the patient’s health deteriorates further. In India, diseases are still stigmatized and the people suffering from them are discriminated against in the society. In the case of stigma related to infectious diseases, stigmatization, blaming others, and discrimination are exacerbated by fear of illness. Many people living with cancers, cardiovascular diseases, chronic respiratory diseases, skin conditions and diabetes are known to encounter similar stigma-related manifestations like avoidance and isolation, exclusion from social participation, both perceived and experienced unfair and unjust treatment in social, education, employment, and healthcare settings. Such experiences are known to discourage help-seeking behavior and the disclosure of health status, which in turn can potentially hamper the treatment and management of these conditions.
AT THE NATIONAL LEVEL
On the National Level, economic burden of diseases is defined in terms of loss of national productivity, morbidity, impoverishment of population and is measured in by indicators like mortality, morbidity, life expectancy, quality of life, quality-adjusted life expectancy, disability-adjusted life expectancy, healthy-days equivalent and activities of daily living. A sick person is not able to work and thus does not contribute to the GDP. Prolonged or chronic illness of a population can severely impact the GDP of the country and subsequently degrade its development status. It further pushes households into poverty. An impoverished, unhealthy country is more susceptible to pandemics, even if the health infrastructure is improving. The cost-of-illness (COI) studies convert the burdens associated with certain illnesses into economic and monetary values so as to measure the socioeconomic costs that are inevitably incurred by a given society in association with certain illnesses. The estimated costs provided by COI studies provide an important basis for estimating the amounts of public health resources spent and productivity losses incurred and thereby make it possible to quantify the socioeconomic burdens that illnesses impose on society in general. Yet, the burden is calculated separately for different diseases/ categories of diseases, thus we don’t have a clear or relative picture of the overall economic burden of all diseases in a country.
As times change, types of illness that affect people also change. Frequent plagues and pandemics gave way to outbursts of malaria, smallpox and yellow fever. As the people developed resistance and vaccines for them, the prevalence of polio, HIV-AIDS increased. In present times, we saw the recurrence and possibility of global pandemics through COVID-19 and the increasing prevalence of lifestyle diseases. To fight these diseases at a national level and reduce the economic burden, we need to induce superior technology and Artificial Intelligence in the healthcare system. Since the COVID Pandemic, the rising popularity of telemedicine and tele-consultation through eSanjeevani has saved 21.59 KM per health visit in distance traveled. This imputes a cumulative cost saving of INR 86.61 billions (approx. 1 billion USD) across the country. In terms of infrastructure, the public health network, equipped with well-trained medical and non-medical staff, is becoming more decentralized and accessible to remote areas. In July 2022, India's doctor-population ratio at 1:854 was judged better than the World Health Organization's standard of 1:1000.
The situation is gradually improving, but it still calls for a multi-pronged approach to strengthen the people, in addition to strengthening the health sector; more attention needs to be given to prevention of diseases. There is a need for investments in nutrition schemes, mental health awareness programs, working conditions, and health insurance systems which would contribute to the holistic development of the people, thus reducing the economic burden of diseases.