Economic impact of Cardiovascular Disease and
Hypertension in Africa
Paper presented at the 3rd International Forum for Hypertension in Africa conference at Sheraton Hotel, Abuja, Nigeria on the 26th
September 2009 by
Dr. Kingsley K. Akinroye, President, African Heart Network
Hypertension is the most common risk factor for CVD morbidity and mortality.
Hypertension is the most common risk factor for CVD morbidity and mortality 972 million people world wide are hypertensive
(will rise to 1.6 billion people by 2025) 7.1 million deaths globally
Onset of CVD at an earlier age; and death at a younger age
Wide spread social and economic hardship
Global Heath burdenCVD- leading cause of death world-wide
Estimated global deaths by cause, all ages, 2005
HIV/AIDS
TuberculosisMalaria
Cancer
Chronic respiratory diseases
Diabetes
Cardiovascular diseases
0
2000000
4000000
6000000
8000000
10000000
12000000
14000000
16000000
18000000
20000000
Source : WHO 2005: «Preventing Chronic Diseases: A Vital Investment»
Projected global deaths by cause (in millions), 2005
17.528
7.586
4.057
2.83
1.607
1.125
0.883
0 5 10 15 20
CVD
Cancer
Chr Resp Dse
HIV/AIDS
Tuberculosis
Diabetes
Malaria
WHO Report 2005
0
100
200
300
400
500
600
700
800
Tanzania Nigeria India China UK
Ag
e-st
and
ard
ized
dea
th r
ates
per
100
,000
HIV/AIDS, TB, Malaria CVD
Projected death rates by specific causes for selected countries, all ages, 2005
WHO Report 2005
Hypertension burden in Africa Stroke is a major complication of Hypertension in Africa Lemogoum et al, Am J Prev Med 2005;29 (5SI):95-101
Stroke mortality and case fatality in some Africa countries exceed those in the developed world
Walker et al, Lancet 2000;355:1684-87
Hypertension is the most consistent and powerful predictor of stroke and is causally involved in more than 70% of stroke cases Lavados et al, Lancet 2005; 365:2206-15. Bronner et al, N Engl
J Med 1995;333: 1392-400
Stroke mortality by region (1990)
Mortality rate (per 100,000)
Former socialist economies 192.35 China 112.12 Established market economies* 98.02 Sub-Saharan Africa 76.25 India 72.89 Middle Eastern Crescent 65.08 Other Asian countries and islands 51.34 Latin America 28.49
*Western Europe, USA, Canada, Australia,New Zealand, Japan
Adapted from Reddy KS, Yusuf S. Circulation 1998;97:596-601
ECONOMIC IMPEDIMENTS IN AFRICA
Multiplicity of health care providers Abundant alternate care givers Lack of capacity of health care providers Affordability of physician for health care Out –of-pocket payment for health care Abandonment of treatment/non compliance
Cost of Illness
Cost of illness (COI) studies are a useful means of beginning to illustrate the economic magnitude of CVD or its risk factors, accounting for both direct medical expenditures and losses due to foregone productivity
Direct Economic Impact
Cost of medical care for health services and medications Ambulances Inpatient or outpatient care Rehabilitation Community health services
Indirect Economic Impact
Indirect costs: Reduction in income owing to lost productivity from illness
or death The cost of adult household members caring for those who
are ill Reduction in future earnings by the selling of assets to cope
with direct costs and unpredictable expenditures Lost opportunities for young members of the household who
leave school in order to care for adults who are ill or to help the household economy
Reduction in income. In more than 80% of African countries
disability insurance systems are underdeveloped or non-existent
Macroeconomic consequences of CVD in Africa Health in general – measured as life expectancy
or adult mortality – is a robust and strong predictor of economic growth
Indirect Economic Impact contd:
Adult life Expectancy in Africa vs Developed Countries
Africa Developed Countries
Ghana - 59.85 Japan – 82.1
Kenya – 57.86 France – 80.98
Uganda – 52.72 Finland – 78.97
Tanzania – 52.01 United Kingdom – 79.01
Nigeria – 46.94 Germany – 79.4
Liberia – 41.84 Spain – 80.9
Mozambique – 41.18 Ireland – 78.9
Change in life expectancy
A 5 – year increase in life expectancy will give a country a 0.3 – 0.5% higher annual GDP growth rate in subsequent years (Barrow 1996)
CVD mortality vs economic growth
Suhrcke and Urban(2006) study: To assess the impact of CVD mortality among the working-age population on economic growth, in developed and developing countries
Result:- In the high-income country sample(developed country): a 1% increase in the mortality rate was found to decrease the growth rate of per - person income in the subsequent five years.
No significant difference in developing countries
Factors responsible for lack of cost effectiveness studies for CVD and
Hypertension intervention in Africa Newness of the appearance and awareness of CVD and
hypertension in Africa; For prevention in particular, a lack of potential profit for
suppliers of the intervention; The multitude of possible interventions because of multitude
health outcomes to examine; Multi-sectoral sources of the problem complicate the design
of possible solutions; Few randomized clinical trials testing interventions
Cost-Effectiveness in Africa
Unwin (2001) : There are no “off-the-shelf” interventions for changing lifestyle that can be assumed to be effective within sub-Saharan Africa;
What can be done now?
Municipalities can build pedestrian and bicycle lanes
Companies can manufacture and market heart healthy products;
Agricultural policies that subsidise excess production of unhealthy foods can be terminated
Challenge of CVD in Africa
Double burden of disease Changing pattern of disease and risk factor
exposure Infectious disease priorities; Constrained budgets Focus on population approaches to
prevention
Challenge of CVD in Africa
Prevention and surveillance The need for appropriate care for CVD places
enormous pressure on the already fragile health care systems jeopardizing the viability of poorly funded public health services
The need for cost-effective strategies in limited resource SSA countries