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

Global Cardiovascular Disease Burden

17 million global deaths due to CVD

¾ in Developing Countries

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

Tobacco use on the rise in developing countries

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

COI Studies

3 components Direct cost

Indirect cost

Intangible cost

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