Review Article - (2016) Volume 13, Issue 5
Gisela Abbam*
Global Executive Director, Government Affairs & Policy at GE Healthcare, BEd (Hons), MBA
Submitted date: September 14, 2016; Accepted date: September 26, 2016; Published date: October 03, 2016
It can be argued that good health is a driver of economic growth as you need a healthy workforce in order to be productive. Health impacts every sector of the economy yet the resources and management of health still remains a priority for the health sector only. Furthermore, the problems, impact and outcomes for health are the responsibility of the health Sector. Most Ministries of Health – from developed to developing countries are struggling to manage their health budgets. Why does an issue that has such serious repercussions for a country’s economy remain only a ‘health sector’ problem? Since health has such an impact on employability why is there not enough emphasis on developing a ‘whole of government’ approach to health?
It can be argued that good health is a driver of economic growth as you need a healthy workforce in order to be productive. Health impacts every sector of the economy yet the resources and management of health still remains a priority for the health sector only. Furthermore, the problems, impact and outcomes for health are the responsibility of the health Sector. Most Ministries of Health – from developed to developing countries are struggling to manage their health budgets. Why does an issue that has such serious repercussions for a country’s economy remain only a ‘health sector’ problem? Since health has such an impact on employability why is there not enough emphasis on developing a ‘whole of government’ approach to health?
It would appear obvious to adopt a care pathway approach for tackling the diseases with the highest economic burden that affect the working population. After all, prevention is better than cure – both in terms of clinical and financial outcomes. Discussions do of course take place on productivity losses and indeed budget deficits, but rarely do governments and economies give due emphasis to the effects of ill health on levels of productivity.
Increasing productivity by reducing the economic burden of ill health in the working population
The World Health Organisation (WHO) has estimated that Brazil, Russia, India and China currently lose more than 20 million productive life-years annually due to non-communicable diseases (NCDs). This number is anticipated to grow by 65% by 20301. The productivity losses associated with disability, unplanned absences and increased accidents account for as much as 400% more than the cost of treatment[1].
The WHO further reports that a reduction in the mortality rate of coronary heart disease (CHD) and stroke by a mere 10% will provide a reduction in economic losses in low- and middleincome countries by approximately USD$25 billion each year[1,2].
It is estimated that 50% of NCD-related deaths are during “productive years,” representing a significant cost to both governments and the commercial sector[1]. The theory underpinning this argument is that healthier individuals can produce more output per hour worked, subsequently leading to increased labour productivity, as healthier people are more efficient in the workplace.
A focus on Stroke
One in six people will have a stroke at some time in their lives. There is an estimated 30 incidences of stroke per 60 seconds worldwide. Stroke is a leading cause of disability worldwide[3].
Take the UK for example where there are over 150,000 strokes each year with a third of the people having permanent disability. In the UK, there are 20,000 people under age 45 who have a stroke each year thereby resulting in about 6,500 people each year under aged 45 who end up with permanent disability (SA 2015). For the 6,500 people each year under age 45, who end up with a permanent disability because of stroke, if they were even earning only the basic wage, it would still be a huge yearly loss to both the people and the economy[3].
The basic hourly wage rate is £9.00/h. Assuming an individual’s monthly wage is £1,260 (quite a low and basic assumption) and his or her yearly wage is circa £15,000, the government is assured of income tax from these 6,500 people each year. The taxes go towards public expenditure in sectors beyond the health sector. These sectors include housing, education and infrastructure to just to name a few. This is what the economy will be losing year on year if efforts are not made to improve the care pathways for the diseases with the highest economic burden.
Approximately 10,000 recurrent strokes can be prevented every year in the UK if transient ischemic attacks (TIA) and minor strokes are treated in time. Also if a suspected stroke is diagnosed within 24 h and treated with thrombolysis the patient would most likely recover and avoid permanent disability, so early diagnosis is key[4,5].
Unaddressed chronic pain
It is estimated that 14 million people live with chronic pain in England alone. In 2011, 31% of men and 37% of women reported persistent pain. Of these, 25% (or one in four – 3.5 million) said that their pain had kept them from usual activities (including work) on at least 14 days in the previous three months. The total cost of chronic back pain to the economy is estimated at £12.3 billion per year[6,7].
Low back pain is ranked highest out of 291 conditions studied by the Global Burden of Disease study, ranking number one for years lost to disability worldwide8. In fact four of the top 12 disabling conditions globally are persistent pain conditions (low-back and neck pain, migraine, arthritis, other musculoskeletal conditions)[6].
The role of technology
Treatments for stroke, such as thrombolysis, can represent the difference between being severely disabled and making an almost complete recovery, but is best administered within four to six hours of the onset of symptoms. The costs are outweighed by the benefits in terms of prevented strokes, fast recovery and preventing permanent disability[5].
Innovative medical technologies can make a difference such as GEHC’s high-definition CT system that was included in the first fully positive recommendation from the National Institute for Health and Care Excellence (NICE)’s Diagnostic Assessment Programme[9]. This aimed to ensure that the NHS can rapidly and consistently adopt clinically and cost effective technologies. The improved resolution of the highdefinition CT system helps address the main challenges of cardiac imaging, namely coronary motion, high heart rates, calcium blooming and accurate myocardial perfusion. The NICE guidance demonstrates there are financial savings to be made by the NHS using new generation scanners for cardiac imaging in these patients[9]. Moreover, following the guidance can lead to improved patient care, often eliminating the need for unnecessary and costly investigations.
Care pathways approach - Scot – Heart study for CHD
A trial comparing the use of coronary CT angiography (CCTA) to standard care alone in more than 4,000 chest pain patients revealed sharply reduced event rates and fewer negative angiographies when CCTA was used to guide patient management, according to results published in the Journal of the American College of Cardiology, the Lancet and Aunt Mimmie.com[10,11].
Through the SCOT-HEART study, using a CT scan as well as the standard tests could improve CHD diagnosis, according to a University of Edinburgh study led by a British Heart Foundation Professor[11].
The researchers found that a CT coronary angiogram led to patients with chest pain having their diagnosis correctly reclassified in a quarter of cases. This often led to a change in the patient's treatment[12,13].
Improved diagnosis of CHD could save lives by helping doctors make better decisions about treatment to reduce a person's risk of a heart attack[14,15].
The number of heart attacks in the group of patients who had the CT scan was around a third less than in the group who received standard tests[11].
A whole of government approach is required in tackling the root causes of ill health at work as this would help improve productivity.
Since better health leads to improved economic growth, and improved economic growth leads to better health—choosing between the two is a false dichotomy. Ministries of Finance and Ministries of Health need to work together to achieve better health and economic outcomes for the population.
There needs to be a key focus on implementation and monitoring of impact and outcomes. If government departments come together to tackle ill health this could lead to better prevention, earlier diagnosis and earlier treatment which would enable a healthier workforce and population.
In summary, I reiterate my belief that one of the ways in which costs can be reduced is by repurposing national health systems from ‘sickness services’ to ‘wellness services’. We should move away from only monitoring activity to focusing on improving outcomes more efficiently. Improving the health of the working population by focusing on prevention, early diagnosis, treatment, management and control of chronic diseases will ultimately reduce the economic burden of ill health.
