Promoting Cardiovascular Health in the Developing World A Critical Challenge to Achieve Global Health (2010) / Chapter Skim
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3 Development and Cardiovascular Disease
3 Development and Cardiovascular Disease
Pages 125-148
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From page 125... ...
The chapter then concludes with a review of the evidence documenting economic impacts of CVD in low and middle income countries, both for countries and for households, highlighting the finding that the burden falls disproportionately on the poor. ECONOMIC DEVELOPMENT AND CARDIOVASCULAR DISEASE Unfortunately, the economics of CVD in low and middle income countries is not heavily studied and methods and data are not uniform; as a
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From page 126... ...
Thus, not only will economic development alone be insufficient to improve chronic disease outcomes in developing countries, but also the widespread appearance of chronic disease also threatens to deter the economic growth needed in many low income countries. Historical experience in and across countries illustrates how increased wealth and development can be expected to affect cardiovascular health.
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From page 127... ...
Conclusion 3.1: In general, CVD risks are rising among low income countries, are highest for middle income developing countries, and then fall off for countries at a more advanced stage of development. This pattern reflects a complex interaction among average per capita income in a country, trends in lifestyle, and other risk factors, and health sys tems capacity to control CVD.
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From page 128... ...
26 SBP: 135 mmHg 6.0 24 5.5 SBP: 125 mmHg 22 5.0 20 4.5 18 4.0 0 5000 10000 15000 20000 25000 30000 GDP (Int $) FIGURE 3.1 CVD risks in relation to national income.
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From page 129... ...
The challenge facing middle income developing countries is to reverse or slow the rise in CVD in an affordable and cost-effective manner. DEVELOPMENT AND SYSTEMIC DRIVERS OF HEALTH Most of the countries that are now considered developed went through an economic transformation in the early to mid-20th century that was accompanied by major advances in health and longer life expectancy.
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From page 130... ...
0 Globalization and Development Information and Foreign direct Health Knowledge and Ur banization investment ; Communications Technology Scienc e Trade policies Technology Industrializatio n Ur ban designs eliminate Communication about ac tivity from work and risk, behavior change, daily living ac cess to health care Commercial Policies Lifest yle Changes and Prac tices Pressure on time ; Ef ficient Marketing women in workplac e; agriculture; Pricing demand for processe d Taste convenience foods food Availabili ty Consumption Patterns Activity Patterns Health Service Availability and Use Foods Work Detection and treatment of risk Calories School Fats /oils Leisure Hospital care for CVD events Salt Tobacco Blood pressure Morbidity Blood cholesterol Incidence Mortalit y Obesit y Blood glucose FIGURE 3.2 Systemic drivers of global CVD. Figure 3-2 rev.eps landscape
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From page 131... ...
The nature of economic production has also changed with the rise of technology-based and other forms of employment that accelerate the transition from rural lifestyles. Occupational health risks -- including sedentariness -- add to a shift toward chronic disease risk exposures.
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Immigration and Acculturation Part of demographic change is population migration and acculturation into new social and cultural contexts. Since the 1970s evidence has grown that immigrants to western countries have higher rates of coronary heart disease (CHD)
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From page 133... ...
. Research on indigenous populations within western countries has also found significant increases in rates of CVD and its associated risk factors when they abandon their traditional diets and ways of life (Yusuf et al., 2001b)
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From page 134... ...
Cultural and Social Norms Health is universally affected by cultural and social norms and behaviors, with wide variation across countries. Cultural food preferences, societal norms for body shape, cultural practices around use of leisure time and physical activity, and gender norms can interact with other risk factors to contribute to high rates of obesity and CVD risk.
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From page 135... ...
But the modern development process also confronts populations with serious and long-lasting health risks, challenging societies to find alternative organizational, technological, and policy choices. Still-developing countries have the advantage that they have not fully adopted the behaviors and conditions that raise CVD risks, and countries all along the development spectrum have opportunities to use policy tools to create strong economic incentives to reverse the course that was established only very recently, and thereby implement healthier growth.
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From page 136... ...
However, it is far from predictive, and the rapidity and variability of the emergence of CVD in developing countries discourages excess reliance on general historical patterns. This section synthesizes evidence from a different source of analysis to better understand the relationship between CVD and economics, namely country studies that demonstrate the economic consequences of CVD and CVD risk factors for individuals, households, and countries.
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From page 137... ...
The study shows relatively small economic gains from reduced chronic diseases and injuries in 2005 of $105-$324 in GDP per capita; however the economic toll rises to between $2856 and $9243 per capita by 2025 (World Bank Europe and Central Asia Human Development Department, 2005)
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From page 138... ...
estimated 10-year cumulative GDP losses of $2.5 billion for Tanzania and $7.6 billion for Nigeria from major chronic diseases.
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From page 139... ...
For instance, a common assumption is that reduced productivity from having a chronic disease will reduce a country's labor supply and thus have macroeconomic impacts. This is a tenuous assumption under conditions of less than full employ ment, and it can inflate the estimated economic loss from chronic disease.
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From page 140... ...
Unfortunately, there is little information that measures how CVD affects household-level economic output in developing countries. Based on a review of studies primarily in high income countries, barriers to employment for people with chronic diseases and risk factors are likely to arise from productivity limitations, costs of disability, and in some cases, stigma (Suhrcke et al., 2006)
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From page 141... ...
Global corporations monitoring the bottom line impacts of worker illhealth, particularly from chronic diseases, are showing dramatic returns on investment of up to $6 in greater productivity for every $1 spent on health promotion for their employees. Their results also show the indirect losses from absenteeism and "presenteeism" far outweigh the direct costs of health care (WEF, 2009)
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From page 142... ...
Many households experience dramatic shifts in spending and forgo other expenditures in order to buy tobacco and alcohol, two major risk factors for CVD. In India, for example, households that consumed tobacco had lower consumption of milk, education, clean fuel, and entertainment.
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From page 143... ...
Thus, poverty plays a role both as a risk factor and as a consequence of CVD. Poverty, as a contributing factor to CVD, is related to the lack of access to health care and health information among the poor as well as exposure to multiple risk factors that increase CVD risk.
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From page 144... ...
The pattern of rising CVD risks with development reflects a complex interaction among average per capita income in a country, trends in lifestyle and other risk factors, and health systems capacity to control CVD. Developing countries at different stages of development face different challenges in choosing public health strategies to reduce the burden of CVD.
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From page 145... ...
Although still not fully understood, the complex interrelationships in which economic development can contribute to and also be affected by the accelerating rates of inadequately addressed CVD and related chronic diseases in low and middle income countries supports the need for both urgent and carefully planned actions. REFERENCES Abegunde, D
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From page 146... ...
2006. The burden of cardiovascular disease in the Indian subconti nent.
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From page 147... ...
1975. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: Prevalence of coronary and hypertensive heart disease and associated risk factors.
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From page 148... ...
2001a. Global burden of cardiovascular diseases: Part I: General considerations, the epidemiologic transition, risk factors, and impact of urbanization.
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