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Is healthy living cost free? What do world data suggest?

The potentials of humans lost due to poor health is immense. Is healthy living, cost free? No, as each of us are on an unique indifference curve with years of healthy living on X axis and affordability on Y axis, tracing the different combinations of healthy living with economic affordability which give the same level of satisfaction to the consumer. This is also conditioned inter alia  by each person’s current status of physical and mental health, age, heredity, habits, pre-existing illnesses, physical affordability, the will to bring lifestyle changes towards a healthy living, the preferred system of medicine,  patience level, life objective and so on. Thus, just because one can economically afford, does not guarantee a healthy living as human body is organically linked and nothing is mutually exclusive. 

Health economics focusses on burden of disease, measured by the concept of Disability Adjusted Life Year (DALY). What is DALY? One DALY is equal to one lost year of healthy life. Therefore, one DALY is equivalent of losing one year of good health due to premature death (called mortality) and due to disease or disability (called morbidity). Thus, DALY is the sum of years of life lost due to premature death and years lived with disease / disability. This is a societal measure and not an individual measure. Study by Max Roser and Hanna Ritchie (2016) on Burden of disease, indicated that the global burden of disease, sums up to a third of a year lost for each person on the planet. 

Causes of disease burden

In 2017, in the world (India) around 62% (56%) of the burden of disease was from non-communicable diseases (NCDs), 28% (34%) of the burden due to communicable, maternal, neonatal and nutritional diseases and 10% (10%) was from injuries. Crucial to note that share of NCDs in disease burden is increasing throughout the world, and India being no exception. The NCDs inter alia include respiratory disease, Diabetes, Mental disorders, liver disease, musculosketal diseases like arthritis, neurological disorders like dementia. The Communicable diseases include Malaria and neglected tropical diseases, HIV/AIDS, TB, and now on will also include Covid19. It is interesting to note that as incomes increase leading to improvement in overall health and living standards, the burden of disease is largely due to NCDs. Therefore, in high income countries, NCDs account for more than 80% of disease burden. In contrast in low-income countries, communicable diseases account for more than 60% of the disease burden. 

What diseases contribute towards burden

The Burden of disease by cause highlights that largely the NCDs such as cardiovascular diseases top the list followed by cancers, neonatal disorders, musculoskeletal disorders, mental and substance use disorders and other NCDs. 

Heart disease, cancer, diabetes, hypertension, arthritis, mental disorders are increasing with per capita income 

 Considering BRICS in addition to US and UK, in all countries, the share of NCDs is increasing with increased percapita incomes. Therefore, it is expected that heart disease, cancer, diabetes, hypertension, arthritis, mental disorders will increase as shown in the graph below. 

Per capita health expenditure will reduce disease burden 

Health expenditure per capita has lead to reducing the burden of disease in India, Russia, Brazil, South Africa (rise and fall), where as in US and UK, the burden of disease has almost remained constant. Therefore, after certain level of percapita health expenditure, it is unlikely that the disease burden will fall and accordingly other noneconomic measures of health needs to be focussed such as yoga, avoiding over eating, keeping mind happy and the like.

Higher per capita income does not reduce years with disability or disease

The number of years lived with disease or disability appears to be invariant with the Percapita income. For example, in India with lower per capita income, a person lives with disease or disability for ten years which is the same even in the US, UK, South Korea, Brazil even with much higher per capita incomes. 

Does Diabetes reduce with increase in per capita incomes?

The proportion of population with diabetes (ages 20 to 79) is around 10% in India and in the US. Therefore increased per capita income does not necessarily reduce the proportion of diabetic population. However, in UK, South Korea, Russia, South Africa, increased per capita incomes have reduced proportion of population with diabetes. It is crucial to look for other reasons too.

Disease burden by Age

Considering the burden of disease by age, world over the age group 15 to 49 years bears the maximum burden followed by those 50-69 years old, under 5 years and 70 years and above. 

Disease burden from NCDs in India by age

By age, the disease burden from NCDs is borne largely by 15-49 year olds followed by 50-69 year olds and the 70+ year olds. Accordingly, the health expenditure would increase. 

How does Life expectancy relate with Number of years lived with disease, disability?

As the life expectancy grows, the number of years lived with disease or disability is growing in most of the countries. This does not mean that life expectancy should not increase, but (1) is it at affordable cost, (2) can the poor and the middle class afford, (3) what are the non-cost solutions to be adopted are crucial.

Non – economic solutions to reduce burden of disease

As the results have shown that the number of years lived with disease, disability have been invariant with per capita incomes, it is crucial to look out for non-economic solutions to reduce the DALYs such as yoga, meditation, keeping mind happy, calm, with patience, alternative medications such as AYUSH, which have not only proven their efficacy especially in the case of controlling Non Communicable Diseases such as heart disease, cancer, arthritis, diabetes, hypertension, but also have proved to be cost effective, it is crucial for the public and the Government to give credence to these alternative solutions. In that case healthy living becomes affordable. 



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Disclaimer

Views expressed above are the author’s own.



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