1. Economic impact of Cardiovascular Disease and Hypertension in Africa Paper presented at the 3 rd International Forum for Hypertension in Africa conference at Sheraton Hotel, Abuja, Nigeria on the 26 th September 2009 by Dr. Kingsley K. Akinroye, President, African Heart Network

2. Global Cardiovascular Disease Burden 17 million global deaths due to CVD ¾ in Developing Countries

3. 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

4. Global Heath burden CVD- leading cause of death world-wide Estimated global deaths by cause, all ages, 2005 Source : WHO 2005: «Preventing Chronic Diseases: A Vital Investment»

5. WHO Report 2005

6. Projected death rates by specific causes for selected countries, all ages, 2005 WHO Report 2005

7. 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

8. Stroke mortality by region (1990) Mortality rate (per 100,000) Former socialist economies192.35 China112.12 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

9. Tobacco use on the rise in developing countries

10. 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

11. 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

12. COI Studies  3 components Direct cost Indirect cost Intangible cost

13. Direct Economic Impact  Cost of medical care for health services and medications Ambulances Inpatient or outpatient care Rehabilitation Community health services

14. 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

15.  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:

16. Adult life Expectancy in Africa vs Developed Countries AfricaDeveloped Countries Ghana - 59.85Japan – 82.1 Kenya – 57.86France – 80.98 Uganda – 52.72Finland – 78.97 Tanzania – 52.01United Kingdom – 79.01 Nigeria – 46.94Germany – 79.4 Liberia – 41.84Spain – 80.9 Mozambique – 41.18Ireland – 78.9

17. 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)

18. 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

19. 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

20. 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;

21. 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

22. 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

23. 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