Healthcare Landscape in Pakistan – Burden of Disease – Asrar Qureshi’s Blog Post 980

Healthcare Landscape in Pakistan – Burden of Disease – Asrar Qureshi’s Blog Post 980

Dear Colleagues! This is Asrar Qureshi’s Blog Post 980 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to aq.pharmaveterans@gmail.com for publishing your contributions here.

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Burden of Disease

Burden of Disease – BoD – is the impact of health problem as measured by financial cost, mortality, morbidity, or other indicators. It is often quantified in terms of Quality-Adjusted-Life-Years – QALY – or Disability-Adjusted-Life-Years – DALY. Both of these metrics quantify the number of years lost due to disability, or disease, or years lived with disability/disease. One DALY can be thought of as one year of healthy life lost. In simpler words, the sum of mortality and morbidity is called the burden of disease because both cause loss of years, measured in DALY.

At the global level, the largest disease burden comes from Cardiovascular & Metabolic diseases (534 million years), Cancers (247 million), Neonatal disorders (200 million), Respiratory infections (160 million), and Mental disorders (138 million). Disease burden has been changing worldwide due to several factors.

Diseases are categorized into three major areas: Communicable diseases which are transferred from one person to another, like from mother to child, or between people; Non-Communicable Diseases – NCDs like diabetes, cardiovascular diseases, Asthma; and injuries caused by trauma, accidents, and natural disasters. 

Pakistan’s health challenges have been compounded by a series of natural disasters including the devastating flood of 2022 affecting over 33 million people, COVID19 pandemic, political turmoil, and ever-evolving security threatening events. The leading causes of premature mortality and morbidity in 2019 were neonatal disorders, ischemic heart disease, stroke, diarrheal diseases, lower respiratory infections, child and maternal malnutrition, air pollution, high systolic blood pressure, dietary risks, and tobacco consumption. 

The various rates of DALYs by region indicate serious equity issues also. Islamabad rate of of DALY was 22,226 per 100,000, but Baluchistan’s rate was more than double at 49,620 per 100,000, and also higher than the country’s rate of 42,059 per 100,000.

Over the last 30 years, the top five causes of disease burden have shifted from communicable to NCDs. Cardiovascular disease, cancers, and diabetes are becoming major causes of death and disability. In fact, researchers forecast that these NCDs will remain the three leading causes of death in the next 30 years.

Some differences were seen in disease burden with respect to age. Respiratory infections had a prevalence of 11% in the 18-21 age group, and 17% in the 36-45 age group. Similarly, diabetes had a prevalence of 13% in the 18-21 age group, and 18% in 46-60 age group. (This was based on the sample survey done by Karandaaz. Diabetes is now estimated at 28-30%). On the other hand, diseases like TB, diarrhea, cancer, hepatitis, kidney disease, and depression had a relatively consistent prevalence across all age groups.

Economic Impact of Burden of Disease

The economic burden is divided into three parts: one, the cost that the government must incur to prevent and/or treat communicable and NCDs; two, the cost that the patient must incur to get treatment; and three, the loss of work years due to mortality and morbidity. When added up, the total cost runs into billions of rupees for every year. 

Despite research, I could not find a consolidated figure for economic impact of the disease burden as a whole. However, I did find information about individual areas which I am sharing below.

Undernutrition/ Malnutrition

World Food Program report of 2017 summary says:

• Maternal nutrition and breastfeeding behavior, along with child underweight, wasting and micronutrient deficiencies, are linked to approximately 177,000 deaths annually in Pakistan, which corresponds to more than one-third of all-child mortality. The lost future workforce is valued at US$ 2.24 billion per year. 

• Cognitive deficits derived from childhood stunting, anemia and iodine deficiency disorders will result in reduced future adult productivity, which is valued at a Net Present Value (NPV) of US$ 3.7 billion per year. 

• Projections indicate that anemia among adult men and women who are engaged in agriculture, industry and other manual labor will lower their economic output by US$ 657 million per year. The cost of utilization of health care services due to zinc deficiencies, suboptimal breastfeeding and low birth weight is estimated at approximately US$ 1 billion annually.

The cumulative economic impact of undernutrition/malnutrition was US$7.6 billion – Rs. 2,128 billion or 2.12 trillion in 2017. It must have increased substantially because people purchasing power has gone down considerably.

Smoking and Tobacco Related Diseases

• 8.8% population consumes tobacco in various forms.

• The total costs attributable to all smoking-related diseases and deaths in Pakistan for 2019 are Rs 615.07 billion ($3.85 billion), and the indirect costs (morbidity and mortality) make up 70 percent of the total cost. Rural residents bear 61 percent, males bear 77 percent and 35–64 age group bears 86% of the total cost. 

• The total tax contribution of tobacco industry (120 billion in 2019) is only around 20 percent of the total cost of smoking. 

• Smoking-attributable total direct and indirect cost of cancer, cardiovascular and respiratory diseases amount to a total of Rs. 437.76 billion (US$ 2.74 billion) which is 3.65 times higher than the overall tax revenue from the tobacco industry (120 billion in 2019). 

• The smoking-attributable direct cost is 8.3 percent of the total health expenditures, which is very high.

Mental Illnesses

• An estimated 10-16% of Pakistan population suffers from mental illness.

• Economic burden of mental illnesses has been rising at an alarming rate, from 250 billion rupees in 2006 to 617 billion in 2020.

Diabetes

• According to International Diabetes Federation, in 2022, 26.7% of adults in Pakistan are affected by Diabetes, making the number of cases approximately 33 million.

• The estimated economic cost of diabetes, treatment of disease, treatment of diabetic complications, and the loss of productivity was estimated to be 7,000 billion rupees in 2022.

Heart Diseases

• Heart diseases are rising in Pakistan. For the foreseeable future, this rising trend will continue as the risk factors are highly prevalent: age-adjusted comparative prevalence of diabetes is around 30%; 37% of adults have high blood pressure; about 25% adult males smoke; 58% are married to first or second cousins. 

• According to Global Burden of Disease study, the estimated age standardized incidence of heart disease was 918 per 100,000, and the age-standardized death rate was 358 per 100,000.

• The economic impact is not available.

Concluded.

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For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intention to infringe upon anyone’s copyrights. If, however, it happens unintentionally, I offer my sincere regrets.

References:

https://en.wikipedia.org/wiki/Disease_burden

https://ourworldindata.org/burden-of-disease

https://www.healthdata.org/news-events/newsroom/news-releases/lancet-pakistan-faces-double-burden-communicable-non

https://www.pc.gov.pk/uploads/report/Economic_Consequences.pdf

https://tobacconomics.org/files/research/677/the-economic-cost-of-tobacco-induced-diseases.pdf 

https://www.cambridge.org/core/journals/bjpsych-international/article/economic-burden-of-mental-illness-in-pakistan-an-estimation-for-the-year-2020-from-existing-evidence/9010FDDCCD76D036E3A682A7B58D4189