8 February 2013
The personal cost of an illness to a patient cannot be measured in monetary terms when we consider pain, physical appearance after treatment, and dysfunction.
Quite properly, these factors are major considerations in shaping a policy agenda for care.
However, studying the economic cost of ill-health for the overall population has decided benefits, particularly in these times when health resources are very tight.
The NHS in Scotland today faces significant tests in dealing with the effects of an ageing population on the provision of services, and the effects of inequality upon health care demand.
One disease that is related is to social disadvantage is diabetes, a serious chronic condition, with type 2 tending to be more prevalent in less affluent areas, a trend reported by Audit Scotland
Diabetes poses public health challenges for the health service, and Diabetes UK has pulled no punches, saying ,
“Diabetes has become one of the biggest health challenges of our time.
“In the UK diabetes is the leading cause of blindness in the in working age people, caused by retinopathy affecting the blood vessels at the back of the eye.
“Diabetes is a main cause of kidney and heart disease, stroke and amputations.
“Diabetes is big, it is growing, it is serious and it is expensive.
“Its rising costs threaten the NHS budget”
In 1997, international experts gathered in Helsinki to tell 9,000 delegates to the International Diabetes Congress of the threat of diabetes becoming a global epidemic .
Local figures here confirm its predicted rise.
In 2001 the number of people in the NHS Tayside area with diabetes was 9,694.
A decade later, that number had more than doubled to 20,066.
A series of studies have shown the magnitude of the effect of diabetes on NHS resources.
In 2008/9 Quality Improvement Scotland indicated that diabetic care accounted for £1billion , equivalent to 10 per cent of the health budget.
This is a great deal higher more than the much more media – reported disease of obesity costs Scottish society .
“We estimate that the total cost to Scottish society of obesity in 2007/8 was in excess of £457 million and it is likely that this is an underestimate. Much of this cost is avoidable,” said the Scottish Government three years ago.
Those with diabetes in Scotland face substantial financial costs, estimated at totalling over £40 million a year .
These costs result from absence from work, through loss of employment and early retirement because of the condition, and travelling costs for treatment.
So in dealing with diseases such as diabetes, assessing its economic cost is not an academic exercise.
It is a major concern of government and it assists them in making better-informed decisions about the level of allocation of resources to health budgets for primary care and scientific research, it presents evidence on how successful or otherwise preventative programmes have been, and it better informs choices made on priorities.
By demonstrating the magnitude of the economic cost of a disease, cost of illness studies play an important part in determining public health policy.
Notwithstanding that, we can go further.
Public health policy is part of overall government policies.
As the incidence of type 2 diabetes correlates with social inequality, then overall government policy, and not just public health policy, needs to be examined.
Obesity shows a similar relationship with inequality, as does smoking.
Therefore, a more determined, better-resourced policy of tackling social inequality generally is a priority if we are to bring down the rates of these diseases.