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close this bookFact sheet No 145: Blindness and Visual Disability Part IV of VII: Socioeconomic Aspects - February 1997 (WHO, 1997, 3 p.)
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Part IV of VII: Socioeconomic Aspects

In addition to being a public health problem, blindness and visual impairment have important socioeconomic implications. The costs of rehabilitation and care may be the most apparent. Equally important are the indirect costs resulting from the loss of productivity.

There is a growing trend worldwide to evaluate disease and disability prevention on the basis of costs incurred and benefits accrued. Public health interventions to prevent blindness are particularly revealing in this respect, as cost savings and return on investment accrue, because of the avoided rehabilitative costs, on the one hand, and the gains in productivity, on the other.

· The Financial Burden of Avoidable Blindness: Accurate data on the total economic and social costs of blindness and severe visual impairment are not available. Moreover, the cost estimates vary widely from country to country, based on the prevalence and causes of blindness, the age of those affected, the employment situation in the country concerned, the wage structure, and the existence and coverage of social, rehabilitative and educational services. However, in every country such costs have been shown to be a considerable strain on the national economy.

* In 1990, the aggregated cost of blindness to the federal budget in the United States was estimated to be approximately US$ 4.1 billion. A minimal federal budgetary cost of a person-year of blindness (vision less than 6/60 in the better eye) for a working-age adult was estimated to be US$ 11,896.

* More importantly, it has been estimated that in the USA, if all the avoidable blindness in persons under 20 and working-age adults were prevented, a potential saving of US$ 1.0 billion per year would accrue to the federal budget.

* In a study from India in 1989, a conservative estimate of the aggregated costs of blindness to the national economy, including a minimal subsistence allowance for the blind, amounted to approximately US$ 4.6 billion per year.

· Social implications: The economic burden of blindness and visual impairment is only part of the story. The person who is blind and his or her family face important social constraints. Both directly and indirectly, visual impairment interferes with various activities of daily living. Blind children have to face developmental challenges. In adult life, employment opportunities for the visually disabled are extremely limited and their participation in a host of leisure activities is seriously hampered. In addition, in many societies visual impairment results in a loss of status and self-esteem. These physical and, especially, the psychosocial implications of visual impairment and blindness cannot be accurately quantified in monetary terms. However, they do erode the quality of life of both the affected individuals and their families.

* A study in the UK indicated that visually disabled people were poorer on average, had lower educational levels, lower employment and less social life than sighted people. These findings probably hold true in all societies. Also, in African settings, it has been reported that blind persons die earlier compared to sighted population.

Prevention: Some examples of cost-effective public health interventions to prevent blindness include:

· Cataract Surgery as Part of Primary Health Care: Cataracts are the most common cause of avoidable blindness. Worldwide, there are an estimated 16 million persons who are blind as a result of cataracts. The majority of these people live in the rural areas of economically developing countries. The burden on the country is significant.

* In the absence of any preventive measures that can be applied in a public health setting, the only recourse is surgery. Cataract surgery is a highly cost-effective intervention: generally sight is restored after a relatively low-cost operation. The costs of cataract surgery vary depending on the country, the technology used, and whether the surgery involves hospitalization.

* With recent trends in making intraocular lenses available at costs as low as

US$ 10, the overall cost of surgery has steadily decreased, and there is a rapidly growing popularity for such surgery including in developing countries.

* A South Asian study revealed that not only did 85% of the men and 58% of the women who regained their sight return to work, but that there was also a financial return of 1500% on the expense in the year following surgery.

* The cost-effectiveness of cataract surgery has been demonstrated worldwide. In addition to the restoration of sight, there is an enhancement of the quality of life. Cataract surgery costs have therefore been evaluated per quality-adjusted life year (QALY) gained. In comparison with other common public health interventions, cataract surgery has been ranked as one of the most cost-effective means offered to adults in the developing world using available technology.

· Onchocerciasis Control: The economic returns on investment in the control of river blindness (onchocerciasis) through the Onchocerciasis Control Programme (OCP) in West Africa are impressive. Covering 11 Sahelian countries, it has helped to protect 30 million people, including more than 10 million children born since 1974, from river blindness, at a cost of US$ 1 per year per person of the total population.

* Over 1.5 million seriously infected persons have recovered fully, and it is estimated that by the turn of the century nearly half a million people will have been prevented from going blind.

* In addition to savings in terms of human sight and suffering, the economic gains are also very impressive. An estimated 25 million hectares of fertile land, once deserted on account of this disabling disease, are being resettled and cultivated.

* It is estimated that the return on the investment of about US$ 570 million - the input into the OCP from its inception to the year 2002 - will be in the range of 16% to 28%.

· Diabetic Retinopathy: In many developed countries, diabetic retinopathy is the most common cause of vision loss in the working population. Sight-threatening retinal complications can be effectively prevented by adequate control of diabetes and through periodic ophthalmoscopic examination and laser photocoagulation when required. In many countries, health education programmes aimed at motivating diabetic patients to undergo periodic eye examinations have proven to be cost-effective.

* In a study in the USA, the annual cost of welfare benefits per patient with severe visual loss caused by diabetes was estimated to be nearly seven times the cost per patient per year of vision saved. The same study concluded that prevention programmes aimed at improving eye care for diabetic patients not only result in substantial federal budgetary savings but are a highly cost-effective health investment for society.

· Retinopathy of Prematurity (ROP): It is the leading cause of blindness among premature infants particularly in developed and rapidly developing economies. The rise in ROP results from the increased survival of low and extremely low birth weight infants, resulting from improvements in neonatal care. Blindness occurring in infancy and childhood is a long-lasting drain, both in terms of social dependence and lost productivity. Therefore, a public health intervention that saves the sight of even a relatively small number of infants and children provides significant savings, while ensuring a better quality of life of those affected.

* Blindness can be prevented in many of these infants through timely screening and treatment. Studies have demonstrated that properly timed screening and treatment for ROP in low and extremely low birth weight infants in the USA result in a net cost saving of US$ 38.3 million to nearly US$ 65 million per year.

The economic and social costs of blindness must be considered from the perspective of both the disabled individual, and the country as a whole. Many of the same economic and social cost considerations apply to both developed and developing countries, although the developing countries have more limited health and social care services and hence lower overall economic resources, to bear the burden of avoidable blindness.

In this context, the need for eliminating avoidable blindness should become a public health priority. Sight-saving interventions should be seen as opportunities for investment with a worthwhile return in both humanitarian and economic terms.

For further information, please contact Health Communication and Public Relations, WHO, Geneva, Telephone (41 22) 791 2532/2584. Fax (41 22) 791 4858.

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