Chronic diseases and health promotion

Part Two. The urgent need for action

Chapter Two. Chronic diseases and poverty

Direct economic impact

Catastrophic expenditure

Direct costs related to chronic disease include out-of-pocket payments for health services and medications. Ongoing health care-related expenses for chronic diseases are a major problem for many poor people. Acute chronic disease-related events - such as a heart attack or stroke - can be disastrously expensive, and are so for millions of people.

People who fall ill often face a dire choice: either to suffer and perhaps die without treatment, or to seek treatment and push their family into poverty. Those who suffer from long-standing chronic diseases are in the worst situation, because the costs of medical care are incurred over a long period of time.

Tobacco use

For various reasons, tobacco use tends to be higher among the poor than wealthier members of society, and they therefore spend relatively more on tobacco products. Spending money on tobacco deprives people of education opportunities that could help lift them out of poverty and also leads to greater health-care costs.

Spotlight: Economic impact of tobacco use

It is estimated that over 10.5 million people in Bangladesh who are malnourished could have an adequate diet if money spent on tobacco were spent on food instead, saving the lives of 350 children under the age of five years each day. The poorest households in Bangladesh spend almost 10 times as much on tobacco as on education.

In countries such as Bulgaria, Egypt, Indonesia, Myanmar and Nepal, household expenditure surveys show that low income households spend 5–15% of their disposable income on tobacco. In India, people are more likely to borrow money and sell their assets during hospitalization if they are tobacco users. The same is true if they are nonusers but belong to households that use tobacco. In the United Kingdom, the average cost of monthly health insurance premiums for a 35-year-old female smoker is 65% higher than the cost for a nonsmoker. Male smokers pay 70% higher health insurance premiums than nonsmokers.