By Thomas R. Insel, Pamela Y. Collins, and Steven E. Hyman
Four years ago, a team of scholars from the Harvard School of Public Health and the World Economic Forum prepared a report on the current and future global economic burden of disease. Science and medicine have made tremendous progress in combating infectious diseases during the past five decades, and the group noted that noncommunicable diseases, such as heart disease and diabetes, now pose a greater risk than contagious illnesses. In 2010, the report’s authors found, noncommunicable diseases caused 63 percent of all deaths around the world, and 80 percent of those fatalities occurred in countries that the World Bank characterizes as low income or middle income. Noncommunicable diseases are partly rooted in lifestyle and diet, and their emergence as a major risk, especially in the developing world, represents the dark side of the economic advances that have also spurred increased longevity, urbanization, and population growth. The scale of the problem is only going to grow: between 2010 and 2030, the report estimated, chronic noncommunicable diseases will reduce global GDP by $46.7 trillion.
These findings reflected a growing consensus among global health experts and economists. But the report did contain one big surprise: it predicted that the largest source of those tremendous future costs would be mental disorders, which the report forecast would account for more than a third of the global economic burden of noncommunicable diseases by 2030. Taken together, the direct economic effects of mental illness (such as spending on care) and the indirect effects (such as lost productivity) already cost the global economy around $2.5 trillion a year. By 2030, the team projected, that amount will increase to around $6 trillion, in constant dollars—more than heart disease and more than cancer, diabetes, and respiratory diseases combined.
These conclusions were dramatic and disturbing. Yet the report had virtually no impact on debates about public health policy, mostly because it did not manage to dislodge persistent and harmful misperceptions about mental illness. In wealthy countries, most people continue to view mental illness as a problem facing individuals and families, rather than as a policy challenge with significant economic and political implications. Meanwhile, in low-income and middle-income countries and within international organizations, officials tend to view mental illness as a “First World problem”; according to that view, worrying about mental health is a luxury that people living in severe poverty or amid violent conflict cannot afford…
…Finally, the international community needs to make a formal commitment to reducing the global economic burden of mental illness. Although mental illness affects the achievement of several of the UN’s MDGs, such as empowering women, reducing child mortality, improving maternal health, and reversing the spread of HIV, the goals made no mention of mental health. Now, the process of drafting successors to the MDGs, the so-called Sustainable Development Goals, is well under way. Mental health advocates involved in the process are pushing for the establishment of specific targets, including a ten percent reduction in suicide by 2020 and a 20 percent increase in treatment for severe mental disorders by the same date. These are achievable goals, but meeting them will require political will, public and private investment, and coordination among the health, financial, social-service, and educational sectors.
Such steps will go a long way toward reducing the damage mental disorders inflict on societies and economies all over the world. But for such measures to succeed, policymakers and experts must first pull mental illness out of the shadows and into the center of debates about global public health.
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