Darkness Invisible

The Hidden Global Costs of Mental Illness

The hidden epidemic: in a mental hospital in Shanxi Province, China, October 2010 Stringer / Courtesy Reuters

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,

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