|
|
|
Health Economic Statement
Imagine, for a moment,
attending a Toronto Maple Leafs hockey game at the Air Canada Centre.
It’s sold out, with all 19,500 seats filled.
As you look across the rows of seats and scan the crowd, imagine that
every fourth person will experience vision loss by age 75.
Every fourth person will no longer be able to drive, to read, or to
see the faces of loved ones.
Among this group, some will experience depression, requiring
counselling or medication.
Others will suffer falls, resulting in broken hips and other injuries
because of their poor vision.
And each will have to adjust to vision loss and overcome emotional and
physical challenges in order to maintain an independent lifestyle.
While the hockey game is fiction, the numbers of those that will lose
their vision and the consequent effects are very much fact.
Canada continues to battle a crisis in vision loss — a crisis that
requires ongoing attention as well as sustained efforts to improve
attitudes and approaches to blindness and visual impairment.
The National Consultation on the Crisis in Vision Loss, held in
Toronto in October 1998, first tackled this issue and provided a solid
collection of initiatives, the most notable being the creation of the
National Coalition for Vision Health.
Other initiatives included:
Placing vision on
the political agenda Securing increased
funding for rehabilitation and research Emphasizing eye
care for early detection of vision loss Giving a voice to
vision-care consumers
While strides have
certainly been made, there is still a great deal of work to be done.
But before moving forward, one should first step back and recognize the
extent to which Canadians cherish their vision and fear vision loss.
So important is vision that seven out of ten Canadians say they fear
losing their vision more than losing the use of their legs or their
hearing. (Environics Research Group, 2003)
One-third would sell everything they owned to save their eyesight, and
another third would cash in all their savings.
In a U.S. study from Lighthouse International (1995), a little over
one-quarter of sighted participants surveyed felt fear when meeting a
person who was blind, concerned that “What happened to them might happen
to me . . . ”
With such reverence for vision, one would think volumes of research on
blindness and vision loss would be available on the subject.
In fact, the opposite is true.
In Canada, concrete research about blindness, be it blindness prevention
or rehabilitation, is lacking when compared to the research done in the
U.S., U.K., and Australia.
In fact, one could make a strong argument for saying that Canada has the
worst record of supporting research of all the G8 countries.
Compare the amount of money spent on blindness research north and south of
the border.
The National Eye Institute (of America), along with two major private
research agencies, spent approximately US$660 million on blindness
research in 2003. That converts to about C$839 million.
Funding for eye research in Canada comes primarily from two federal
agencies — The Canadian Institute of Health Research (CIHR) and the
Natural Sciences and Engineering Research Council (NSERC).
The Canada Research Chair program (CRC) is currently funding about 15
professorships in vision-health–related areas.
The Quebec Vision Health Research Network, the E.A. Baker Foundation for
the Prevention of Blindness (the research arm of The Canadian National
Institute for the Blind), the Foundation Fighting Blindness (Canada), and
the Glaucoma Research Society are also involved in research projects on a
smaller scale.
Add up the budgets of all of these Canadian organizations, and the total
amount is about C$28 million a year. And this is double what was spent in
1999.
So lacking is Canadian research, it could be argued that the social and
economic impacts of blindness on Canadian society have yet to be
determined.
Could funds be better spent to preserve the vision of Canadians or
directed to better help those who have lost their vision lead independent
and productive lives?
Could health-care costs be slashed through blindness prevention programs?
Could social assistance costs be reduced through programs that boost the
independence of Canadians who are visually impaired?
To answer these questions, The Canadian National Institute for the Blind
(CNIB), in partnership with all of Canada’s leading vision health
organizations, is hosting The Cost
of Blindness – What it means to Canadians,
from January 31 to February 1, 2004, in Toronto.
The two-day event will feature a collection of national and international
experts in the fields of blindness, low vision, and epidemiology who will
share their knowledge and shed some much-needed light on the effects of
blindness in Canada.
The chief aim of the symposium is to establish a body of research that
clearly identifies what measures can be taken for Canada to develop
strategies to ease social and financial pressures and ultimately change
social policy.
Specifically, an action plan will emerge from this event that offers
solutions to inequities such as poor access to vision rehabilitation and
inadequate reimbursement for treatment for age-related blindness.
But before attaching a dollar figure to blindness, one should be familiar
with the prevalence of blindness and visual impairment in Canada and
internationally.
Globally, the number of people who are blind or visually impaired is
staggering. The World Health Organization (WHO) estimates there are
currently 44 million blind people in the world and an estimated 180
million who are visually impaired. That’s just under six times the
population of Canada.
So rampant is vision loss, the WHO states, “A person in the world loses
his or her sight every five seconds, and a child loses his or her sight
every minute.”
In 2001, Statistics Canada identified 610,950 Canadians as having a seeing
disability, defined as “difficulty seeing ordinary newsprint or clearly
seeing the face of someone from four metres.”
However, what is alarming is how this figure is expected to skyrocket over
the next 20 years, as more and more Canadians reach their senior years.
By 2010, it’s estimated there will be approximately 700,058 people who are
visually impaired, and by the year 2020, approximately 828,361.
The projection of the future need for vision rehabilitation services such
as those offered by the CNIB also offers strong evidence of this looming
crisis.
In 2002, the CNIB helped over 104,000 clients adjust to vision loss
through rehabilitation programs, counselling, and other services.
Call it the calm before the storm. The CNIB expects the number of CNIB
clients to balloon to over 187,000 in just 15 years.
Over half of these new clients will seek the CNIB’s help to adjust to
age-related macular degeneration (AMD) — Canada’s leading cause of
blindness, with 78,000 new cases diagnosed in 2003. And that figure is
expected to triple over the next 25 years.
Now the leading cause of blindness in North America, AMD causes the
deterioration of the macula, located near the centre of the retina,
resulting in a gradual or sudden loss of central vision, leaving
peripheral, or side vision, intact.
More people are affected by AMD than glaucoma and cataracts combined. Yet
for decades, this condition has eluded the spotlight, possibly because it
does not lead to total blindness, or because seniors simply accepted AMD
as a natural part of aging.
The results of research exploring possible treatments and causes of AMD
are beginning to emerge, including identifying smoking as a principal risk
factor.
Dr. Paul Mitchell, co-author of the
Blue Mountain Eye Study in
Australia, commented, “We determined that smoking may now cause or
contribute to up to 20 per cent of new blindness in Australians over 50
years old. That is a very high proportion due to an avoidable risk
factor.”
Is there a doctor in the house?
Unfortunately, while the number of Canadians who develop AMD and other eye
conditions soars, so too does the waiting time to see an eye-care
physician.
“As a result of government cutbacks, coupled with a standard rate of
retirement, the wait to receive an appointment with a general
ophthalmologist, referred by a GP, has doubled in the last decade to a
median referral time of 27.9 weeks,” stated the Fraser Institute, in its
report Hospital Waiting Lists for
Canada, 2001.
That’s just shy of 200 days to wait as a patient’s vision potentially
deteriorates. (Certain forms of AMD develop in a matter of weeks.)
From seeing a specialist to receiving surgical treatment, the wait time is
also extremely long at 16 weeks — or another 112 days.
The root of this lengthy delay? Canadian training programs are producing
only 20 ophthalmologists per year in contrast to the 40 produced in the
1980s, the Canadian Ophthalmological Society (COS) reported to the
Commission on the Future of Health Care in December 2001.
And yet projections for the demand for ophthalmologists’ services indicate
an increase of 44 per cent between 1997 and 2016.
“Without addressing this challenge and implementing solutions now, we will
have a country in which ophthalmology services are available only in large
urban centres,” the COS concluded.
In the meantime, ophthalmologists are not getting any younger. The
Canadian Medical Association reported over one-third of practising
ophthalmologists are over 55. By 2015, 43 per cent will be over 55. (CMA
figures projected in 2001)
So what does blindness cost Canada?
So while the prevalence of blindness increases and waiting times lengthen,
what is the economic expense for Canadian society? A definitive answer to
this question is elusive at best, hence the need for the Cost of Blindness
symposium.
“Understanding the true financial burden of eye disease in Canada is
necessary in order to guide policy decisions with respect to health-care
funding for ocular health and social support for those with visual
disabilities,” stressed Dr. David Maberley, an assistant professor with
the University of British Columbia’s Ophthalmology Department.
Dr. Maberley estimates that the annual cost of blindness in Canada is
approximately C$1 billion, based on CNIB registry data, disability
benefits, and tax exemptions.
A look Down Under
Australia perhaps offers the best model at present regarding the cost of
blindness.
Professor Hugh Taylor, the director of the Centre of Eye Research
Australia (CERA), calculated that the Australian government spent A$2.08
billion for eye care and rehabilitation costs in 2001.
Here is how Taylor broke down the costs (in Australian dollars):
Refractive error - $250 million
Cataracts - $378 million
Diabetes - $326 million
Glaucoma - $320 million
Macular degeneration - $180 million
Blind pension and entitlements $625 million
Societal costs of vision loss and blindness
Beyond simply costs, Dr. Taylor also highlights how vision loss
contributes to higher costs in other health-care fields.
As a result of his research, he concluded that with blindness:
Difficulty with
daily living doubles. The risk of falls
doubles. The risk of depression
triples. The risk of hip fractures
quadruples. Ease of social
functioning is cut in half.
Cost of vision loss south of the border
Lighthouse International, based in New York, also conducted a study in 2002 to
examine the costs associated with vision loss:
In 1981, the
economic impact of visual disorders and disabilities was
approximately US$14.1 billion per year. By 1995, this figure was
estimated to have risen to more than US$38.4 billion — $22.3 billion
in direct costs and another US$16.1 billion in indirect costs each
year. (National Advisory Eye Council, 1998)
Visual impairment has
been identified as one of the four most significant contributors to lost
independence among older Americans. The loss of independence (due to all causes)
costs an additional US$26 billion in medical and long-term costs per year.
(Alliance for Aging Research, 1999)
A shift in attitude
To bring about change, there must first be a shift in attitude towards investing
in blindness programs, urges Corinne Kirchner, director of the Department of
Policy Research and Program Evaluation at the American Foundation for the Blind.
In an article for the Journal of Visual
Impairment and Blindness, she suggests
that, instead of asking, “What are the costs to society of having X number of
blind and visually impaired people?”, one should ask, “What are the costs to
society of preventing or limiting the economic productivity of people who are
blind or visually impaired?”
Money spent on rehabilitation should be regarded as an investment in
productivity, not as a cost.
“Currently, education, rehabilitation, and opportunities for full social
participation of people with disabilities are at great risk of being curtailed
in the wake of radical cost-cutting, based on economic cost-benefit ratios
derived from studies with outdated negative assumptions,” she warned.
Breaking down barriers in the workplace
Gail Fawcett, author of Living With
Disability in Canada: An Economic Portrait,
commented, “The employability of persons with disabilities has as much to do
with their environment as it does with their disabilities.”
Employers are often hesitant to hire people with vision impairment. According to
a study by Karen Wolffe and Anthony Candela (2002), employers are concerned
about the expense associated with workplace accommodations, which delays
vision-impaired employees reaching full productivity.
To a large extent, these concerns reflect a lack of experience in dealing with
someone with a visual impairment. Wolffe and Candela (2002) found that those who
have had experience hiring someone with vision loss are far more likely to do so
again.
Candela and Wolffe (2001) found employers' concerns and reluctance to hire
people with disabilities reflected social stereotypes about blindness and fear
about the condition.
This stigma is damaging, as it undermines the image of visually impaired
employees as hard-working, contributing members of society.
Workplace accommodation — not as expensive as you might think
“As one would expect, legally blind respondents do incur extra costs for
adaptive technology for the workplace and home,” said Kirchner.
She co-authored a paper titled Lifestyles
of Employed Legally Blind People: A Study of Expenditures and Time Use.
“But the average costs, under US$500 and $1,300, respectively, tend to be lower
than one might have expected,” she stressed.
“As activists have long claimed and as previous studies have shown, legally
blind people clearly can pursue a wide variety of careers and lead lives that
are economically and socially very similar to those of the sighted majority,”
she concluded.
High unemployment rate among visually impaired
But because of these lingering stereotypes and fears, the National Council on
Disability (United States data, 1994) commissioned a poll that estimated that 70
to 80 per cent of people who are blind or visually impaired are unemployed.
Recent data on Canadian statistics are not available, however the CNIB believes
the statistics are similar in Canada.
Statistics Canada did estimate in 2001 that of the 3.4 million Canadians of
working age with any kind of disability, 67 per cent of those physically able to
work are unemployed.
Lost productivity among people who are blind or visually impaired
“Four out of five working-age blind Canadians do not have an opportunity to work
and contribute to this country’s economic growth,” said Chris Stark, in a paper
released by the National Federation of the Blind this summer.
“Most blind persons have an inadequate income during working age and after
retirement, well below the level of other Canadians. Blind persons have a
standard of living inferior to all other Canadians,” he added.
And what is a person who is 50 years old and develops AMD supposed to do when he
or she suddenly cannot see? What resources or support services are there for
this person to resume working?
Braille readers hit the books
While so many doors remain closed for working-age Canadians who are visually
impaired, consider the accomplishments of blind and visually impaired Canadians
who read braille.
In a CNIB study titled, “Understanding
Braille Literacy and Its Impact on Library Services to Canadians,”
just six per cent of the braille readers who
responded to this survey were unemployed, a lower figure than the general
population.
Fifty-two per cent of braille readers reported household incomes higher than
C$25,000, with 14 per cent earning more than C$50,000 — a significantly higher
figure than the 10 per cent of the general population reported by Statistics
Canada in 1993.
Statistics Canada also reported that 8.8 per cent of Canadians held university
degrees. Compared to the general population, 11 per cent of braille readers have
a university degree, and 14 per cent have more than one degree.
Access to information
Closely related to the high unemployment rate is the lack of information
available to those who are blind or visually impaired.
Currently, just three per cent of information is available in alternative
formats such as braille, audio, or electronic text. Imagine being able to read
three per cent of a textbook, or three per cent of a newspaper.
With just three per cent available, people who are blind or visually impaired
are considered “information poor,” threatening literacy and independence.
This gap separates children who are blind or visually impaired from their
sighted peers. Blind students — at school, college, or university — are always
at risk of falling behind.
The same disparity is an enormous obstacle for adults in the workplace.
Canadians who are blind or visually impaired simply cannot compete in the
classroom and in the workplace if they do not have access to information.
The need for a national assistive devices program
Even if information were made more readily available, Canadians who are blind or
visually impaired need the technology devices to obtain it, such as CCTVs, voice
recognition organizers, screen-reading software, and braille displays.
Each province has limited programs in place to help cover the cost of such
devices to help people on income-support programs to return to work.
However, only Alberta, Saskatchewan, Ontario, and Quebec have programs that have
a much broader scope, enabling working people, seniors, and children to acquire
necessary devices for personal and professional use.
Canadians who reside outside these four provinces and are not on government
assistance must bear the full cost of any such equipment, which can cost from
C$100 for a magnifier to C$10,000 for a braille display.
The CNIB is lobbying to have a national assistive devices program that
transcends provincial borders where, “the only eligibility is the disability.”
Potential savings with blindness programs, initiatives
The potential savings that would be realized by investing in blindness
prevention and assistance programs is again relatively unknown in Canada.
However, the financial gain appears to be enormous when looking at the global
picture.
Dr. Kevin Frick, an associate professor at the Johns Hopkins Bloomberg School of
Public Health, examined the initiatives set forward by VISION 2020 — an
international coalition of blindness groups determined to eliminate avoidable
blindness by the year 2020.
Frick concluded that VISION 2020 initiatives would increase global economic
productivity to the tune of an economic gain of US$102 billion from 2003 to
2020.
Without VISION 2020 intervention, the world’s blind would increase from US$44
million in 2000 to US$76 million in 2020, he warned.
Financially, the global economic productivity lost will soar from US$19 billion
in 2000 to US$50 billion in 2020.
REFERENCES
The Canadian National Institute for the Blind.
Understanding Braille Literacy and Its Impact on
Library Services to Blind Canadians.
October 22, 1995.
Environics Research Group. Awareness of
Age-Related Macular Degeneration (AMD) and Attitudes and Behaviours re Vision
Loss. June 2003.
Frick, K.D., A. Foster. “The Magnitude and Cost of Global Blindness: An
Increasing Problem That Can Be Alleviated.”
American Journal of Ophthalmology
April 2003, p. 471–76.
Kirchner, Corrine. “Economic Aspects of Blindness and Low Vision: A New
Perspective.” Journal of Visual Impairment
and Blindness Nov/Dec 95, Part 1 of 2,
Vol. 89, Issue 6, p. 506–14.
Leonard, R. Statistics on Vision Impairment: A Resource Manual. Arlene Gordon
Research Institute of Lighthouse International. April 2002.
Maberley, D. The Cost of Blindness in Canada: A Protocol.
The Department of Ophthalmology, University of British Columbia. November 12,
2002.
McBroom, L., C. Kirchner, K.A. Nelson, W.H. Graves.
Lifestyles of Employed Legally Blind People: A Study of Expenditures and Time
Use. Rehabilitation Research and Training
Center on Blindness and Low Vision, Mississippi State University. April 1992.
Pratt B., Anderson D., Lindley S.
Ophthalmology Resource Planning for Canada.
Submission to the Commission on the Future of Health Care in Canada by the
Canadian Ophthalmologic Society. December 21, 2001.
Stark, C., M. Stark. “Blinding Grinding Poverty.” National Federation of the
Blind: Advocates for Equality. Canadian
Blind Monitor Volume 14.
Statistics Canada. A Profile of Disability
in Canada, 2001. Participation and
Activity Limitation Survey. December 2002.
Taylor, H. Costs of Vision Loss to
Governments. University of Melbourne. Eye
Care for the Community. 2002.
Taylor, H. Societal Costs of Vision Loss
and Blindness. University of Melbourne.
Eye Care for the Community. 2002.
Walker, M., G. Wilson. Waiting Your Turn,
Hospital Waiting Lists in Canada. Fraser
Institute Study. September 25, 2001.
Wolffe, K., A. Candela. “A Qualitative Analysis of Employers’ Experiences With
Visually Impaired Workers.” Journal of
Visual Impairment and Blindness September
2002, Volume 96, No. 9.
|
