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Economic Consequences of Blindness

Introduction

Blindness and poor vision have a tremendous impact on quality of life, particularly for those living in poverty. The blind are heavily affected economically, as ninety percent of blind individuals cannot work.(1)  Culturally, there are often negative stigmas associated with blindness, further alienating the afflicted from their communities.(2)   Social disadvantages are also significant.  Half of the blind people in impoverished countries report a loss of social standing and decision-making authority, and 80 percent of all women note a loss of authority within their families.(3) 

Furthermore, people with cataract have poorer quality of life and increased difficulties with activities of daily living. (4),(5)  Blind individuals are less likely to engage in productive activities than others.  Since poverty among older people in Africa and Asia may be related to an inability to satisfy social and economic roles,(6)  the restrictive impact of cataract visual impairment on productive and leisure activities may contribute to poverty in these settings.

Community Economic Impact

While these debilitating consequences for the patient are substantial, blindness also affects family and community members.  Because blindness imposes restrictions on the ability to move about and control self and environment, a high proportion (75%) of visually impaired people require assistance with everyday tasks.(7)

In developing countries, most blind adults need to be led by either sighted children or sighted adults.  When a child becomes the caretaker, that child is often not able to attend school.  Alternatively, when a sighted adult becomes the caregiver, he or she often needs to stop working. Thus, there are long-term repercussions for economics and education that extend beyond the blind individual.  In fact, the social fabric of a community is affected on a practical level.

“The physical and emotional toll impacts not just the individual and family but the social and economic fabric of communities and everyone’s existence. Sudden blindness of one individual in a family can become the tipping point for survival when they are impoverished to begin with.”(8)

For example, cataract has economic implications through reduced productivity of the visually impaired person as well as opportunity costs to household members who look after them. (9), (10)  Estimates of this economic impact of cataract have been based on assumptions of likely productivity losses. Such findings support the wider impact of cataract beyond individual quality of life, through loss of productivity, with implications for the household economy.(11)

Economic Burden of Blindness

Researchers Smith and Smith estimated that the annual worldwide productivity cost of blindness was $168 billion using 1993 data on prevalence rates, gross domestic products, and populations.(12)   These authors assumed that all adults and children were productive and that all blind individuals were completely unproductive.  This projected cost could be decreased either by limiting the prevalence of blindness or by decreasing the impact of blindness on productivity through workplace accommodations.

In 1997 the economic burden of blindness in India was estimated at $US 4.4 million (about 72.5% of government health expenditure in that year), and the cumulative loss over the lifetime of the blind was $77.4 million, in the same order of magnitude as the loss due to HIV/AIDS in India.(13)  Childhood blindness accounted for 28.7% of this lifetime loss. This research study predicted that if the 52% of blindness in India due to cataract was treated with an investment of $.15 billion and it is assumed that 80% of those operated on are not blind after surgery and 45% of those blind from cataract are in the labor-productive age group, the saving in annual GNP would be $1.1 billion.  This projection shows that treatment is a cost-effective intervention and makes a compelling case for the direction of funds toward such efforts.

Furthermore, both of these assessments of the economic cost of blindness do not take into account the economic losses felt by family members who must leave work to assist the blind as well as those incurred by children who are not able to attend school.   Thus the economic burden of blindness is likely to be more substantial than predicted in these models. 

Ultimately, investments in avoidable blindness and visual impairment can yield high levels of economic and social returns, while dramatically improving the quality of life of individuals and families.  VISION 2020, a joint program of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB), aims to eliminate avoidable blindness from five important diseases.  If successful, this will result in “a reduction of 429 million blind person-years and a minimum saving of $102 billion over the period from 2003 to 2020”.(14)

Footnotes

Community Eye Health Online Course

• Table of Contents
• Module 1
• Module 2
• Module 3
• Module 4
• Module 5
• Module 6
• Module 7
• Module 8
• Module 9
• Module 10
• Module 11
• Module 12
• Module 13
• Guidelines For Evaluating Eye Care Work