Health is the most important aspect that leads to the economic and social development of a community. The increasing incidence of cardiovascular disease across the globe has been a consequence of increased life expectancy, changes in diet, sedentary lifestyles and availability of nutrition dense diets. While the focus of the developed countries is on the prevention of non-communicable diseases such as, diabetes, hypertension, cardiovascular disease and high lipid levels in blood, several low and middle-income countries are yet to make prevention a priority. Health is a pre-requisite for any country to progress economically. Because lack of optimal health compromises the ability of the workforce to contribute in full capacity to the nation’s GDP. Besides, the costs incurred by the healthcare system on treatment of the disease, particularly in case of preventable disease, can cause patients and their families to become impoverished due to debts taken from money lenders. This becomes an impediment for social and economic growth. The occurrence of ailments such as HIV/AIDS in women of child bearing age puts the health of the child at risk. It necessitates long term treatment. Though ART increases the life expectancy of patients and many of them are able to return to the workforce, the social stigma attached to the disease may reduce the motivation for many women to continue with the medication. The prolonged distress may cause mental health issues in many women who remain worried about the health of the unborn child. Many people living in low income countries such as Indonesia have to pay out-of-pocket due to poor insurance coverage and their families become debt ridden and remain so for many years. Some may even sell assets to generate money for treatment.
In order to select articles for this paper, keywords were used to search the NCBI and PubMed database that included, importance of health, outcomes of good maternal health on the economy, impact of HIV/AIDS infection among mothers on the economic status of families, risk factors for cardiovascular disease and its economic and social impact. Papers that addressed the issue of social stigma were also chosen for this study. Relevant papers were chosen upon reading the title and the abstract of the paper. A total of 25 papers were chosen for this study. Some papers pertaining to the above-mentioned topics were selected because the studies were done in Indonesia as this country from the Asia-Pacific region has been chosen as a case study for the current study.
Importance of Health
Health may often mean the absence of a disease but the World Health Organisation defines health as 'a state of physical mental and social well-being and not merely the absence of disease or infirmity’ (WHO.int, 2017). It is important for people to maintain good health because they can participate in the tasks that make their life more fulfilling and their contribution to the economic betterment of the society provides more meaning to their life. A healthy body enables a person to carry out all the functions and duties at home, in the place of work and as a citizen of a country. Diseases may be infectious or non-communicable. While infectious diseases are caused due to transmission of pathogens from one individual to another, non-communicable diseases are usually an outcome of poor lifestyle (Farhud, 2015). HIV/AIDS is an infectious disease that can be transmitted due use of contaminated needles, sexual contact or can be passed from a mother to child at the time of birth and globally about 1.5 million people die a premature death due to the disease. Exacerbations among AIDS patients of other infectious diseases such as tuberculosis are also high (Harries, 2015).
Good health is an outcome of good education, gainful employment and the ability to seek medical advice when disease occurs. A good socioeconomic status improves the chances of good health while people from poor socioeconomic backgrounds suffer and are not able to access treatment in the event of an illness. Tobacco use, poor nutrition and a physically inactive lifestyle compound the chances of poor health (Pampel & Krueger, 2010). Variables of lifestyle that can impact health include intake of diet that supports a healthy body mass index (BMI), exercise and quality of sleep. Factors that impact health negatively include substance abuse and improper use of medication (Farhud, 2015). HIV/AIDS and cardiovascular disease may be the outcome of risky health behaviours.
Maternal mortality in general has been high in Indonesia. The rate of maternal mortality was studied in the eastern Indonesian province of Nusa Tengarra Timur (NTT). The MMR for the province is more than the national average at 271deaths per 100,000 live births. Several factors cause the high MMR in Indonesia. Access to good healthcare is limited, there is a shortage of trained healthcare staff. There is low awareness about maternal health and people are culturally constrained on several aspects of safe motherhood. Nutritional status of women is low, use of contraception is unmet. All maternal deaths are not recorded due to a frail system. Due to poverty and lack of education many births take place at home, antenatal care is difficult to access due to remote or rural location (Belton, Myers, & Ngana, 2014).
According to a study in an Indonesian hospital on the incidence of HIV/AIDS, it was found that more women are now getting infected and that many of them are pregnant at the time of their diagnosis. Unprotected sex was found to be the main mode of infection (Rahmalia, et al., 2015).
Impact of maternal health on household economics
Health matters concerning women are important for protection and for the sustainable development of a society. Investment in the area of women's health pays dividends not only in the arena of protection of women's rights but also in economic growth. Economic and societal growth depends to a large extent on the health status of women. Poor maternal health causes a reduction in the availability of resources in households. The concomitant increase in the spending on provision of healthcare is met through loans from family members or money lenders (Powell-Jackson & Hoque, 2012). Most households where illness strikes make out-of-pocket expenditure for treatment and source the additional spending on healthcare from their income, borrowings, savings, selling asset or livestock (Alam & Mahal, 2014). The overall impact on household economics is detrimental occurs and it takes several years for families to be free of debt.
Social impact on women suffering from HIV/AIDS
In cases where the illness among pregnant mothers is HIV/AIDS, the childbearing women face a host of social challenges along with the economic burden. Even in cases where the pregnancy is normal, the women have to cope with stress and uncertainties because they are suffering from a life-threatening disease. Depression, feeling rejected and insomnia are other mental health issues that women with recently diagnosed HIV/AIDS may experience (Orza, et al., 2015). The society they live is more likely to discriminate against them and stigmatising behaviours may have to be dealt with. Technology and medication like the antiretroviral therapy help women to deal with the medical aspects of the disease but the stress associated with social stigma deals a blow to their mental health, as they may suffer from stress during the gestation period. The preparedness and education required among communities to integrate these women into society is severely lacking. Instead of helping them align with the society and deal with the distress of suffering from HIV/AIDS during the pregnancy, the negative attitudes of the community make the situation more difficult for the child bearing mothers (Kontomanolis, et al., 2017). Social disadvantage of women living with HIV/AIDS affects their mental health and compromises their human rights, ability to seek treatment and the ability to adhere to medication, so policy makers must make interventions directed at resolving their plight (Orza, et al., 2015). Stigmatised women may often have different vulnerability and sensitivity to the discrimination faced by them, even though the treatment may be carried out in confidentially. The impact of stigma may be so great that women may choose to reject treatment even at a risk to the foetus (Kontomanolis, et al., 2017). The treatment given to the child bearing women afflicted with HIV should be without discrimination on grounds of nationality, race, religion, or condition (Shapiro, et al., 2016). The impact of stigma and discrimination can be rather severe. In a study where women reported being morally judged and did not receive respect during treatment tried to avoid taking treatment for prevention of parent-to-child transmission of HIV (Rahangdale, et al., 2010). Social support for patients should therefore cover the physical and mental dimensions that are affected due to long term chronic diseases such as HIV/AIDS. While there is considerable progress in the treatment and medical advancements in the treatment of AIDS/HIV, there is hardly any effort or research done towards minimising stigma and measurement of the impact of the discrimination faced by patients.
Studies at the macroeconomic level show that expenditure on maternal and child health improve productivity and thus lead to substantial social and economic benefits. Investment in health helps in a society’s development and of course has its intrinsic benefits (Onarheim, 2016). Better maternal health improves the child’s health and this improves the economic condition of the family and the community that they live in. In case of women afflicted with HIV, the treatment through antiretroviral therapy, the health benefits have been enormous and so have improved the economic well-being of their families (Bor, et al., 2013). A study in Africa found that ART could increase the life expectancy by about 11.3 years and so the social value of ART treatment has increased and this may have implications for funding agencies and policy makers. The increase in life expectancy and treatment enables the affected to work and remain employed, thus the economy receives a boost. Investments in maternal health therefore translate into economic benefits, particularly for the low and middle- income countries (Halim, et al., 2015).
Economic impact of cardiovascular disease
Globally, the prevalence of cardiovascular disease has exceeded that of infectious diseases such as, HIV. What was once known as a disease of the affluent, now afflicts more people in the low and middle-income countries of the world. By 2020, cardiovascular disease will be the reason for most deaths. As countries shift from agrarian economies to industrialized economies, several social and economic changes have occurred. Longevity has increased, better public health facilities have developed and so has the propensity to suffer from chronic non- communicable diseases (Gaziano, et al., 2010). But the co-morbidities of cardiovascular disease, such as, stroke and cardiac attacks are often debilitating, require long term treatment and can cause loss of work force.
The economic burden occurs due to costs incurred by the health care system, since patients suffering from cardiovascular disease may often require hospitalisation. Procedures related to the treatment such as, catheterization, use of stents and other medication costs add up to enormous amounts. Upon discharge, there are the expenses incurred at the outpatient department, secondary prevention and costs incurred at the pharmacy. Treatment may involve visits to the nursing home, rehabilitation of the patient, costs of nursing at home and several other expenses. In most cases patients receive treatment in the hope that they will be able to return to work and lead active lives after the treatment. The microeconomic impact on the household is substantial. The family may have to spend all their savings towards treatment and they may have to sell property to be able to raise enough funds for the treatment. In many countries insurance coverage for health expenses is almost negligible (Schieber, et al., 2007). The loss due to reduced or no productivity at work due to the inability of the patient to work impacts from the macroeconomic point of view. At times, even caregivers may have to give up work or remain absent from work on a prolonged so as to be able to care for a family member.
Cardiovascular disease is a consequence of several risk factors associated with modern lifestyle. Cigarette smoking, excess weight, hypertension, diabetes, elevated total cholesterol and dyslipidemia are risk factors that increase the likelihood of a person suffering from cardiovascular disease. The economic development of Indonesia has brought on health challenges that are an outcome of modern lifestyle in all low and middle- income countries. Cardiovascular disease occurrence has emerged as a major public health challenge because, a third of all deaths in Indonesia are now due to cardiovascular disease (Hussain, et al., 2016). The relative affluence is usually cited as the reason for changes in diet and nutritional habits that has increased the risk of vascular diseases and stroke in Indonesia.
The economic impact of cardiovascular disease and non-communicable diseases in Indonesia is high and is expected to rise further, as in all low and middle income countries. The economic burden of cardiovascular disease is also likely to increase as the expenditure on medical facilities is set to increase. The lost hours of work due to the disease will also affect household incomes and the economic hardship for the affected families shall increase. Since the coverage of health insurance is low, most families depend on out-of-pocket expenditure for treatment. The country struggles to meet the healthcare needs due to rising incidence of non-communicable disease on one hand and reducing infant and maternal deaths on the other (Schr?ders, et al., 2017).
In Indonesia, a study found that 73% of men above the age of 45 years were smokers. The incidence of arrhythmia, cardiovascular disease and heart failure was fond to be high among the people from this age group (Sumartono, et al., 2011).
Impact of cardiovascular disease on social progress
Lower age of onset of cardiovascular disease has been observed among populations in South east Asia, including Indonesia. The average age of patients who have suffered from myocardial infarction is 52 years whereas, it is 60-65 years in Western countries. This leads to a fall in the workforce capacity and the potential of economic growth is affected. The fall in economic productivity is considerable. In a study on the impact of cardiovascular disease on the microeconomics of the family in four countries-Argentina, India, China and Tanzania, the effect of hospitalization on the family financial health was studied. The study evaluated the source of the funding for meeting hospital expenses, how impoverished the family became as a result of the illness, alterations in the functional capacity and productivity due to the illness and the quantum of the expenditure were assessed. Substantial financial stress was experienced by the families because the expenses were made out-of-pocket and medical insurance coverage was non-existent (Huffman, et al., 2011). Rural status and low education increased financial distress among the patients’ families. The countries in South east Asia have yet to work on aspects that reduce the morbidity and mortality caused by cardiovascular disease. Preventive steps to reduce the incidence of cardiovascular disease are required. Patients who receive social and emotional support are more likely to recover from their illness quickly (Reblin & Uchino, 2008). Socioeconomic groups with better education, access to healthcare in urban hospitals and those with insurance cover are able to finance their healthcare expenditure without undergoing financial distress.
The impact of the caregiving responsibilities on the family is substantial. Family members may get overwhelmed due to the demands of care in taking care of a family member. Care taking can cause exhaustion, depression and affect the physical and mental health of the family member. The demands of a cardiovascular patient’s healthcare regimen are often complex, they need assistance with a low sodium diet, fluid management, constant assessment of symptoms such as, shortness of breath and interrupted sleep is required. This reduces the quality of life of the family member providing care. Repeated hospitalisation increases anxiety and depression of the caregiver. Several times, the caregiver may be a spouse with advanced age and health problems of their own (Dunbar, et al., 2008).
While managing the patient’s chronic disease condition, the family have to adapt to a changed routine and altered behaviour that helps the patient to manage the disease better. Supportive family environment improves patient outcomes but critical family members can reduce adherence to diet and medication and affect the patient negatively (Rosland, et al., 2012).
In Indonesia, the increasing disease burden due to non-communicable diseases and cardiovascular disease in particular, has occurred due to increased life expectancy, increased consumption of fat, sedentary lifestyles and high incidence of tobacco smoking. Traditional healthcare in Indonesia has been geared to attend to infectious diseases in a disease-focussed manner. The prevention of cardiovascular disease requires complex multisectoral health program that is sustained over a long period. But deficiencies in political involvement in public health, lack of dedicated health institutions that can work towards the prevention of cardiovascular disease, lack of recognition of non-communicable diseases as a serious health concern are factors that demand attention (Schr?ders, et al., 2017). Prevention of cardiovascular disease requires that it become part of the social fabric.
The importance of preserving and maintaining good health has been the emphasis of many public health programs. When citizens are healthy they can contribute to the economic and social growth of a country. Infectious diseases such as, HIV/AIDS affect the economic growth of a country due to the high cost of long term treatment on one hand and loss of workforce hours on the other. Maternal HIV/AIDS takes a toll on the microeconomics of the family and reduces the earnings of the family. The social impact of the disease causes considerable distress to child-bearing women because they have to confront people who judge them on moral grounds. There is little motivation for the woman then to undergo the long treatment. The distress that is experienced by the women affects development on the economic and social fronts. Family earnings drop and the families often become debt ridden. The prevalence of cardiovascular disease has increased due to changes in lifestyle and increase in the incidence of hypertension, diabetes due to improved diet, sedentary lifestyles and ignorance about methods for prevention. In countries like Indonesia the public health initiatives in prevention of cardiovascular disease are often lacking. Families have to make provision for the treatment if illness occurs in the family. Very few people have health insurance, so borrowing money from other family members and money-lenders is the only option. The disease leaves a person weak and they cannot return to the workforce in full capacity. This pushes the family further into the throes of poverty. Family members providing care to the patient experience stress as they have to make lifestyle adaptations to suit the needs of the patient. The impact of disease on the lives of people are detrimental and it takes them several years to cope with the demands of treatment and the consequent economic challenges.
Alam, K., & Mahal, A. (2014). Economic impacts of health shocks on households in low and middle income countries: a review of the literature. Global Health, 10(21), doi: 10.1186/1744-8603-10-21.
Belton, S., Myers, B., & Ngana, F. R. (2014). Maternal deaths in eastern Indonesia: 20 years and still walking: an ethnographic study. BMC Pregnancy and Childbirth, 14(39):
Bor, J., Herbst, A., Newell, M., & B?rnighausen, T. (2013). Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science, 339(6122), 961-5.
Dunbar, S. B., Clark, P. C., Quinn, C., Gary, R. A., & Kaslow, N. J. (2008). Family Influences on Heart Failure Self-care and Outcomes. The Journal of Cardiovascular Nursing, 23(3), 258-265.
Farhud, D. D. (2015). Impact of Lifestyle on Health. Iranian Journal of Public Health, 44(11), 1442–1444.
Gaziano, T. A., Bitton, A., Anand, S., Abrahams-Gessel, S., & Murphy, A. (2010). Growing Epidemic of Coronary Heart Disease in Low- and Middle-Income Countries. . Current Problems in Cardiology, 35(2), 72-115.
Halim, N., Spielman, K., & Larson, B. (2015). The economic consequences of selected maternal and early childhood nutrition interventions in low- and middle-income countries: a review of the literature, 2000—2013. BMC Women’s Health, 15(33).
Harries, A. D. (2015). Communicable and non-communicable diseases: connections, synergies and benefits of integrating care. Public Health Action, 5(3), 156-157.
Huffman, M., Rao, K., Pichon-Riviere, A., Zhao, D., Harikrishnan, S., Ramaiya, K., . . . [ ... ], P. D. (2011). A Cross-Sectional Study of the Microeconomic Impact of Cardiovascular Disease Hospitalization in Four Low- and Middle-Income Countries. PLoS ONE, 6(6), e20821.
Hussain, M. A., Al Mamun, A., Peters, S. A., Woodward, M., & Huxley, R. R. (2016). The Burden of Cardiovascular Disease Attributable to Major Modifiable Risk Factors in Indonesia. Journal of Epidemiology, 26(10), 515-521.
Kontomanolis, E., Michalopoulos, S., Gkasdaris, G., & Fasoulakis, Z. (2017). The social stigma of HIV-AIDS: society's role. HIV AIDS (Auckl). , 9, 111-118.
Onarheim, K. H. (2016). Economic Benefits of Investing in Women’s Health: A Systematic Review. . PLoS One, 11(3), e0150120.
Orza, L., Bewley, S., Logie, C. H., Crone, E. T., Moroz, S., Strachan, S., & … Welbourn, A. (2015). How does living with HIV impact on women’s mental health? Voices from a global survey. Journal of the International AIDS Society, 18(6(5)), 20289.
Pampel, F. C., & Krueger, P. M. (2010). Socioeconomic Disparities in Health Behaviors. Annual Review of Sociology,, 36, 349-370.
Powell-Jackson, T., & Hoque, M. (2012). Economic consequences of maternal illness in rural Bangladesh. Health Economics, 21(7), 796-810.
Rahangdale, L., Banandur, P., Sreenivas, A., Turan, J., Washington, R., & Cohen, C. (2010). Stigma as experienced by women accessing prevention of parent-to-child transmission of HIV services in Karnataka, India. AIDS Care, 22(7), 836-42.
Rahmalia, A., WisaksaMeijerink, H., Indrati, A., Alisjahbana, B., Roeleveld, N., van der Ven, A., . . . van Crevel, R. (2015). Women with HIV in Indonesia: are they bridging a concentrated epidemic to the wider community? BMC Research Notes, 8:757.
Reblin, M., & Uchino, B. N. (2008). Social and Emotional Support and its Implication for Health. . Current Opinion in Psychiatry, , 21(2), 201-205.
Rosland, A.-M., Heisler, M., & Piette, J. D. (2012). The Impact of Family Behaviors and Communication Patterns on Chronic Illness Outcomes: A Systematic Review. . Journal of Behavioral Medicine, 35(2), 221-239.
Schieber, G., Gottret, P., Fleisher, L., & Leive, A. (2007). Financing global health: mission unaccomplished. Health affairs, 26(4), 921-34.
Schr?ders, J., Wall, S., Hakimi, M., Dewi, F. S., Weinehall, L., Nichter, M., & … Ng, N. (2017). How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis. PLoS ONE, 12(6), e0179186.
Shapiro, R., Dryden-Peterson, S., Powis, K., Zash, R., & Lockman, S. (2016). Hidden in plain sight: HIV, antiretrovirals, and stillbirths. The lancet, 387(10032), 1994-5.
Sumartono, W., Sirait, A. M., Holy, M., & Thabrany, H. (2011). Smoking and Socio-Demographic Determinant of Cardiovascular Diseases among Males 45+ Years in Indonesia. . International Journal of Environmental Research and Public Health, 8(2), 528-539.
WHO.int. (2017). en/. Retrieved October 2, 2017, from