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Ill-health contributes to impoverishment, a process brought into sharper focus by the impact of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. This paper reviews studies that have measured the economic costs and consequences of illness for households, focusing on malaria, tuberculosis (TB), and HIV/AIDS. It finds that in resource-poor settings illness imposed high and regressive cost burdens on patients and their families. Direct and indirect costs of illness for malaria were less than 10% of the household income, but still significant when combined with the costs of other illnesses. The costs of TB and HIV/AIDS were catastrophic for households (more than 10% of the income). Health service weaknesses in many countries, including low coverage, user charges, and poor quality of care, contributed to high costs. Poor households in developing countries with a member with TB or HIV/AIDS struggled to cope, highlighting the urgent need for a substantial increase in health sector investment to expand access to preventive and curative health services. Government and non-governmental interventions should also be broadened to encompass measures that reduce the substantial indirect costs associated with diseases such as malaria, TB, and HIV/AIDS.
Received October 3, 2003. Accepted for publication January 28, 2004.
Acknowledgments: I thank Sirkku Juhola (School of Development Studies) and Yot Teerawattananon (School of Medicine, Health Policy and Practice) at the University of East Anglia for undertaking comprehensive literature searches for this review paper. I also thank Professor Anne Mills (London School of Hygiene and Tropical Medicine) and Dr. Sassy Molyneux (Kenya Medical Research Institute–Wellcome Collaborative Research Program, Kilifi, Kenya) for their comments on a working paper (on which this paper is based) written for the Disease Control Priorities Project (DCPP) initiated by the World Health Organization, Fogarty International Center of the U.S. National Institutes of Health and the World Bank.
Financial support: I received a consultancy payment from the DCPP to write a working paper on the household costs of illness for a DCPP workshop held in South Africa on July 4, 2003. As a result of that meeting, this paper was solicited for the American Journal of Tropical Medicine and Hygiene.
Author’s address: Steven Russell, School of Development Studies, University of East Anglia, Norwich, NR4 7TJ, United Kingdom, Telephone: 44-1603-59-3373, Fax: 44-1603-45-1999, E-mail: s.russell{at}uea.ac.uk.
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