Economic Benefits of International Collaborations in Behavioral

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Economic Benefits of International Collaborations
in Behavioral Social Sciences

• Sonia Suchday, Ph.D.
• Co-Director, Institute of Public Health Sciences
• Associate Professor Program Director
• Clinical Psychology Ph.D. (Health Emphasis)
  Program
• Ferkauf Graduate School of Psychology
• Albert Einstein College of Medicine
• Yeshiva University

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• Chronic diseases
• long duration
• generally slow progression
• leading cause of mortality in the world
• 60 of all deaths
• Out of 35 million deaths in 2005,
• half were under 70 half were women
• World Health Organization

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The economic impact billions
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Costs of Chronic Disease

• In 2005, 133 million people, almost half of all
  Americans lived with at least one chronic
  condition.
• Medical care costs of people with chronic
  diseases more than 75 of the nations 2
  trillion medical care costs.
• Chronic diseases account for 1/3 of the years of
  potential life lost before age 65
• Hospitalizations for pregnancy-related
  complications occurring before delivery 1
  billion/year
• Direct and indirect costs of diabetes 174
  billion/year
• Arthritis 81 billion estimated total costs
  (medical care lost productivity) 128
  billion/year
• Direct and indirect costs associated with smoking
  exceed 193 billion/year
• Cost of heart disease stroke 448 billion in
  2008
• Total costs of obesity 117 billion/year in
  2000
• Direct costs of Cancer estimated 89
  billion/year
• Dental Services 98.6 billion/year
• Centers for Disease Control

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Chronic Disease

• 80 Low Middle Income Countries
• Young people and Women are particularly
  vulnerable
• Double Burden of Disease
• Chronic Disease Low funding priority
• Social Behavioral factors - important role in
  etiology course disease
• Behavioral Social Interventions are even lower
  on the priority scale

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Interheart TrialSalim Yusuf, Population Health
Research Inst, CANADA

• Aims
• Etiology across cultures
• Factors predicting incidence
• Retrospective, Case-Controlled study
• N27,000 representing 52 countries/multiple
  ethnic groups, multiple languages
• First Presentation of MI
• 10 years younger - Middle East, Africa, South
  Asia compared with other regions of the world
• Identification of 2 important etiological factors
• Smoking abdominal obesity

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Social Behavioral Aspects in Low Middle
Income Countries

• Lack of an evidence-base
• Lack of ongoing research efforts
• Existent Workforce
• Poorly Trained
• Not Productive
• Lack of Resources

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• The development of society, rich or poor
• can be judged by the quality of its population's
  health
• how fairly health is distributed across the
  social spectrum
• degree of protection provided from disadvantage
  due to ill-health
• Health Equity is central to this premise.
• Marmot, 2007

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Illness Prevention Health Promotion Effort

• Intuitively effective
• Analyses have been criticized for over-stating
  under-stating, costs benefits
• Humanitarian Gains are clearer
• Frequently, include social behavioral variables

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Cost-Effectiveness of Prevention

• 1 spent on water fluoridation 38 saved in
  dental restorative treatment
• Clinical smoking cessation interventions
  savings of 2,587/year of life saved most
  effective of all preventive strategies!
• For each 1 spent on the Safer Choice Program (a
  school-based HIV, other STD, and pregnancy
  prevention program) 2.65 saved on medical and
  social costs
• Every 1 spent on preconception care programs for
  women with diabetes 5.19 saved by preventing
  costly complications in both mothers and babies
• Implementing the Arthritis Self-Help Course among
  10,000 individuals with arthritis net savings
  of more than 2.5 million,
• reduce pain by 18 percent among participants.
• A mammogram every 2 years for women aged 5069
  costs 9,000 per year of life saved. This cost
  compares favorably with other widely used
  clinical preventive services
• CDC, USA

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Behavioral SocialInternational Collaborations
Contentious but productive

• Conceptual Benefits culture dependent
  independent phenomena
• Pragmatic Gains unique research areas,
  distinctive populations, large sample size for
  rare conditions
• Ultimately, collaboration works better than any
  other alternative!
• Outside researchers working without partnership
  with local researchers
• Inside researchers not having the benefit of
  comparative data from other contexts
• Workshop Report of the National Research Council
  of the National Academies

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Challenges of International Collaboration

• Across disciplinary, institutional, academic,
  political boundaries
• Handling, managing, access to data sets differs
• Negotiations over power status
• Control over design expectations of authorship
• Conventional work habits pacing, workloads,
  vacations, sensitivity to deadlines, reporting
  requirements
• Adequate Protection for Human Participants
• Workshop Report of the National Research Council
  of the National Academies

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Economics of Collaboration

• Building Social Capital
• features of Social Organization that can be
  cornerstones to facilitate collective action
• Kawachi
• Trust
• Reciprocity Norms
• Support Networks