The impact of fetal alcohol exposure

A new CAMH study about prenatal alcohol exposure makes a strong case for intervention and prevention.

Fetal alcohol spectrum disorder (FASD) “consumes a huge amount of resources, both economic and societal, in Canada,” say the researchers in the study report The Burden and Economic Impact of Fetal Alcohol Spectrum Disorder in Canada, released early this year. The researchers estimated that, for 2013, the total cost associated with FASD in Canada was about $1.8 billion.

FASD refers to a group of disorders caused by prenatal alcohol exposure, of which fetal alcohol syndrome (FAS) is the most severe form. FASD encompasses a broad range of mild to severe symptoms, including physical impairments and mental, behavioural and emotional difficulties. According to a very conservative and rough estimate, approximately 1 per cent of Canadians – or about 355,000 people – may have FASD.

Touching all sectors

For this study, the researchers developed a comprehensive evidence-based model to calculate the economic impact of FASD in Canada.

“Almost all sectors of society are involved: health care, social services and corrections,” explains Dr. Svetlana (Lana) Popova, CAMH Senior Scientist, who led the study. Loss of productivity of individuals with FASD due to disability and premature mortality was the biggest contributor to the overall cost, accounting for 42 per cent of the total cost. The second-largest contributor was the cost of corrections, representing 30 per cent. Health care costs made up 10 per cent, with the remainder split among other direct costs, such as children in care, supportive housing, and special education.

“We hope that the results of this study will help people who are living with FASD to have access to a better diagnostic system and interventions to help them and their families to have a better quality of life,” says Dr. Popova. “People with FASD also develop many secondary disabilities,” including mental illnesses, dropping out of school, substance use, unemployment, poverty, involvement with the law and incarceration. Children born with FASD will not grow out of the condition, and may require assistance from their families and health, community and other service providers throughout their lives. But early diagnosis and appropriate interventions can help to reduce or even avoid these secondary disabilities and enable people to work and have families. “With appropriate support and strong social ties, people with FASD can do up to four times better on some indicators,” says Dr. Popova.

While the researchers looked at costs for 2013, the economic impact is not a one-year incident, but a recurring cost each year. “It’s better to prevent these costs by spending $1 million a year than to spend $2 billion a year,” says Dr. Popova. (Dr. Popova recently presented to the House of Commons Standing Committee on Justice and Human Rights.)

Alcohol consumption during pregnancy is one of the leading known preventable causes of developmental and birth defects among Canadians. The researchers stressed that their work is not meant to stigmatize mothers with alcohol dependence, and their hope is that the study will increase awareness of the detrimental effects of alcohol during pregnancy and encourage policies and programs aimed at prevention, not only in Canada, but around the world.

“Severely underestimated”

Dr. Popova cautions that the total cost of $1.8 billion is a “very conservative estimate” because the researchers used the most conservative assumptions. “The biggest problem is there are no data in many sectors,” says Dr. Popova. For example, the cost of corrections does not include other law-enforcement costs such as policing and trials. “With time, we hope this work will draw the attention of many sectors of our society who are working with populations with FASD to collect data.”

A prevalence of 1 per cent in the Canadian population is also “severely underestimated,” explains Dr. Popova, who is one of the leading investigators in a World Health Organization (WHO) research project to estimate the number of people living with FASD in Canada and five other countries. FASD is under-represented because it is difficult to diagnose and doctors may not be appropriately trained to recognize the characteristics of FASD. That’s partly because fetal alcohol syndrome (FAS), the most severe form of FASD, is the only officially recognized medical diagnosis at this time, creating a knowledge gap among healthcare providers. As well, FASD may be misdiagnosed because its symptoms are similar to mental health disorders.

This research was funded by the Public Health Agency of Canada.

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