Abstract
This article argues that despite significant advancements in the prevention of cardiovascular diseases, efforts to address sleep-related illnesses have lagged, particularly on a global scale. The COVID-19 pandemic has highlighted numerous health disparities, and as we move towards recovery, there is a critical opportunity to enhance public health initiatives by incorporating robust sleep medicine practices.
Chronic diseases claim millions of lives globally each year. While progress has been made in many areas of public health, the burden remains disproportionately high in low- and middle-income countries (LMICs). Sleep is not experienced equitably yet is ubiquitous. Sleep health is often neglected in public health efforts to treat chronic disease.1,2 There is excellent epidemiological knowledge about risk factors for chronic disease, such as smoking, physical activity, diet, and alcohol consumption, and there is mounting evidence that poor sleep quality is a significant risk factor for chronic disease.1–4 We understand many sleep disorders in the context of well-conducted research carried out in relatively affluent countries or areas, but this overlooks low-income settings where synergism between communicable and non-communicable disease worsens outcomes. The World Health Organization suggests that 86% of preventable premature deaths due to non-communicable disease occur in LMICs. 5 We understand that wealthier individuals generally have better sleep and health compared to their less-privileged counterparts.6,7 Despite progress in avoidance of cardiovascular disease, the prevention of sleep-related illness has been slow from a global perspective. Post-pandemic, this is an opportunity to improve the prevention of chronic disease through the improvements in sleep medicine.
The message that sleep health is crucial for healthy societies, is undeniable. Insufficient sleep is linked to a range of chronic diseases, including cardiovascular disease, obesity, diabetes, and mental health problems.1–4 Beyond duration, sleep health also encompasses regularity, quality, and satisfaction. 8 For many in low-income settings, social determinants create significant barriers to achieving good sleep. Poorer societies may experience greater difficulty accessing resources such as appropriate beds, health education, and their neighbourhoods may be noisier. 9 These groups of people may also experience occupational inequalities. Shift work, irregular schedules, and physically demanding jobs disproportionately affect low-wage earners, further disrupting sleep patterns and contributing to chronic sleep deprivation. 10 Financial insecurity, social isolation, and exposure to violence are just some of the stressors that may be more pronounced in low-income communities.9,11 These chronic stressors can significantly impact sleep quality, leading to a vicious cycle of poor sleep and worsened mental and physical health.
The problem is multifaceted, and the cost to society is likely to exceed billions per year. This burden falls disproportionately on LMICs, straining their already limited healthcare resources. For example, the RAND study suggests a cost exceeding £40 billion per year to countries directly due to sleep problems. 12 This number is likely to continue to grow and is likely to be even higher in LMICs due to reduced access to appropriate healthcare. These studies serve to highlight the imperative need to consider sleep at a public health level.
Unfortunately, science alone and studies rarely result in action and changed minds. Achieving healthier sleep will require cross-sectional and multidisciplined action at all levels of society – political, business, local councils, general public, healthcare professionals, and schools. We have learnt from previous public health interventions that it is possible to significantly improve the health of nations and populations.13,14 Tackling the chronic disease problems related to sleep may require local community-based interventions, urban planning considerations, workplace reforms, and improved access to healthcare.
From a research perspective, studies focusing on the most vulnerable groups, racial/ethnic minorities, and deprived areas should be considered to help reduce disparities in health. Appropriate methodologies need to be developed to take into account more diverse groups and social strata. Research is required into how to translate the science behind sleep into effective, sustainable, and actionable public health interventions.
Improved strategies addressing poor sleep quality and its risk factors are urgently required. Investing in sleep health is not solely about sleep, but a crucial step towards preventing chronic disease, unlocking potential for learning and creativity, and achieving better global health outcomes. Inequalities in wealth and health are reciprocally linked, and future research into inequalities into sleep health should be considered as part of the long-term strategy to improve global health.
