24 October 2012

Realising the scale of chronic disease

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The scale of the economic burden of chronic conditions dwarfs that of the economic crisis and climate change, suggesting the need for more prevention down to the individual level

Medical experts pointed to non-infectious diseases—diabetes, cancer and heart disease— as a ticking time bomb at a recent meeting of health experts at the European Health Forum in Gastein, Austria. “The economic burden we have to bear from non-communicable disease is now bigger than from the economic crisis according to the World Economic Forum, and more of a threat than climate change,” said Judith Watt, Director of the international non-governmental organisation NCD (non-communicable diseases) Alliance.

Evaluating the cost associated with such diseases helps us understand the scale of the problem, albeit in a reductionist manner. The health forum heard that the total economic cost of all these diseases will add up to an estimated 23 trillion euro by 2030, representing 48% of global GDP in 2010, and pushing millions below the poverty line. In human terms, NCDs are responsible for 86 % of all deaths in the 53 countries of the WHO Region Europe. 

A number of the experts noted that politicians tend to favour quick fix solutions at minimum expense, whereas the payoff for diseases like diabetes and cancer occur on a longer time scale. Money going into health care “is an investment, not a cost,” Paola Testori Coggi, Director General for Health and Consumers in the European Commission, in Brussels, Belgium, told the conference: “It  allows working people to stay longer in their working lives.”

“But if we don’t invest in health in the medium term, society will not be sustainable,” she argued, “the workforce will suffer greater sickness levels and less people will be able to work to pension age.” Indeed, previous studies have also shown the burden chronic disease may impose on economic growth. “If the frequency of non-communicable diseases increases by 10%, economic growth shrinks by 0.5%,” Washington DC, US-based World Bank expert Armin Fidler said, citing a 2011 study in the Lancet medical journal. “They shorten a person’s healthy life span and cut down on productivity in what are referred to as a person’s best years.”

Solutions exist, nevertheless.

Fidler stressed the need to make preventive measures a priority, through policies. He suggested taking action against smoking, reducing salt intake, eliminating trans-fats and reducing saturated fatty acids and promoting exercise by transport policies and other strategies. For example, taxing sugar and fat can not only improve health but also raise money for health care. If a 17.5% value-added tax were placed on unhealthy food in Great Britain, a British Medical Journal study published in May 2012 found, it would translate into 900 to 2,700 fewer deaths per year from heart disease.

The role of personal responsibility is not to be under estimated. “The patient must play a role by making better decisions in their life styles which can influence their health in future years... I refer mainly to tobacco use, physical activity and healthy diet. We all have a social responsibility to make better choices,” Testori Coggi said.

Yet, targeting the health sector itself may not be sufficient. Instead, an integrated approach could be needed. South Australia, for example, looked at how urban planning decisions could help people walk to work and not encourage them to use their cars. Coggi concluded: “Investments are needed not only in health sectors but perhaps most useful investments are in other sectors whether it is in communication, in transport and infrastructure, in urban planning or in smart policies to incentivise people to use the right behaviours.”
 

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