Chronicity

Chronicity was the buzzword for last week's major global conference - the Geneva Health Forum. It is a term that encompasses the breadth of chronic health conditions, including the high profile non-communicable diseases (NCDs) such as heart disease, diabetes and cancer. This year's forum pulled together a wide range of participants from all over the world to consider how health systems can make a more substantial impact to stem the tide of chronicity facing those in both developing and developed countries.

40% of all mortalities are caused by NCDs. This should not surprise or shock us. After all, everyone has to die of something. If we are successful enough at keeping infectious diseases at bay, then it is likely to be an NCD that gets us in the end. We are not going to make any impression on the 100% mortality rate that we all face. However, many of these chronic diseases are affecting the young and middle aged. Two thirds of these cases could be prevented. One third can be treated.

Chronicity is something that requires a significant input of medical resources. The control of diabetes requires daily medication and regular check ups. Cancers and heart disease can be treated with ever more effective but expensive interventions. Where people are incapacitated for the long term, the burden of care is high. One calculation suggests that assuming current trends in both morbidity and treatment, the cost of health services in the United States will rise from its current unsustainable peak of 18% of GDP to an astronomical 40% by 2050. Clearly that is not going to happen. New approaches to the prevention and treatment of chronicity are essential.

This raises key questions. Chronic diseases are often related to lifestyles. The impact of proper exercise and diet regimes in prevention is by far and away the most significant. Yet people struggle to make the changes they need because of limits to personal self-discipline and the influence of social habits. Then there is the question of death. In countries with comprehensive health systems, the cost of care in the final 3 months can often exceed the sum total of all prior costs of care. The medical profession tries to meet our unrealistic expectations with huge inputs of treatment when there is little purpose in extending life. Death is too often perceived as a failure of care.

I have no doubt that the Church can offer a great deal to these conundrums; to promote prevention, to support the care of the chronically sick and to help find an appropriate setting and expectation for the end of life. These are dilemmas facing individuals, families and communities. Our healing vocation sits very squarely in this territory. We can help improve diets, help draw in more people to exercise opportunities and be present to care for those whose lives are blighted by long term chronicity.

Perhaps you have some ideas about this or experiences to share? Feel free to comment.

Paul